Menstrual Disorders
Menstrual disorders — from irregular cycles to heavy bleeding or complete absence of periods — are common and, in most cases, treatable with personalized management.
Symptoms of menstrual disorders — when to be concerned
Every woman has her own "normal" — what matters is recognizing changes in your own cycle and evaluating them with a gynecologist.
- Menorrhagia: Very heavy period bleeding (>80 ml) or prolonged (>7 days) — the most common reason for consultation
- Dysmenorrhea: Severe period pain that affects daily life and is not relieved by simple analgesics
- Oligomenorrhea: Infrequent periods — fewer than 8 cycles per year or cycles >35 days
- Amenorrhea: Complete absence of periods for >3 months (secondary) or never (primary)
- Metrorrhagia: Bleeding between periods or after sexual intercourse — always requires evaluation
- Polymenorrhea: Cycles <21 days
- Premenstrual syndrome (PMS/PMDD): Severe physical or emotional changes in the week before the period
Causes and risk factors
A menstrual disorder is a symptom, not a diagnosis — there is usually an underlying cause that needs to be identified.
- Hormonal imbalances: PCOS (polycystic ovary syndrome) — the most common cause of irregular cycles
- Thyroid disorders: Hypo- or hyperthyroidism directly disrupt the cycle
- Structural uterine conditions: Fibroids, endometrial polyps, endometriosis
- Stress and psychological factors: Chronic stress disrupts the hypothalamus-pituitary-ovary axis
- Eating disorders / extreme weight loss: Amenorrhea due to low energy intake
- Excessive physical exercise: Athletic amenorrhea in high-performance athletes
- Perimenopausal changes: Normal cycle changes at age 40+
- Medications: Antipsychotics, antidepressants, anticoagulants, hormonal preparations
Types of menstrual disorders — what they are
Understanding the type of disorder helps in accurate diagnosis and selection of appropriate treatment.
- Functional: No organic damage — cause is hormonal, psychological or lifestyle-related
- Organic: Underlying structural condition (fibroid, polyp, endometriosis, adenomyosis)
- Endocrine: Thyroid, adrenal or pituitary disorders (hyperprolactinemia)
- Iatrogenic: Bleeding related to contraceptives, IUD or medications
Tests for evaluation of structural causes
When ultrasound is not enough or endometrial pathology is suspected.
- Hysteroscopy: Direct visual examination of the uterine cavity — gold standard for polyps and submucosal fibroids
- Pelvic MRI: Detailed assessment of adenomyosis and fibroid mapping before surgery
- Endometrial biopsy: For endometrial thickening or postmenopausal bleeding
- Complete blood count / iron / ferritin: Assessment of anemia from chronic bleeding
How menstrual disorders are diagnosed
Diagnosis requires a detailed history (cycle diary), clinical examination and targeted tests — a single test is not enough.
- Detailed gynecological history: Age of menarche, regularity, quantity, pain, last period
- Transvaginal ultrasound: Assessment of endometrium, ovaries, detection of fibroids or polyps
- Hormonal blood tests: FSH, LH, estradiol, progesterone, AMH, testosterone
- Thyroid tests: TSH, T4 — always in new amenorrhea or irregular cycle
- Prolactin: Exclusion of hyperprolactinemia in amenorrhea
Treatment of menstrual disorders — hormonal options
Treatment depends on the cause, age and desire for pregnancy. There is no single solution for all.
- Oral contraceptives: Cycle regulation, reduction of bleeding and dysmenorrhea — first choice in many cases
- Mirena IUS: Intrauterine progesterone device — excellent for menorrhagia, reduces bleeding >90%
- Progestins: For luteal phase deficiencies or cycle regulation
- Metformin + contraceptives: For PCOS with irregular cycle
- Thyroid hormones / dopaminergic agents: If the cause is thyroid pathology or hyperprolactinemia
Surgical and minimally invasive treatment
Surgery is indicated when there is a structural cause (fibroid, polyp) or when medication is not sufficient.
- Hysteroscopic polypectomy: Minimally invasive, no incisions — immediate resolution of bleeding from polyps
- Hysteroscopic myomectomy: Removal of submucosal fibroids causing bleeding
- Laparoscopic / robotic myomectomy: For larger or difficult-to-reach fibroids
- Endometrial ablation/resection: Permanent reduction of endometrium in women who do not desire pregnancy
Prevention and regular follow-up
Many menstrual disorders can be prevented or detected early with regular check-ups.
- Annual gynecological check-up with ultrasound — early detection of structural pathology
- Cycle diary: Recording regularity, quantity and pain for reliable history
- Stress management, balanced diet and avoidance of extreme weight loss
- Immediate visit for: bleeding between periods, bleeding after sexual intercourse, absence of period >3 months
Symptoms
Every woman has her own "normal" — what matters is recognizing changes in your own cycle and evaluating them with a gynecologist.
- Menorrhagia: Very heavy period bleeding (>80 ml) or prolonged (>7 days) — the most common reason for consultation
- Dysmenorrhea: Severe period pain that affects daily life and is not relieved by simple analgesics
- Oligomenorrhea: Infrequent periods — fewer than 8 cycles per year or cycles >35 days
- Amenorrhea: Complete absence of periods for >3 months (secondary) or never (primary)
- Metrorrhagia: Bleeding between periods or after sexual intercourse — always requires evaluation
- Polymenorrhea: Cycles <21 days
- Premenstrual syndrome (PMS/PMDD): Severe physical or emotional changes in the week before the period
A menstrual disorder is a symptom, not a diagnosis — there is usually an underlying cause that needs to be identified.
- Hormonal imbalances: PCOS (polycystic ovary syndrome) — the most common cause of irregular cycles
- Thyroid disorders: Hypo- or hyperthyroidism directly disrupt the cycle
- Structural uterine conditions: Fibroids, endometrial polyps, endometriosis
- Stress and psychological factors: Chronic stress disrupts the hypothalamus-pituitary-ovary axis
- Eating disorders / extreme weight loss: Amenorrhea due to low energy intake
- Excessive physical exercise: Athletic amenorrhea in high-performance athletes
- Perimenopausal changes: Normal cycle changes at age 40+
- Medications: Antipsychotics, antidepressants, anticoagulants, hormonal preparations
Understanding the type of disorder helps in accurate diagnosis and selection of appropriate treatment.
- Functional: No organic damage — cause is hormonal, psychological or lifestyle-related
- Organic: Underlying structural condition (fibroid, polyp, endometriosis, adenomyosis)
- Endocrine: Thyroid, adrenal or pituitary disorders (hyperprolactinemia)
- Iatrogenic: Bleeding related to contraceptives, IUD or medications
This information is for educational purposes and does not replace medical advice. For diagnosis and personalized treatment, book an appointment.
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