Menstrual disorders
Menstrual disorders are changes in the timing, amount or pain of periods that are outside the usual pattern. They include irregular periods, heavy bleeding, painful periods and missed periods. At EVE Women and Fertility Clinic in Gunjur, Bangalore, Dr. Swati Shree finds the cause using the FIGO PALM-COEIN framework, treats it, and helps you avoid complications such as anaemia.
At a glance
- Typical cycle
about 21 to 35 days in adults, with bleeding for up to 8 days
- Heavy bleeding signs
soaking a pad every 1 to 2 hours, clots larger than a coin, periods that interfere with work or sleep, tiredness or breathlessness from anaemia
- Common causes
PCOS, thyroid disorders, fibroids, polyps, adenomyosis, hormone imbalance, bleeding disorders, medicines, pregnancy
- Tests
pregnancy test, blood count, thyroid, ultrasound, others as indicated
- Treatments
medicine, hormonal IUD, procedures, or surgery, matched to the cause
- Missed periods
need a pregnancy test first
Types of menstrual disorder
| Problem | What it means |
|---|---|
| Irregular periods | Cycles that vary widely in length, or come less than 21 or more than 35 days apart |
| Heavy menstrual bleeding | Bleeding that interferes with daily life, often over 80 mL a month |
| Painful periods (dysmenorrhoea) | Severe cramps that limit activity |
| Missed periods (amenorrhoea) | No periods for 3 months or more, after pregnancy is excluded |
| Bleeding between periods or after sex | Needs examination to find the cause |
| Premenstrual symptoms | Severe mood or physical symptoms before periods |
Causes (PALM-COEIN)
Doctors use the FIGO PALM-COEIN system. PALM are structural causes: Polyps, Adenomyosis, Leiomyoma (fibroids) and Malignancy or hyperplasia. COEIN are non-structural causes: Coagulopathy (bleeding disorders), Ovulatory dysfunction, Endometrial causes, Iatrogenic (medicine-related) and Not otherwise classified. This framework helps find a cause, rather than treating the symptom alone.
What happens at EVE
History
Dr. Swati asks about your cycle length, flow, pain, clots, medicines and family history.
Examination
A general and, if needed, pelvic examination.
Tests
Pregnancy test, a blood count for anaemia, thyroid and prolactin, and a pelvic ultrasound. Further tests such as a biopsy are used when indicated.
Treatment
Options include non-hormonal medicine to reduce bleeding and pain, hormonal pills, a hormonal IUD, treatment of the underlying condition, and procedures or surgery for polyps, fibroids and adenomyosis.
Follow-up
A review after a few cycles shows if the plan is working.
Heavy bleeding and anaemia
Heavy periods are a common cause of iron-deficiency anaemia in Indian women, causing tiredness, breathlessness, dizziness, hair loss and poor concentration. Dr. Swati checks haemoglobin and iron, and treats the anaemia as well as the bleeding.
When to see a doctor
- Periods that are very heavy, last over 8 days, or cause tiredness or dizziness
- No periods for 3 months, and you are not pregnant
- Bleeding after sex, between periods or after menopause
- Severe pain with periods that is new or getting worse
When to get help straight away. Heavy bleeding that soaks a pad every hour for several hours, bleeding with dizziness or fainting, or bleeding with severe pain in a woman who might be pregnant needs emergency care. Call 108 or 112.
FAQs
What is a normal period?
In adults, cycles usually come every 21 to 35 days, and last up to 8 days, with a flow that does not stop you from living normally. Cycles vary a little each month. Teenagers can have longer, more irregular cycles in the first two years.
Why are my periods irregular?
Common causes are PCOS, thyroid problems, high prolactin, stress, weight change, intense exercise, breastfeeding and approaching menopause. Pregnancy should always be ruled out. A history, a scan and a few blood tests usually find the cause.
How do I know if my bleeding is too heavy?
Heavy bleeding means soaking through a pad every hour or two, passing large clots, bleeding that lasts over 8 days, or feeling tired, dizzy or breathless. If periods affect work or sleep, or you may be anaemic, see a doctor.
Can heavy periods be treated without surgery?
Often, yes. Non-hormonal tablets that reduce bleeding, hormonal pills and a hormonal IUD are effective for many women. Treatment depends on the cause. Fibroids, polyps and adenomyosis may need procedures. Dr. Swati explains all options.
Does an irregular cycle affect fertility?
Yes, if it means you ovulate irregularly or not at all. Irregular periods are a common sign of PCOS or thyroid problems, both treatable. A fertility evaluation and follicular monitoring show whether you ovulate and when.
I missed my period. Should I worry?
First do a pregnancy test. If it is negative and you miss three periods in a row, or are late repeatedly, see a doctor. Causes include stress, weight change, PCOS, thyroid problems and early menopause. They are usually treatable.
Sources
- FIGO classification of causes of abnormal uterine bleeding in the reproductive years (PALM-COEIN)
- NICE Guideline NG88: Heavy menstrual bleeding: assessment and management
- ACOG Committee Opinion: Menstruation in girls and adolescents
