At a glance: Menstrual disorders

Many women have pain, general discomfort, or cramps during their monthly period. It can also be unusually strong or irregular. If the symptoms are mild, women are often able to cope with them. Yet if they are stronger, therapy may be needed. We offer a brief overview of the different types of menstrual disorders and options for coping and treating them. Detailed information on the individual aspects can be found in our feature.

Menstruation

The first and last periods mark the beginning and end of a woman’s reproductive years. During menstruation, the mucous membranes lining the inside of the womb (uterus) that are regenerated each month are shed. These membranes make up what is called the endometrium. If a woman does not become pregnant during this cycle, this lining is shed together with the period. You can read more about how the female reproductive cycle works here.

Period pain

Period pain (dysmenorrhea) occurs when the muscles of the womb tighten to help shed the mucous membrane. Usually the tightening of the muscles goes on unnoticed or causes only a slight pulling. Yet in some women the pain is much stronger. The pain may be limited to the lower abdomen, but it could also radiate to the back or the legs. Sometimes other health problems are behind these symptoms, like diseases of the gastrointestinal tract or endometriosis – a condition where the endometrial lining also grows outside of the uterine cavity. For this reason, it may be a good idea to seek out a doctor if you have longer-lasting strong symptoms to find out what is causing them.

Treating period pain

There are different ways to lessen period pain or to prevent it. Not everything that is recommended has also been tested scientifically. Many women try out different things and then learn from experience what helps them best. Non-drug options include

• Movement, relaxation and breathing exercises (for example yoga),
• Applying heat (for example baths, hot water bottles),
• Massage,
• Psychological pain therapies (for example behavioral therapy, biofeedback),
• Changes in diet and
• Procedures aiming to influence the pain stimulus (for example acupuncture).

Anti-inflammatory painkillers from the group of non-steroidal anti-inflammatory drugs (NSAIDs) have been proven to relieve menstruation symptoms. The pill can also help period pain as a hormonal contraceptive. Alternative therapies (for example acupuncture) as well as dietary supplements were not shown to help. You can read more about period pain in our fact sheet.

Heavy periods

Some women lose an abnormally high amount of blood during menstruation. The cause of heavy menstrual bleeding (menorrhagia) is usually benign growths in the womb: These can either be growths in the muscle layer of the womb, the so-called myomas, or growths in the tissue lining the womb (the endometrium) – then they are called polyps. Some women cope quite well with heavier bleeding. In others this heavy menstrual bleeding can lead to iron deficiency, and then to anemia. The main symptoms of anemia are weakness and exhaustion. Heavy menstrual bleeding is often felt to be bothersome or embarrassing and can lead to mood swings as well as sluggishness.

Treating heavy periods

The oral contraceptive pill (often simply called “the pill”) is a hormone-based medication that can reduce menstrual bleeding in some women. It contains either estrogen and progestin, or progestin alone. Women who have menorrhagia more frequently take a pure progestin medication. A hormone-releasing intrauterine device (IUD) can also relieve symptoms. Both treatments also prevent pregnancy at the same time, however.

If benign tissue growths in the womb like myomas or polyps in the tissue lining the womb are causing heavy bleeding, they can be surgically removed. After surgery, pregnancy is usually still possible. Another option is to remove the tissue lining the womb, leaving the womb itself intact. But this tissue can grow back and make a new operation necessary. Removing the entire uterus (hysterectomy) is, however, a very serious step and more distressing than removing only the lining. This involves a larger operation, which sometimes has serious adverse effects, for example secondary bleeding. A woman can no longer have children after a hysterectomy is performed. Yet most women are satisfied with the results of this operation because they no longer have periods, and therefore do not have any symptoms, either.

Tranexamic acid is a medication for reducing the tendency to bleed. It is not as effective as the hormone-releasing IUD and also has more adverse effects than hormonal medications like the pill, for example allergic reactions and vision problems. Non-steroidal anti-inflammatory drugs (NSAIDs) can also relieve period pain, and can possibly reduce bleeding somewhat. You can find out more about the different treatment options here.

If heavy menstrual bleeding is causing anemia, this can also sometimes be treated with iron tablets.

Disorders of the period rhythm

If a menstrual cycle does not follow its usual rhythm, it does not always mean that a disease is the cause or that treatment is needed. But it can be a good idea to talk to a gynecologist to rule out the possibility.

Cycles that are much shorter than 28 days (less than about 21 days), are called polymenorrhea. If the cycle is much longer (over about 35 days), it is called oligomenorrhea. Either of these could be triggered by hormonal changes.

When one period is missed over 3 cycles, it is called amenorrhea. Besides pregnancy, this can be caused by mental or physical strain, or severe malnutrition. Some women also experience light bleeding between periods, also called spotting. These bleedings may only happen in the middle of the cycle and last for a few days, for example. This is often the result of ovulation and not a cause of concern. Other women have spotting only in the second half of the menstrual cycle, which can be an indication of problems like impairment of the corpus luteum (from the Latin for “yellow body”), for example. Then it may be a good idea to talk to a doctor.


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: April, 2014. You can find out more about how our health information is updated here.

© IQWiG (Institute for Quality and Efficiency in Health Care)