Menstruation problems: Causes, Treatment, and When to see a doctor

Menstruation becomes a part of a woman’s routine as soon as she attains puberty. Day 1 of menstruation marks the beginning of a new menstrual cycle. The girl attains puberty or first menstruation on the day when the first unfertilized egg and the uterine lining sheds and bleeds. And from then, the normal menstruation occurs between 21 to 35 days and lasts for 4 to 7 days. 

However, People in India still consider it taboo to even speak about it. And so many-a-times menstruation issues like delay in getting periods, periods occurring in less than 21 days or more than 35 days, skipping of periods, heavy and painful periods get ignored, covered in the name of social stigma or “not-important” attitude many of us carry. 

In India, approximately 23% of the women between 20 to 29 years suffer from these menstruation issues, followed by young teen girls accounting for nearly 18%. As the young population is gripped by abnormal menstruations, ignoring these issues can only lead to radical complications like infertility. 

This article opens the pages of the possible reasons and treatment options for abnormal menstrual issues women are dealing with regularly. 

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What are Menstruation problems?

Before we get into what precisely menstrual issues are, let’s cognize what normal menstruation is all about? Menstrual periods are normal when the uterine tissue discharges itself through the vagina. Typically, every menstruation passes out anytime between 21 to 35 days and lasts for 4 to 7 days. Any difference in the duration of the period, length of the menstrual cycle, and other abnormalities for a record of more than three months will require medical intervention and assistance. 

Some of the possible conditions caused due to menstruation problems are tabled below.

Menstruation Problems: Possible causes

Excessive stress, changes in diet, external environment, and routine too can impact menstrual cycles. And for a woman, the menstrual duration and pattern are not always the same and can change between cycles. However, some of the medical factors contributing to the differential menstruation changes include:

• Medications: Medicines such as Birth control pills taken to avoid pregnancy interfere in ovulation. Some women experience irregular or absence of menstruation for more than six months after discontinuation of birth control pills. Steroids and blood thinners or anticoagulants affect hormonal production and menstrual cycles.
• Uterine fibroids and polyps: Uterine polyps and fibroids, though benign growths of the uterus, can cause heavy bleeding and painful abdominal cramps during menstruation. Sometimes large fibroids put immense pressure on the bladder or rectum, causing pain and discomfort. 
• Endometriosis: In endometriosis, the endometrium grows outside the uterus, attaches to the ovaries, fallopian tubes, and other abdominal organs. When the uterine lining (endometrium) breaks and gets discharged as menstrual flow during menstruation, the endometrial tissues outside the uterus also break down. And so, excessive bleeding, exhilarating pain before and during the periods is typically seen in women with endometriosis.
• Polycystic Ovarian Syndrome (PCOS): Women with PCOS have ovaries that do not release eggs on time, resulting in irregular menstruation. The higher amounts of androgens, multiple cysts in the ovaries, and hormonal imbalances add to the irregularities. And so, sometimes PCOS-affected women completely stop menstruating (amenorrhea). 
• Pelvic Inflammatory Diseases (PID): The sexually transmitted bacteria such as Chlamydia trachomatis and Neisseria gonorrhoeae enter the female reproductive tract through the vaginal opening. Women having PID often have heavy vaginal flow with an unpleasant odor, infrequent periods, severe abdominal pain, fever, nausea, vomiting, or diarrhea during menstruation. 
• Premature Ovarian Insufficiency (POI): The ovaries of some women under the age of 40 do not ovulate, and all of a sudden, menstruation comes to a halt. The possible reasons for POI can be hormonal changes, cancer treatment such as chemotherapy, radiation, a genetic predisposition of POI genes, or certain chromosomal anomalies. 
• Other causes: Other medical reasons for abnormal menstruation conditions include endocrine disorders such as thyroid or pituitary disorders, uterine cancer, cervical cancer, ectopic pregnancy, or a miscarriage. 

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Menstruation Problems: Treatment

The treatment approach for menstruation problems depends on the underlying cause. In such an aspect, keeping track of the menstrual cycle, flow between periods, pain, and pattern becomes mandatory. A detailed study of the medical history and menstrual cycle followed by a physical examination, a pap smear test is a part of the diagnostic approach. In case of a comprehensive analysis, other investigative tests too can be considered such as,

• Blood tests – to eliminate anemia and other disorders
• Endocervical culture – to check for infections, if any
• A Pelvic Ultrasound Scan – to view the presence of polyps, fibroids, ovarian cysts
• Endometrial Biopsy – to check for hormonal disorders, endometriosis, or cancer
• Laparoscopy – to diagnose endometriosis and other abdominal conditions

After a thorough evaluation and analysis of the exact cause of menstrual abnormalities, choosing the course of treatment becomes easy. A briefing of the possible treatment options is as below.

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When to see a doctor?

Pay attention to the changes of your menstrual cycle, note the days of heavy flow and spotting between periods, and in case you find any one or more of the following symptoms, contact the doctor to seek medical help.

• Heavy menstrual flow (soaking through a sanitary pad or tampon every hour for several hours) 
• Passing of large blood clots
• Severe pain before, during, or in between your periods
• A period lasting for more than seven days
• Regular periods have suddenly become very irregular 
• An abnormal smelling vaginal discharge
• Vaginal bleeding or spotting between periods or post-menopause
• Fever
• Nausea or vomiting during menstruation
• Fainting or feeling dizzy

Conclusion/ Take-Away

Small changes in menstruation are completely normal. Occasional heavy or light periods with cramps are generally not a worrying issue. If you are experiencing prolonged menstruation problems for three months or more or having unusually heavy periods, you will need to seek medical help immediately. Your doctor will understand the menstrual pattern and necessary tests to treat the underlying issue. 

References: 

Overview | https://www.nichd.nih.gov/health/topics/menstruation 

Overview | https://www.healthline.com/health/menstrual-problems#outlook