In this article, I have discussed the most common menstrual disorders faced by girls in their adolescence and the method of diagnosis of the same.
Female menstrual disorders are common during adolescence due to the slow maturation of the system situated in the brain called the hypothalamic-pituitary axis. The hypothalamic-pituitary axis is the mediator of the menstrual cycle. The failure of this system may lead to variations in the menstrual cycle. It can last up to two to five years after menarche (the first occurrence of menstruation). More than two-thirds of adolescent problems are related to menstruation in the forms of dysmenorrhea (painful period), amenorrhea or oligomenorrhea (absent or reduced periods), and menorrhagia (abnormal uterine bleeding).
It is one of the common gynecological complaints during adolescence. About 60% of girls between the age of 12-17 years complain of dysmenorrhea. However, only 15% seek medical advice. The first few periods are pain-free due to the absence of ovulation. After that, dragging pelvic pain is common. This is due to pelvic vascular engorgement under the reflex of sex steroids. Dysmenorrhea may be primary or secondary.
Primary dysmenorrhea (spasmodic) develops early after uterus menarche, within the first two years. It is defined as painful menstrual cramps in the absence of clinically detected pelvic pathology. Possible diagnoses in the case of atypical severe pain are endocrine, myometrial disturbing action, prostaglandins, and vasopressin.
Secondary dysmenorrhea (congestive) may occur many years after menarche. The pain is usually more severe and precedes menstruation by several days. Colicky pain before a flow is relieved with menstruation. Common causes are endometriosis, pelvic inflammatory disease (PID), congenital genital tract malformation, cervical stenosis, cervical polyp, fibroid, intrauterine adhesion, and IUCD (intrauterine contraceptive device).
A careful history is key to diagnosis.
A pelvic examination is avoided in the young girl who is not active sexually. In such cases, genital per rectal examination can be done.
A pelvic ultrasound will help to diagnose conditions such as structural uterine defects, fibroid, endometriosis, PID, and polyp.
Rarely diagnostic laparoscopy is needed in case of severe atypical pain.
Primary amenorrhea is when a girl does not start menstruation by the age of 16 years. Amenorrhea can be diagnosed with clinical history and examination. Also, we need to check thyroid tests, ultrasound, laparoscopy, and prolactin levels. Causes of primary amenorrhea are as follows:
CNS disorders like pituitary gland tumor, craniopharyngioma, stress, and antidepressant drugs.
Adrenal dysfunction like Cushing syndrome and congenital adrenal hyperplasia.
Ovarian dysfunction like premature ovarian failure and androgen-secreting tumor.
Outflow tract dysfunction like Scheuermann's syndrome, cervical or vaginal agenesis, imperforate hymen.
Abnormal uterine bleeding is usually associated with anovulatory cycles. However, there are multiple reasons for anovulation.
Anovulation due to inappropriate maturation of the HPA axis (hypothalamic–pituitary–adrenal axis), PCOS (polycystic ovarian syndrome), stress, obesity, and excessive exercise.
It can also be due to blood dyscrasias like sickle cell anemia and ITP (idiopathic thrombocytic purpura), infections like endometritis and cervicitis, and systemic disorders like liver and kidney disease.
Anatomical lesions like polyp, foreign body, sexual abuse, fibroid, and malignancy can result in anovulation.
Pregnancy complications like post-abortion, ectopic pregnancy, hydatidiform mole (growth inside the uterus at the beginning of pregnancy), and retained products of conception can cause intermenstrual bleeding.
Hypothalamic factors like eating disorders, stress, and low body fat can give rise to menorrhagia.
The diagnosis of menorrhagia depends on a thorough history, clinical examination, abdominal and vaginal examination, ultrasound, and diagnostic hysterolaparoscopy.
Menstrual flow and cycle length.
History of any gynecologic surgery or gynecologic disorders.
History of sexually transmitted diseases.
History of any contraceptive use.
Family history of fibroids.
History of a breast discharge.
Blood clotting disorders.
Blood Tests: It is done to evaluate iron deficiency (anemia) or conditions like thyroid disorders or blood-clotting abnormalities.
Pap Test: The cervical cells are collected and tested for infection, inflammation, or changes that can be cancerous or can lead to cancer.
Ultrasound: High-frequency sound waves are used to create a detailed image of the pelvic organs.
Magnetic Resonance Imaging (MRI): It is a diagnostic procedure that provides detailed images of the reproductive organs by using a combination of large magnets, radio frequencies, and a computer.
Hysteroscopy: A hysteroscope inserted through the vagina to visualize the canal of the cervix and the interior of the uterus for examination.
Biopsy (Endometrial): A needle is used to remove the tissue samples from the uterus lining during surgery to determine any cancer or other abnormal cells.
Dilation and Curettage (D&C): A common gynecological surgery consists of widening the cervical canal with a dilator and scraping the uterine cavity with a curette (a spoon-shaped surgical tool) to remove tissue.
Laparoscopy: It is a minor surgical procedure in which a thin tube with a lens and a light is inserted inside an incision in the abdominal wall to see into the pelvic and abdomen area.
Transvaginal Ultrasound: It uses sound waves to produce images of the female reproductive organs, including the cervix, uterus, ovaries, fallopian tubes, and pelvic area.
Cystoscopy: It is a thin tube with a camera and a light on its end. It is inserted into the urethra and bladder and transmits images to a screen for the doctor to see. The doctor will be able to see if there is any endometrial tissue inside the bladder. This is rarely needed in the diagnosis of a bleeding disorder.
Consulting about your menstrual disorder symptoms with your doctor can help decide what type of treatments can be best reduce or relieve your symptoms, including:
Vitamin or mineral supplements.
The treatment plan is based on the following factors:
Age, overall health, and medical history.
The extent of the condition.
Possible cause of the condition.
Tolerance for specific medications, procedures, or therapies.
1) Endometrial Ablation: It involves using heat, electricity, laser, freezing, or other methods to destroy the uterus lining. These are recommended only for womenwho do not wish to get pregnant anymore. However, in the following treatment, a person must use contraception. Even though the endometrial ablation destroys the uterine lining, there is a slight chance of pregnancy, which could be dangerous to both the mother and the fetus. But overall, endometrial ablation procedures have a reasonable success rate at reducing heavy bleeding.
2) Endometrial Resection: In this surgical procedure, the surgeon will use an electrosurgical wire loop to remove the uterus lining.
3) Dilation and Curettage (D&C): In a D&C, the cervix is dilated, and special instruments are used to scrape away the uterine lining. A D&C can also be used to diagnose abnormal uterine bleeding. It is usually done under local anesthesia in the out-patients. However, this treatment is often only a temporary solution to heavy bleeding.
4) Myomectomy: Fibroids, which are the common cause of heavy bleeding, get resolved by removing the fibroids by a myomectomy procedure.
5) Hysterectomy: This is a commonly performed surgical procedure to end heavy bleeding. It is the only treatment that guarantees that bleeding will stop. It is a radical surgery that removes the uterus. A lengthy recovery period of about four to six weeks may be required for some women. Fatigue associated with this procedure can last much longer.
The types of menstrual disorders are:
- Premenstrual Syndrome (PMS).
- Premenstrual dysphoric disorder (PMDD).
- Abnormal uterine bleeding.
- Oligomenorrhea (light or infrequent bleeding).
- Amenorrhea (no menstrual bleeding).
- Dysmenorrhea (painful cramps).
- Menorrhagia (heavy bleeding).
- Metrorrhagia (bleeding in between the two periods).
The cause for menstrual disorders are:
- Hormonal imbalances.
- Clotting irregularities.
- Certain medications.
Dysmenorrhea is a menstrual disorder that can be identified by painful menstruation. The pain will usually be seen in the lower abdomen or pelvis.
The side effects of not menstruating are loss of elastic support to tissues like skin, thickening of blood vessels, and weakening of bones.
Irregular period is when a girl does not get her period for more than 4 to 5 weeks. It is normal for the cycles to be irregular for the first two years after the girl starts to get her period. But if the periods do not get regular even after the initial two years, it is considered irregular. Young girls usually get irregular periods due to hormonal imbalances. For example, if thyroid hormone levels are too low or too high can cause irregularities with periods.
For most girls, the first menstrual period is when she is around 12 years of age. But it can also be at eight years. The first period at the age of 8 or below is considered the youngest age for a girl to start her period.
The health conditions related to menstruation are:
- Heart disease and stroke.
- Problems in getting pregnant.
The common symptoms of the menstrual disorder may include:
- Abnormal menstrual bleeding.
- Pain or cramping.
- Emotional distress
- Bloating or fullness in the abdomen.
The diagnostic methods for detecting menstrual disorders are:
- Physical pelvic examination.
- Pap smear test.
- A blood test or urine test is done to rule out pregnancy.
- Endometrial biopsy.
- Hysteroscopy (small camera inserted into the uterus to find out any abnormalities).
An average period can last for about 2 to 7 days, but it is usually only 3 to 5 days for most women with a regular menstrual cycle.
The three signs that your daughter will get her period are:
- The development of her breast buds.
- Growth of the pubic hair.
- Vaginal discharge (2 to 3 years before the first period).
Last reviewed at:
10 Jun 2021 - 5 min read
Query: Hi doctor,I am sexually active with one partner only. I am not well for the last 4 months. I am having bad backache and a smelly, white thick sometimes brown color vaginal discharge, lower abdomen pain and vaginal pain while urination. I have consulted my gynecologist and took proper medicine. Now a... Read Full »
Article Overview: Abdominal pain during periods is a very common issue affecting women.Adhering to a healthy lifestyle i.e balanced diet, physical activity,mental relaxation etc improves the ability to cope with pain.Pain killers can be taken as advised by your gynaecologist. Read Article
Abdominal Pain: Abdominal pain during periods is a very common issue affecting 40-70% of women in the reproductive age group. In medical terms we call this as dysmenorrhoea. This is associated with significant psychological, physical, behavioral and social distress. Usually it starts at the onset... Read Article
Most Popular Articles
Do you have a question on Intermenstrual Bleeding or Abnormal Uterine Bleeding?Ask a Doctor Online