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Menstrual Disorders

The menstrual cycle is the weeks-long, hormone-driven process during which a woman’s body readies for pregnancy. No two menstrual cycles are identical. Some women experience irregular and painful periods, heavier periods, menstrual cramps, or bleeding between periods. Collectively, these are known as menstrual disorders. Irregular and painful periods and other menstrual disorders can affect women’s health in a variety of ways, including contributing to anxiety and depression, fatigue, and bowel problems.

The menstrual cycle lasts an average of 28 days. During that time, the body goes through several days of menstrual bleeding (also known as a period), followed by a rise in levels of the hormones estrogen and progesterone, thickening of the lining of the uterus and release of an egg from the ovary (ovulation). If no pregnancy occurs, hormone levels fall, and the uterine lining is discarded during bleeding. That starts a new cycle.

  • Types

    • Heavy menstrual periods. This is excessive menstrual bleeding or bleeding that lasts longer than one week. Heavy period causes include problems with the uterus or a bleeding disorder, such as von Willebrand disease.
    • Irregular menstruation. This includes going longer than 35 days between periods or periods that are absent for three or more months, despite not being pregnant.
    • Painful periods. This is a common menstrual disorder that causes intense abdominal cramps.
    • Premenstrual syndrome (PMS). A collection of symptoms that can occur between ovulation and the start of a new period, PMS may include breast tenderness, bloating, abdominal cramps, constipation, headache, fatigue, irritability, food cravings and difficulty sleeping.
    • Premenstrual dysphoric disorder (PMDD). PMDD can cause many of the same symptoms as PMS, but they’re typically worse.
  • Symptoms

    Different menstrual disorders cause different symptoms, but common symptoms include:

    • Abdominal cramps
    • Anxiety
    • Bloating
    • Constipation
    • Depression
    • Difficulty concentrating
    • Fatigue
    • Food cravings
    • Headache
    • Heavy or prolonged menstrual bleeding
    • Irritability
    • Mood changes
    • Painful or irregular periods
    • Sleep problems
  • Prevention

    • It’s not always possible to prevent irregular and painful periods, but you may be able to reduce your risk or ease the effects of symptoms by eating healthy. Two weeks before your period starts, avoid caffeine, salt and sugar as much as possible, which may help reduce PMS symptoms.
    • Other steps you can take include exercising regularly (but avoid overexercising), setting a sleep schedule and getting seven to eight hours of sleep each night, and managing stress. 
  • Risk Factors

    • Anorexia
    • Bleeding disorders
    • Bulimia
    • Certain forms of birth control
    • Certain medications
    • Endometrial polyps
    • Endometriosis
    • Miscarriage
    • Overexercising
    • Perimenopause
    • Polycystic ovary syndrome
    • Poorly managed diabetes
    • Primary ovarian insufficiency
    • Thyroid dysfunction
    • Uterine fibroids
  • Diagnosis

    • Medical history and physical exam. Your physician will ask about your medical history, especially any chronic conditions you may have, and any symptoms you’ve experienced. He or she will also conduct a standard physical exam.
    • Blood tests. Your physician may order these tests to check the levels of certain hormones or rule out other causes of symptoms, such as anemia.
    • Imaging tests. Different types of ultrasound allow your physician to determine whether uterine fibroids or another abnormality of the pelvic organs could be causing symptoms.
    • Endometrial biopsy. Taking a sample of the lining of the uterus can reveal whether endometriosis or another condition is present.
    • Hysteroscopy. During this procedure, your physician will use a scope to examine the lining of the uterus.
  • Treatment

    The treatment your physician prescribes depends on your diagnosis.

    • Lifestyle changes, such as exercising, following a healthy diet and getting enough sleep, may help with PMS and PMDD. Over-the-counter pain relievers and prescription birth control pills can ease physical symptoms. Antidepressants may reduce mental health symptoms.
    • Birth control pills and nonsteroidal anti-inflammatory medications (NSAIDs) can provide relief from painful periods. NSAIDs can also help with heavy menstrual periods, as can the use of an intrauterine device.
    • If you don’t receive relief from irregular or heavy periods using conservative treatments, your physician may recommend [gynecologic surgery]. Depending on your diagnosis, you may need to undergo a procedure to remove or block blood flow to uterine fibroids, take out the uterine lining without incisions, or remove the uterus, which is known as hysterectomy.  
  • Follow-up Care

    • Follow your physician’s treatment instructions carefully and take any medications as directed. Be sure to make recommended lifestyle changes to complement medical therapy.
    • Keep all follow-up appointments with your physician.
    • Notify your physician promptly if you experience any new or more severe symptoms.