Understanding Menstrual Health: Common Problems and When to See a Gynecologist

Reviewed by Dr. Kenneth Barron, MD

Your menstrual health plays a key role in your overall quality of life. Recognizing and understanding common menstrual issues is essential for knowing when to seek medical advice. Many people with a uterus face challenges with their menstrual cycle, but with proper information and support, these issues can be effectively managed.

What is Considered Normal Menstruation?

A normal menstrual cycle typically spans 28 days, though some variations are common. As long as the duration is similar each month, menstrual cycles can range from every 21 to every 35 days. One to two day variation each month is considered normal. This refers from the 1st day of bleeding to the next 1st day of bleeding. Menstruation (a period) involves the shedding of the uterine lining, resulting in bleeding that lasts 2 to 7 days on average. Normal menstruation is accompanied by mild cramps, changes in mood, and minor discomfort.

What is Irregular Menstruation?

Irregular menstruation refers to variations in the menstrual cycle that deviate from a 21 to 35-day range. This can include cycles that are consistently longer or shorter than normal, missed periods, or an unpredictable flow.

Irregular periods can happen for many reasons, such as hormonal imbalances, stress, significant changes in weight, or conditions like Polycystic Ovary Syndrome (PCOS). Occasional irregular periods are usually nothing to worry about, but if your periods are often irregular or if you notice sudden changes in your cycle, it could be a sign of health issues such as thyroid problems, PCOS, or reproductive tract issues. It’s a good idea to see a healthcare provider if this happens.

Tracking your periods with a calendar or a smartphone app can be very helpful so that you can keep an eye on your cycle length, flow, and any symptoms you’re experiencing. This can also be valuable for your healthcare provider to determine the cause of your irregular menstruation and how to help.

What are Common Menstrual Problems?

Menstrual problems can vary widely, from painful periods to heavy bleeding or even a lack of menstruation. Here are some of the most common issues and how they can be addressed.

Dysmenorrhea (Painful Menstrual Periods)

Dysmenorrhea is characterized by severe menstrual cramps caused by uterine contractions. It might also include nausea, headaches, and diarrhea.

Over-the-counter pain relievers, heat therapy, and hormonal birth control can alleviate symptoms. Lifestyle changes such as exercise and select dietary adjustments and supplements may also help.

Menorrhagia (Heavy Menstrual Bleeding)

Menorrhagia is defined as excessive menstrual bleeding with any of the following characteristics:

• Bleeding that lasts more than 7 days.
• Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
• Needing to wear more than one pad at a time to control menstrual flow.
• Needing to change pads or tampons during the night.
• Menstrual flow with blood clots that are as big as a quarter or larger.

Causes include hormonal imbalances, fibroids, polyps, or bleeding disorders.

Treatment varies from medications like tranexamic acid to surgical interventions such as endometrial ablation, removal of polyps or fibroids, or hysterectomy. Medical consultation is crucial if bleeding is severe or disrupts daily life.

Amenorrhea (Absence of Menstruation)

Amenorrhea means not having your period. There are two types: primary and secondary.

Primary amenorrhea is when a person has not started menstruating by age 15. Secondary amenorrhea occurs when someone who previously had regular periods stops menstruating for more than three months. Causes can include hormonal imbalances, structural issues in the reproductive system, rapid weight loss, low body weight, serious athletes, eating disorders, and high levels of stress.

To diagnose amenorrhea, doctors use hormonal tests, imaging studies like ultrasounds, and physical exams to find the underlying cause. Treatment depends on the diagnosis and can range from hormonal therapy to addressing other health issues that may be causing the absence of menstruation.

What are the Different Types of Menstrual Disorders?

There are several types of menstrual disorders, including:

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormonal disorder characterized by irregular periods, excess androgen levels (testosterone), and multiple small ovarian cysts. Symptoms include irregular menstrual cycles, acne, weight gain, and hair growth on the face or body. Diagnostic criteria typically involve hormonal tests, ultrasound imaging to detect ovarian cysts, and evaluation of symptoms.

Management focuses on symptom control and reducing long-term health risks such as diabetes and cardiovascular disease. Treatment might include hormonal contraceptives to regulate your menstrual period, lifestyle modifications like diet and exercise to manage weight, and medications to address specific symptoms.

Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus, causing pain, infertility, and other symptoms. Symptoms include pelvic pain, painful periods, pain during intercourse, and infertility. The condition can significantly impact your daily activities, relationships, and mental health due to chronic pain and fertility challenges.

Treatment ranges from pain management with over-the-counter or prescription medications to hormonal therapies aimed at suppressing menstrual cycles and reducing pain. Surgical options like laparoscopic excision might be necessary to remove the abnormal tissue to relieve pain symptoms and to improve fertility. Endometriosis surgery is one of the treatments we focus on at the Center for Advanced Gynecology. Consulting a specialist is crucial for accurate diagnosis and tailored treatment plans, especially when symptoms interfere with daily life or fertility goals.

When to See a Gynecologist

There are many instances when you should schedule an appointment with a gynecologist. These can include:

• Irregular Menstrual Cycles/Missed Periods: If your menstrual cycle is frequently irregular or you notice sudden changes in your pattern, it's a good idea to visit a gynecologist. Experiencing missed periods can also be a sign that it’s time to see a gynecologist. While occasional missed periods might not be a cause for concern, consistent irregularities can indicate underlying issues that need medical attention. Your gynecologist can help diagnose the problem and suggest treatments or lifestyle changes to regulate your cycle.
• Prolonged Menstrual Bleeding: If you are dealing with prolonged menstrual bleeding or find that your periods last longer than usual, it’s important to consult a gynecologist. Prolonged bleeding can lead to anemia and other health issues, so getting it checked out is essential. A gynecologist can identify the cause and recommend treatments to manage the bleeding.
• Abnormal Bleeding: Abnormal bleeding, such as bleeding between periods or excessively heavy periods, should also prompt a visit to your gynecologist. Abnormal uterine bleeding can be a symptom of various conditions, including fibroids, polyps, endometriosis, or hormonal imbalances. Early diagnosis and treatment can help prevent more serious complications and improve your quality of life.

Why Choose The Center For Advanced Gynecology

The Center for Advanced Gynecology, established in 2018, is dedicated to improving your health by offering expertise in various areas, with a specific focus on gynecological care and advanced surgical techniques when surgery is needed.

Our team provides specialized expertise in non-surgical treatment of chronic pelvic pain, painful intercourse, pudendal neuralgia, and vaginal, vulvar, and bladder pain.

Since opening our doors, we have recognized the need in our community for more than just specialty care and have a growing practice in routine gynecologic care, cancer screening, Pap smears, menopausal management, hormonal imbalances, hormone replacement therapy, menstrual abnormalities, breast care, contraceptive care, urinary incontinence, and pelvic organ prolapse.

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