Menstrual Problems: Causes
Girls normally start having menstrual periods when they are 13-14 years of age, but this can vary widely. A typical menstrual cycle lasts 28 days, but regular cycles between 21 and 35 days are all considered normal. Menopause occurs when women stop having menstrual periods, usually in their late forties or early fifties.
Absence of periods (clinical term: amenorrhea)
Doctors talk about primary amenorrhea when a menstruation has not occurred by the age of 16. Amongst the causes to exclude are an abnormal anatomy of the uterus, cervix or vagina, delayed puberty, excessive exercise, eating disorders and hormonal inbalance.
Doctors use the term secondary amenorrhea when menstruations have occurred in the past but have now stopped for at least 6 months. When this happens in a woman's late forties this may indicate the onset of menopause. If it happens earlier other causes should be excluded such as polycystic ovarian syndrome, a chronic illness, a hormone imbalance, medicines to treat psychiatric illness, cancer drugs, abnormal thyroid function or early depletion of the egg reserve.
Infrequent periods (clinical term: oligomenorrhea)
The length of the cycle can vary quite a bit. Some women have regular menstrual cycles of 21 days and others have longer cycles up to 35 days. Menstrual cycles longer than 35 days are too long. When that happens a concern is that ovulation doesn't happen frequently enough. Another concern in women with very long cycles (2 -3 months) is that there is an increased long-term risk of cancer of the uterus. Polycystic ovarian syndrome is a common but not the only cause of irregular periods.
Menstrual cramps or period pains (clinical term: dysmenorrhea)
Menstrual cramps are painful sensations in the lower abdomen that can occur both before and during a woman's menstrual period. The severity of the pain can range from a vague discomfort to severe pain which makes it hard to continue normal activities.
Usually menstrual cramps have no obvious underlying cause even when they are severe. Sometimes a cause can be identified such as the presence of endometriosis, fibroids, endometrial polyps or infection.
Heavy menstrual periods (clinical term: menorrhagia)
Before menopause many women report heavy menstrual bleeding. With menorrhagia though, every menstrual bleed causes enough blood loss and cramping to interfere with normal activities. Often no obvious cause can be identified, but endometriosis, fibroids, endometrial polyps, infection, cancer, certain medications, bleeding disorders and PCOS are examples of medical conditions that can cause menorrhagia.