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Menstrual disorders - Highlights

Description

An in-depth report on the causes, treatment, and prevention of menstrual cramps.

Alternative Names

Dysmenorrhea; Menorrhagia; Amenorrhea; Cramps; Heavy menstrual bleeding

Highlights:

Normal Menstruation

Menstruation typically begins when a girl is about 12 - 13 years old.
The normal length of a menstrual cycle is 21 - 35 days, the average cycle being 28 days.
Menstrual periods typically last 4 - 8 days, the average period lasting 6 days.
Menopause usually occurs around the age of 51. Many women begin to experience symptoms when they are 40 - 44 years old.

Menstrual Disorders

Menstrual disorders include:

Painful cramps (dysmenorrhea) during menstruation. Primary dysmenorrhea is directly related to and caused by menstruation. Secondary dysmenorrhea is caused by another condition, such as endometriosis or uterine fibroids.
Heavy bleeding (menorrhagia, metrorrhagia, or menometrorrhagia) includes prolonged menstrual periods or excessive bleeding.
Absence of menstruation (amenorrhea) can be either primary or secondary. Primary amenorrhea is considered when a girl does not begin to menstruate by the age of 16. Secondary amenorrhea occurs when periods that were previously regular stop for at least three months.
Light or infrequent menstruation (oligomenorrhea) refers to menstrual periods that occur more than 35 days apart. It usually is not a cause for concern, except if periods occur more than 3 months apart.

Treatment for Menstrual Disorders

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, or acetaminophen can help provide pain relief for cramps.
Oral contraceptives can help regulate menstrual periods and reduce heavy bleeding. Newer continuous-dosing oral contraceptives reduce or eliminate menstrual periods. The LNG-IUS (Mirena), a progesterone intrauterine device, is often recommended as a first-line treatment for heavy bleeding
Gonadotropin-releasing hormone (GnRH) agonists are sometimes used to treat severe heavy bleeding.
Endometrial ablation is a surgical option. In some cases, hysterectomy may be considered.

Resources

www.acog.org -- American College of Obstetricians and Gynecologists
www.resolve.org -- National Infertility Association
www.asrm.com -- American Society for Reproductive Medicine
www.endometriosisassn.org -- Endometriosis Association

References

American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care; Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006 Nov;118(5):2245-50.

Apgar BS, Kaufman AH, George-Nwogu U, Kittendorf A. Treatment of menorrhagia. Am Fam Physician. 2007 Jun 15;75(12):1813-9.

Beaumont H, Augood C, Duckitt K, Lethaby A. Danazol for heavy menstrual bleeding. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001017.

Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008 Jun;35(2):219-34.

Chen EC, Danis PG, Tweed E. Clinical inquiries. Menstrual disturbances in perimenopausal women: what's best? J Fam Pract. 2009 Jun;58(6):E3.

Damlo S. ACOG guidelines on endometrial ablation. Am Fam Physician. 2008 Feb 15;77(4):545-549.

Dietrich JE. Von Willebrand's disease. J Pediatr Adolesc Gynecol. 2007 Jun;20(3):153-5.

Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009 May;113(5):1104-16.

Lethaby A, Irvine G, Cameron I. Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001016.

Lobo RA. Abnormal uterine bleeding. Ovalutory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, Lobo RA, Lentz G, Gershenson D, eds. Comprehensive Gynecology. 5th ed. St. Louis, MO: Mosby; 2007:chap 37.

Lobo RA. Primary and secondary amenorrhea and precocious puberty. Etiology, diagnostic evaluation, management. In: Katz VL, Lobo RA, Lentz G, Gershenson D, eds. Comprehensive Gynecology. 5th ed. St. Louis, MO: Mosby; 2007:chap 38.

Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Fam Physician. 2006 Apr 15;73(8):1374-82.

Ortiz DD. Chronic pelvic pain in women. Am Fam Physician. 2008 Jun 1;77(11):1535-42.

Practice Committee of American Society for Reproductive Medicine. Indications and options for endometrial ablation. Fertil Steril. 2008 Nov;90(5 Suppl):S236-40.

Proctor ML, Farquhar CM. Dysmenorrhoea. Clin Evid. 2006 Jun;(15):2429-48.

Sambrook AM, Bain C, Parkin DE, Cooper KG. A randomised comparison of microwave endometrial ablation with transcervical resection of the endometrium: follow up at a minimum of 10 years. BJOG. 2009 Jul;116(8):1033-7. Epub 2009 May 11.

Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8.

Wong CL, Farquhar C, Roberts H, Proctor M. Oral contraceptive pill as treatment for primary dysmenorrhoea. Cochrane Database Syst Rev. 2009 Apr 15;(2):CD002120.

Reviewed last on: 8/5/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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