Menstrual Problems

Four Common Menstrual Problems

Menstrual problems are disorders that affect a woman’s normal menstrual cycle. Ranging from severe bleeding to skipped periods, these conditions are often accompanied with symptoms that sometimes interfere with a woman’s daily life. As one of the most common reasons why women visit their gynecologists, menstrual problems can pose serious consequences if not addressed, such as female infertility.

What’s a Normal Menstrual Period?

A menstrual cycle refers to a series of monthly changes a woman experiences as her body prepares for a possible pregnancy. In a normal menstrual cycle, one of the ovaries releases a mature egg, which will travel down the fallopian tube and into the uterus for fertilization. At the same time, hormones cause the uterine lining (endometrium) to thicken in order for the fertilized egg to be implanted into the womb. If fertilization does not occur, the uterine lining is shed and expelled from the body through the process of menstruation.

The menstrual cycle, which is counted from the first day of the period up to the first day of the next period, varies from woman to woman. On average, a period occurs every 21 to 35 days and lasts 2 to 7 days. However, it is common and normal for a woman to have shorter or longer cycles. Any major changes in the frequency, amount of blood flow, and symptoms of a period may indicate menstrual problems which need to be resolved immediately.

4 Common Menstrual Problems & Symptoms

Many women will experience menstrual problems at some point in their lives, the most common of which are:


This is an umbrella term for a range of physical and emotional symptoms that a woman experiences before her period. Symptoms in varying intensities include bloating, mood swings, anxiety, headaches, breast tenderness, fatigue and depression. These usually begin one week before the period and go away once it starts. While the exact cause of PMS remains unknown, the condition is often attributed to cyclical hormonal fluctuations.


This condition refers to menstrual bleeding that is so heavy that it interferes with the woman’s normal activities. With menorrhagia, periods may last for more than 7 days, and the woman may soak through tampons or sanitary pads every hour for several consecutive hours. Untreated, it can lead to anemia, shortness of breath, fatigue and pain. Menorrhagia is said to be caused by hormonal imbalance, fibroids, cancer and other medical conditions.


The opposite of menorrhagia, amenorrhea is the condition where either a woman hasn’t had her first period by 16 years old, or a woman’s period abruptly stops for three months or longer. It is normal for a woman to have amenorrhea, however, before puberty, during pregnancy and after menopause. Causes include hormonal imbalance, premature ovarian failure, polycystic ovary syndrome (PCOS) and genetic disorders. Some medications, particularly contraception, can also cause irregular or missed periods.


Typically caused by uterine contractions, dysmenorrhea refers to periods where the woman experiences persistent and severe cramps and back or abdominal pain. In more serious cases, symptoms include diarrhea, lightheadedness and fatigue. Dysmenorrhea may also be caused by stress, fibroids, endometriosis and pelvic inflammatory diseases.

Diagnosis of Menstrual Problems

Menstrual problems may be diagnosed by simply reviewing the symptoms experienced by the patient, followed with medical history assessment, physical and pelvic examinations, and imaging and laboratory tests such as blood tests, ultrasound and transvaginal ultrasonography. In some cases, the patient may be asked to start a menstrual cycle diary to better track the timing, severity, trigger and duration of the symptoms, which the doctor can use to make an accurate diagnosis and treatment plan.

Treatment of Menstrual Problems

Menstrual problems, especially PMS and dysmennorhea, are usually experienced a week before the period and go away once it starts or finishes. Most symptoms may be managed by stress management, diet and lifestyle adjustments, home remedies and over-the-counter medicines.

The cessation of menstruation, known as menopause, will require special menopause treatment.

Depending on the cause, severe menorrhagia may be treated with surgical procedures such as dilation and curettage (D&C), uterine artery embolization, ultrasound surgery, endometrial ablation or resection, and hysterectomy.

Amenorrhea is addressed using birth control pills and estrogen replacement therapy. If cysts, fibroids or tumors are causing delayed or missed periods, a combination of medical and surgical procedures may be performed to shrink, destroy or remove these abnormalities from the body to facilitate normal menstrual flow.

Dr Ann Tan is a dedicated gynaecologist and obstetrician known for her expertise and commitment to women’s healthcare. She is also an experienced fertility doctor in Singapore who helps couples with conception so that they may achieve their dreams of having a complete family.

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