Menstrual Disorders

This article contains self-care information for the selected condition. If you have questions or need more comprehensive treatment advice, please consult a medical professional.

During the menstrual period, the inner lining of the uterus detaches and is then expelled through the vagina as menstrual blood. Most people experience mild symptoms such as cramps caused by contractions of the uterus while some feel none at all aside from the bleeding itself. These symptoms are due to natural changes in hormone levels and are usually manageable with little impact on day-to-day life. They usually occur up to a week before the period starts and can continue for the first 2-3 days when bleeding is heavier.

Menstrual disorders occur when symptoms are more intense and have a negative impact on daily life. Painful menstruation and other physical symptoms during periods are called dysmenorrhea while physical symptoms accompanied by emotional changes before the period starts are known as premenstrual syndrome or PMS. When PMS symptoms are very severe and have a deep impact on the person’s social and professional life, this is classified as premenstrual dysphoric disorder.

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Dysmenorrhea is classified as primary when there is no specific cause and as secondary when an underlying condition leads to painful periods.With primary dysmenorrhea, the prostaglandin chemicals which cause the uterus to contract are overproduced by the body. This leads the uterus to contract too much causing intense pain. 1 2 3 4

As well as an overproduction of prostaglandins, secondary dysmenorrhea is usually caused by an underlying condition:

• Endometriosis: when the uterine lining tissue grows outside the uterus on the surface of other organs like the bladder, intestines, or ovaries. This tissue responds to hormonal stimulation during the menstrual cycle but cannot be expelled as period blood during the bleeding phase of the cycle. This causes affected organs to stick together as well as scarring which can in turn cause complications such as chronic pain and infertility.
• Adenomyosis: similar to endometriosis but instead of tissue growing on other organs, it grows in the muscular part of the uterus, making it bigger and sometimes causing pain.
• Uterine fibroids: non-cancerous tumors that can grow in different layers of the uterus. These tumors increase the size of the uterus and may cause pain, abnormal bleeding, and add pressure on other organs. 1 2 3 4

The causes of PMS are still not very clear but are certainly related to a drop in levels of the hormone estrogen just before the period starts. Physical symptoms like cramps, nausea, breast pain, swelling and headaches can occur as well as emotional symptoms like mood swings, crying, depression and insomnia. 1 2 3 4

The symptoms between primary vs. secondary dysmenorrhea are not the same. Primary dysmenorrhea’s main symptom is pelvic pain usually in the form of cramps and may be accompanied by: 1 3

• Headaches
• Diarrhea
• Nausea
• Vomiting
• Dizziness
• Leg and back pain

Symptoms of primary dysmenorrhea usually start during or just before menstruation. They can last up to 2-3 days during the period, varying from woman to woman. Usually, they are worse on the days that the flow is more intense.

Younger girls are more likely to have primary dysmenorrhea with the condition naturally getting better the older they get. Periods tend to be less painful and primary dysmenorrhea can even disappear after childbirth.

Secondary dysmenorrhea tends to start later in life and lasts longer during periods. As well as common dysmenorrhea symptoms others may be present:

• Pain during penetrative sex
• Heavy menstrual bleeding
• Difficulties getting pregnant
• Abnormal uterine bleeding
• Painful periods that don't get better with treatment

Symptoms of premenstrual syndrome usually start around a week before the period and tend to get better once it starts. Symptoms can vary from month to month but are normally present to some degree every cycle. Symptoms can be emotional or physical or both. 2 4 5

• Depression
• Mood changes
• Sudden crying
• Anxiety
• Irritability
• Sadness
• Difficulties sleeping
• Decreased sex drive
• Tiredness with needs to take naps during the day
• Social withdrawal

• Appetite changes
• Fatigue
• Headaches
• Acne
• Abdominal pain
• Constipation or diarrhea
• Breast tenderness
• Bloating
• Swelling of feet, legs and hands
• Weight gain

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To diagnose dysmenorrhea, a medical professional will assess symptoms and do a physical exam. Imaging tests such as an ultrasound or an MRI may be used to differentiate primary from secondary dysmenorrhea. These exams help the medical professional to look at the pelvic organs and exclude the presence of underlying causes like uterine fibroids.

In some cases, minor keyhole surgery like a laparoscopy might be necessary. This allows the doctor to have a good view of the internal organs and diagnose any problems that might be causing pain like endometriosis. 1 2 3 4 5

With premenstrual syndrome, diagnosis is done by tracking and analyzing symptoms with the help of a medical professional.

Symptoms should be recorded every day for at least 3 months in a row. This should include how the person feels and rating of how severe the symptoms are. Periods should also be recorded so that the onset of symptoms can be compared with phases in the menstrual cycle. PMS is diagnosed when a doctor confirms a pattern recurring over at least 3 consecutive months. PMS symptoms first appear at least 5-7 days before the period and end max 4 days after the period starts. Very intense recurring symptoms of PMS might be PMDD or premenstrual dysphoric disorder. 1 2 3 4 5

Menstrual pain can be easily and effectively treated at home.

Hot water bottles and warm baths: applying warm compresses to the belly or taking a hot shower can help. Heat relaxes the contracting uterine muscles.

Light exercise: stretching and gentle yoga positions like child’s pose or cat-cow apply light pressure to the womb which soothes pain. Aerobic activities like a walk or a bike ride produce endorphins which block pain.

Sleep and relaxation: sleep and relaxation help prevent pain and are a good coping method. 1 3 6

NSAIDs (nonsteroidal anti-inflammatory drugs) are over-the-counter medications like ibuprofen or naproxen which target chemicals that cause pain. It’s best to be cautious when taking any NSAIDs due to potential side effects.

Buscopan stops muscles contracting and is very effective for treating period cramps.

Estrogen and progestin birth control methods or any method that contains hormones, like the pill, injections, vaginal ring, implants, patches, or hormonal IUD help to treat pain. This option should be evaluated and prescribed by a gynecologist.

Cannabis-based products like CBD have been proven effective in treating many gynecological conditions, including primary and secondary dysmenorrhea.

For secondary dysmenorrhea, the specific cause needs to be addressed.

For endometriosis, common hormonal methods like birth control pills, hormonal IUDs and other progestin pills suppress menstruation. This helps with symptoms and the rate of progression. In severe cases, other medications called GnRH antagonists stop the menstrual cycle completely but can also cause intense side effects. Sometimes laparoscopy, a minimally invasive surgery, might be needed for effective treatment of the condition.

If the cause of the pain is uterine fibroids, medication like hormonal birth control, NSAIDs and GnRH may be enough to treat them. However, sometimes the only effective treatment is fibroid removal surgery.

Adenomyosis can also be managed with medications but surgery can be an option in cases where medication is ineffective.

In extreme cases where all of the above options fail to help, the uterus may be removed in a procedure known as a hysterectomy.

Coping with symptoms of premenstrual syndrome can be very difficult. Some simple lifestyle changes can make mild to moderate symptoms easier to cope with and improve quality of life. Severe symptoms that interfere with enjoyment of daily life should be assessed by a medical professional.

Regular exercise improves quality of life by producing chemicals like endorphins that help reduce depression and mood swings. It also helps with abdominal bloating, swelling in legs and feet and improves the quality of sleep.

Introducing a healthier diet by eating less sugar, fat, and salt can help with cravings, bloating and weight gain during PMS. Eating fiber-rich fruit and veg helps intestinal discomfort like constipation and diarrhea while reducing alcohol and caffeine can be a good way to prevent headaches and mood swings. Drinking plenty of water is always a good idea and helps with PMS too.

Meditation and relaxation are very important measures to control anxiety and depression. This helps people cope with emotional symptoms, improves social and professional performance, and contributes to better sleep.

PMS and PMDD have a big emotional effect so talking about it with a psychologist or psychotherapist can help people manage their symptoms. 2 4 5

NSAIDs can be used to relieve cramps and headaches.

Diuretics can help with swelling and bloating by helping the kidneys get rid of retained fluids.

Controlled doses of hormones (like the birth control pill) prevent ovulation and naturally-occurring hormonal changes. As a result, people can avoid hormonal drops that trigger symptoms.In more intense cases, antidepressants and anti-anxiety drugs can be very helpful. Antidepressants can be used continuously or for 2 weeks before symptoms start whereas anti-anxiety medication can be used only when needed. There are many medication options in these cases which should all be discussed with a medical doctor. 2 4 5

Lifestyle changes like eating well, exercising, reducing stress, meditating, and consuming less alcohol can be very helpful in preventing both dysmenorrhea and PMS symptoms.

Unfortunately, as yet there is no efficient, scientifically-proven method for avoiding most causes of secondary dysmenorrhea like fibroids, adenomyosis, or endometriosis. However, using hormonal methods and NSAIDs can reduce the impact of symptoms.

Dietary supplements like calcium, magnesium, and vitamin E and vitamin D might help prevent menstrual disorder symptoms.

Taking ibuprofen 2-3 days before the period starts can also reduce the chances of having extremely painful cramps.

Hormonal birth control methods can also prevent painful periods and other PMS symptoms. 1 2 3 7

The prognosis differs from the type of menstrual disorder. 1 2 3 4

The prognosis in these cases is good. There are no severe complications associated with this condition and symptoms tend to reduce naturally with age.

The prognosis depends a lot on the cause and the grade of progression of each situation. Cases that don't require surgery and respond well to medications tend to have a good prognosis. Other more severe cases can have a negative impact on the person's life and might require surgery.

Mild and moderate cases tend to respond well to simple life changes and medication. Some more severe cases that have a greater impact on a person's life can be more difficult to manage but most of the time have a good prognosis.