Menstrual Disorders

Menstrual
Disorders

Menstrual disorders encompass a range of conditions that affect the normal menstrual cycle. These disorders can significantly impact quality of life, reproductive health, and overall well-being.

Common menstrual disorders include dysmenorrhoea (painful periods), menorrhagia (heavy menstrual bleeding), oligomenorrhoea (infrequent periods), amenorrhoea (absence of periods), and premenstrual syndrome (PMS).

In Australia, addressing menstrual disorders involves a multidisciplinary approach, often requiring the expertise of gynaecologists, endocrinologists, and general practitioners.

Common Menstrual Disorders

Dysmenorrhoea

Dysmenorrhoea is characterised by severe and frequent menstrual cramps and pain during menstruation.

Causes: Dysmenorrhoea can be primary or secondary. Primary dysmenorrhoea is caused by natural chemicals in the body called prostaglandins, which trigger uterine contractions. Secondary dysmenorrhoea is often due to underlying medical conditions such as endometriosis, fibroids, or pelvic inflammatory disease (PID).
Symptoms: Symptoms include intense, throbbing or cramping pain in the lower abdomen, which may radiate to the lower back and thighs. Nausea, vomiting, diarrhoea, and headaches can also occur.
Risk Factors: Risk factors include a family history of dysmenorrhoea, early onset of menstruation (before age 11), heavy menstrual flow, smoking, and obesity.
Treatment Options: Treatment includes nonsteroidal anti-inflammatory drugs (NSAIDs), hormonal contraceptives (birth control pills, patches, or IUDs), lifestyle changes (regular exercise, a healthy diet), and in some cases, surgery to address underlying conditions.

Menorrhagia, or better known as Heavy Menstrual Bleeding (HMB)

HMB is defined as abnormally heavy or prolonged menstrual bleeding.

Causes: Causes include hormonal imbalances, uterine fibroids, polyps, adenomyosis, pelvic inflammatory disease, thyroid problems, and certain medications (e.g., anticoagulants).
Symptoms: Symptoms include soaking through one or more sanitary pads or tampons every hour for several consecutive hours, the need to use double sanitary protection, periods lasting longer than seven days, and passing large blood clots.
Risk Factors: Risk factors include age (adolescents and perimenopausal women), hormonal imbalances, uterine abnormalities, and certain medical conditions (e.g., thyroid disorders, blood clotting disorders).
Treatment Options: Treatment may involve hormonal therapies (oral contraceptives, progestin therapy), non-hormonal medications (tranexamic acid, NSAIDs), and surgical interventions (endometrial ablation, myomectomy, hysterectomy).

Oligomenorrhoea

Oligomenorrhoea refers to infrequent menstrual periods, typically occurring more than 35 days apart.

Causes: Causes include hormonal imbalances, polycystic ovary syndrome (PCOS), thyroid disorders, excessive exercise, significant weight loss or gain, and chronic illnesses.
Symptoms: Symptoms are characterised by infrequent menstrual cycles, which may be lighter or heavier than normal.
Risk Factors: Risk factors include a history of irregular periods, PCOS, thyroid disorders, eating disorders, and high levels of physical activity.
Treatment Options: Treatment focuses on addressing the underlying cause. This may involve lifestyle modifications (diet, exercise), hormonal treatments (birth control pills, hormone therapy), and managing associated conditions (thyroid treatment, insulin-sensitising drugs for PCOS).

Amenorrhoea

Amenorrhoea is the absence of menstruation. It can be primary (when a woman has not had her first period by age 16) or secondary (when a woman who previously had regular periods stops menstruating for three or more months).

Causes: Primary amenorrhoea can be due to genetic or anatomical abnormalities, while secondary amenorrhoea can result from pregnancy, breastfeeding, menopause, stress, significant weight loss, excessive exercise, thyroid issues, and PCOS.
Symptoms: The main symptom is the absence of menstrual periods. Other symptoms may include hair loss, headache, vision changes, and excess facial hair.
Risk Factors: Risk factors include family history, eating disorders, excessive exercise, obesity, and chronic diseases.
Treatment Options: Treatment depends on the cause. It may involve lifestyle changes, nutritional support, stress management, hormonal treatments, or surgery to correct anatomical issues.

Premature Ovarian Insufficiency (Premature Menopause)

Premature ovarian insufficiency (POI), also known as premature menopause, occurs when the ovaries stop functioning spontanetously before the age of 40. This condition can lead to the cessation of menstrual periods and reduced fertility.

Causes: POI can be caused by genetic factors, autoimmune disorders, chemotherapy or radiation therapy, surgery involving the ovaries, and infections or other health conditions.
Symptoms: Symptoms of POI include irregular or missed periods, hot flashes and night sweats, vaginal dryness, mood swings and irritability, and decreased libido.
Risk Factors: Risk factors for POI include a family history of the condition, certain genetic conditions (e.g., Turner syndrome, Fragile X syndrome), autoimmune diseases (e.g., thyroid disease, rheumatoid arthritis), smoking, and a history of ovarian surgery or chemotherapy.
Treatment Options: Treatment options for POI include hormone replacement therapy (HRT) to manage symptoms and protect bone health, calcium and vitamin D supplements, regular exercise and a healthy diet, psychological support and counselling, and fertility treatments for those seeking pregnancy (e.g., IVF with donor eggs).

Premenstrual Syndrome (PMS)

Premenstrual syndrome (PMS) includes a variety of physical, emotional, and behavioural symptoms that occur before the onset of menstruation.

Causes: The exact cause is unknown, but it is believed to be related to hormonal changes during the menstrual cycle, chemical changes in the brain, and lifestyle factors.
Symptoms: Symptoms vary widely and can include mood swings, irritability, depression, anxiety, bloating, breast tenderness, headaches, and fatigue.
Risk Factors: Risk factors include a family history of PMS, high stress levels, poor diet, and lack of exercise.
Treatment Options: Treatment includes lifestyle modifications (regular exercise, a balanced diet, adequate sleep), stress management techniques, over-the-counter pain relievers, and, in some cases, hormonal treatments or antidepressants.

In Australia, the management of menstrual disorders, including heavy menstrual bleeding (HMB), emphasises early intervention, patient education, and equitable access to healthcare. The National Women’s Health Strategy 2020–2030 highlights the importance of improving menstrual health literacy through public health campaigns and school education programs, ensuring timely access to specialist care for diagnosis and treatment, and promoting informed decision-making among women.

The Heavy Menstrual Bleeding Clinical Care Standard, developed by the Australian Commission on Safety and Quality in Health Care, outlines eight quality statements to guide the care of women with HMB. These statements emphasise comprehensive assessment, informed choice, and the provision of the least invasive and most effective treatment options. Additionally, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the Royal Australian College of General Practitioners (RACGP) provide evidence-based guidelines to support healthcare professionals in delivering high-quality care for common menstrual disorders.

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