Menstrual Disorders

Menstrual disorders are problems related to a woman's normal menstrual cycle. They are one of the most common reasons women visit their gynecologist.

Menstrual disorders and their symptoms can disrupt a woman's daily life. They can also affect her ability to become pregnant.

There are many types of menstrual disorders, including:

• Abnormal menstrual bleeding - Excessive or prolonged menstrual bleeding
• Amenorrhea - The absence of menstrual bleeding
• Oligomenorrhea - Light or infrequent menstruation
• Fibroids - Noncancerous uterine tumors
• Premenstrual syndrome (PMS) - Physical and emotional discomfort prior to menstruation
• Premenstrual dysphonic disorder (PMDD) - Severe physical and emotional discomfort prior to menstruation

Menstrual disorders can be caused by a variety of factors, including:

• Uterine fibroids
• Hormonal imbalances
• Clotting disorders
• Cancer
• Sexually transmitted infections (STIs)
• Polycystic ovary syndrome (PCOS) - cysts on the ovaries
• Genetics

Symptoms may include:

• Abnormal menstrual bleeding
• Pain or cramping
• Depression
• Headaches
• Emotional distress
• Bloating or fullness in the abdomen

If your periods come too frequently (fewer than 21 days apart), not often enough (more than three months apart), or last longer than 10 days, talk with your doctor.

Diagnosis starts with a detailed medical history and physical exam, including a pelvic exam and Pap smear. You may be asked to keep a diary of your menstrual cycles, including dates, amount of flow, pain and any other symptoms.

Additional testing may include:

• Blood tests
• Hormonal tests
• Ultrasound - To detect conditions that may be causing menstrual disorders.
• Hysterosonography - An ultrasound using sterile saline to expand the uterine cavity for better imaging.
• Magnetic resonance imaging (MRI) - For intricate pictures of the uterus and surrounding organs.
• Hysteroscopy - An office procedure that uses a small, lighted telescope (hysteroscope) inserted through the vagina and cervix to examine the uterus for fibroids, polyps, or other areas of concerns.
• Laparoscopy - Looks for abnormalities of the reproductive organs using a tiny lighted instrument with a camera on the end (laparoscope) inserted through a small incision in the abdomen.
• Endometrial biopsy - An office procedure in which a small sample of the lining of the uterus is removed to examine for abnormal cells.
• Dilation and Curettage (D&C) - Involves scraping the inside lining of the uterus and cervix to take tissue samples or relieve heavy bleeding.

Treatment for menstrual disorders will depend on the underlying cause, the woman’s desire to have children, and other factors. 

Treatment options range from lifestyle changes to medical options to surgery, including
 

• Dietary changes - Such as reducing salt, caffeine, sugar, and alcohol intake before a woman's period to reduce cramping and other symptoms.
• Medical treatment - Using pain relievers for cramps and hormonal contraceptives to help reduce heavy bleeding and regulate, reduce or even eliminate menstrual periods.
• Surgical treatment - Surgery can be performed:
  • Using hysteroscopy, a minimally invasive approach to examine and treat areas of concern inside the uterus
  • Through laparoscopy, using a scope inserted in small incisions in the abdomen
  • Through traditional abdominal techniques
  • Procedures include endometrial ablation, which destroys the lining of the uterus to stop periods, and hysterectomy, the surgical removal of the uterus.

To schedule an appointment with a Baylor College of Medicine physician specializing in menstrual disorders, call the department of Obstetrics and Gynecology at (713) 798-7500.