Menstrual disorders

It is possibly the most commonly known and experienced of the menstrual disorders. Premenstrual syndrome (or PMS) comprises of a series of physical and psychological symptoms that start a few hours to several days before the period, and usually disappear soon after its arrival. The most common symptoms of PMS are:

• Severe fatigue
• Tenderness or even pain in the chest
• Irritability
• Insomnia
• Anxiety
• Difficulty concentrating
• Swelling of the lower abdomen
• Headaches
• Transient weight gain

Premenstrual syndrome is thought to affect 20-40% of women of childbearing age, with symptoms varying in intensity. Approximately 5% suffer from a severe form of PMS called premenstrual dysphoric disorder.

Dysmenorrhoea is pain in the lower abdomen that precedes or accompanies menstruation. It may be accompanied by headaches, nausea, vomiting, diarrhoea or fatigue. Dysmenorrhoea may have no identified cause or may be related to another disorder: endometriosis, uterine fibroids, genital tuberculosis, cysts and tumours in the ovaries, congenital abnormalities, the use of a copper intrauterine device, etc. Depending on the cause of the dysmenorrhoea, it can be treated with non-steroidal anti-inflammatory drugs, antispasmodics, hormone treatments, but also with non-medicinal measures such as placing a hot water bottle on the stomach, acupuncture or relaxation exercises.

Amenorrhoea is defined as the total absence of menstruation. Primary amenorrhoea occurs when, by the age of 16, menstruation has not yet started. In the case of secondary amenorrhoea, menstruation occurs and then disappears. Secondary amenorrhoea is much more common than primary amenorrhoea. The absence of menstruation can have several causes:

• Delayed puberty
• Congenital malformation of the uterus
• A genetic disease (Turner's syndrome and Kallmann's syndrome in particular)
• Taking oestroprogestogenic contraceptives
• Discontinuation of a contraceptive
• Following an abortion or surgery on the uterus
• Early menopause
• Stress
• Psychological shock
• An eating disorder, especially anorexia
• Pregnancy and breastfeeding

If the amenorrhoea is caused by another disorder, this should be treated where possible. If a girl has not yet had her first period and all tests are normal, she is examined every 3-6 months to monitor the progress of her puberty. She may be prescribed a progestin and sometimes oestrogen to trigger the onset of menstruation and to stimulate the development of secondary sexual characteristics, such as breasts.

Menorrhagia, also known as hypermenorrhoea, is the occurrence of abnormal uterine bleeding during the normal period. The amount of blood normally lost during menstruation is on average 2 oz (4 tbsp) and the usual duration of menstruation is between 3 and 7 days. A woman with menorrhagia may lose up to 3 oz (6 tablespoons) or more and sometimes over 7 days. Hypermenorrhoea can have several causes:

• Hormonal imbalance: too much estrogen or too little progesterone
• Presence of organic lesions such as fibroids or polyps
• Development of endometrial cells inside the uterine muscle (adenomyosis)

Treatment of menorrhagia will depend on the cause but often includes taking a progesterone derivative to regulate the menstrual cycle.

Breakthrough bleeding is bleeding that occurs between periods. Most of the time, this spotting is not serious.

This bleeding can be caused by a range of factors, including:

• The insertion of an IUD (intrauterine device)
• Taking hormonal contraceptives
• Expulsion of an IUD or inflammation of the endometrium
• Forgetting to take the contraceptive pill or taking emergency contraception (morning-after pill)
• A uterine fibroid
• Lesions of the cervix or vulva-vaginal region (micro-trauma, polyps, etc.)
• Endometriosis (abnormal growth of the lining of the uterus, sometimes proliferating to other organs)
• A fall or blow to the genital area
• Cancer of the cervix or endometrium, or even of the ovaries
• An infection

Again, the solutions depend on the causes of the metrorrhagia. Once the diagnosis has been made, the doctor will propose an appropriate treatment (surgery, antibiotics, etc.).