Common menstrual disorders how to manage them

Common menstrual disorders

• Primary dysmenorrhea
  
• Secondary dysmenorrhea
  
• Heavy menstrual bleeding (menorrhagia)
  
• Oligomenorrhea
  
• Amenorrhea
  
• Polymenorrhea
  
• Anovulatory cycles
  
• Premenstrual syndrome (PMS)
  
• Premenstrual dysphoric disorder (PMDD)
  
• Endometriosis
  
• Adenomyosis
  
• Uterine fibroids
  
• Bleeding disorders
  
• Perimenopausal changes
  

When pain is the main sign

• Clinicians may suggest an anti-inflammatory tablet (e.g., ibuprofen or mefenamic acid) 12–24 hours before the expected period and for 48–72 hours, because early blocking reduces cramp severity; therefore fewer rescue doses are needed.
  
• These drugs may be avoided with stomach ulcers, kidney disease, or certain heart risks, because side-effects can outweigh benefits; so alternatives are discussed.
  
• Local heat for about 20 minutes may help, because warmth relaxes muscle; therefore pain can drop without extra tablets.
  
• Regular activity across the month may be encouraged, because it lowers baseline inflammation; so cramps often ease over time.
  

• Doctors may recommend continuous combined pills (without the placebo break), because fewer bleeds mean fewer prostaglandin spikes; so pain episodes reduce.
  
• Doctors may suggest progestin-only options (pill, injection, implant) or a levonorgestrel intrauterine device (LNG-IUD), because steady local progesterone thins the lining; therefore both pain and flow fall.
  
• But when pregnancy is a current goal, suppression may be modified, so pain control does not block ovulation.
  

When bleeding is the main sign

• Iron tablets providing about 60–120 mg elemental iron daily may be advised, because this dose rebuilds stores; therefore tiredness improves; but tea or coffee near the dose lowers absorption, so doctors often suggest spacing them by one to two hours.
  
• During heavy days, tranexamic acid may be prescribed, because it helps clots stay on the uterine lining; therefore blood loss drops; but it is used with caution in people at high clot risk, so history is reviewed first.
  
• Anti-inflammatory tablets may also reduce flow, because they lower prostaglandins that dilate vessels; therefore pad changes can be less frequent.
  

• Combined pills, progestin-only methods, or an LNG-IUD may be recommended, because they thin the lining; therefore bleeding often falls within one to two cycles; but light spotting can occur early, so expectations are set.
  

When timing is the main sign

• A pregnancy test is typically done early, because it redirects the plan immediately; therefore unnecessary tests are avoided.
  
• Thyroid (TSH) and prolactin tests may be ordered, because thyroid imbalance and high prolactin delay ovulation; so correcting them often restores cycles.
  
• If PCOS is suspected, androgen testing may be considered, because higher male-type hormones disturb ovulation; therefore insulin-focused strategies help.
  

• Protein- and fibre-forward meals plus resistance training two to three times weekly may be encouraged, because they improve insulin sensitivity; so ovulation becomes more regular.
  
• For regulation, combined pills or cyclic progesterone may be offered, because they create predictable bleeds and protect the lining; therefore timing becomes easier to track.
  
• Metformin may suit some PCOS patterns, because it improves insulin action; but it is not universal, so selection is individualized.
  
• Therefore, if absence of periods persists, evaluation is escalated in order to protect bone health and future fertility.
  

When symptoms arrive before each period

• A two-cycle symptom diary may be suggested, because it confirms the late-cycle pattern; therefore therapy can be timed precisely.
  
• Regular sleep, steady exercise, and limiting alcohol may reduce peaks, because they stabilise brain and hormone rhythms; so day-to-day function improves.
  
• For PMDD, SSRIs may be recommended daily or only in late-cycle days, because they raise serotonin signalling; therefore mood and irritability often improve within one to two cycles; but dosing is individual, so follow-up is planned.
  
• Some combined pills containing drospirenone may help when contraception is desired, because steadier hormone levels reduce symptom swings; therefore many feel better.
  
• Calcium 1,200 mg/day may offer modest benefit for some, because calcium influences muscle and nerve symptoms; so it is sometimes added.
  

Life-stage notes that change choices

• Adolescents: Irregular cycles in the first one to two years after the first period occur because ovulation is still maturing; therefore watchful guidance is common; but very heavy first periods or a family history of easy bruising may indicate a bleeding disorder, so early testing is considered.
  
• Reproductive years: Options that also provide contraception (combined pills or LNG-IUD) may address symptoms and family planning together, because one treatment solves two needs; therefore adherence improves.
  
• After 35 / after childbirth: Adenomyosis and fibroids are more common; therefore ultrasound-guided plans are frequent; but future fertility still matters, so uterus-sparing choices are prioritised when possible.
  
• Perimenopause: Timing and flow vary; so protecting the lining and preventing anemia become priorities; because hot flashes and sleep issues add burden, supportive care is often included.
  

Tests that guide next steps and what each one means

• Pregnancy test: changes the entire plan, because pregnancy alters causes and treatments; therefore it comes first.
  
• Complete blood count (CBC) and ferritin: show anemia and iron stores; because ferritin reflects reserves, low values therefore justify iron repletion even with “normal” hemoglobin.
  
• TSH and prolactin: detect hormonal causes of timing changes; so correction can restore ovulation.
  
• Pelvic ultrasound: identifies fibroids and features of adenomyosis and assesses the uterine lining when bleeding is heavy or pain persists; therefore procedures or devices can be targeted.
  
• Diagnostic laparoscopy: keyhole surgery may be considered when endometriosis remains likely after medical therapy or when fertility planning needs confirmation; because direct visualization is definitive, therefore it is reserved for select cases.
  

A treatment ladder that matches goals

1. Non-hormonal first steps (useful when avoiding hormones or planning pregnancy soon)
   

• Pre-emptive anti-inflammatory tablets may be suggested, because early prostaglandin blocking lowers pain; therefore fewer rescue doses are needed.
  
• Tranexamic acid may be prescribed on heavy days, because it stabilises clots on the uterine surface; so blood loss falls.
  
• Iron repletion may be started if levels are low, because restoring stores improves energy; therefore daily function returns.
  
• Heat therapy and regular exercise may support symptom control, because they relax muscle and reduce inflammation; so comfort improves.
  

1. Hormonal steps (when cycle control or contraception is wanted)
   

• Combined pills (cyclic or continuous), progestin-only methods, or an LNG-IUD may be recommended, because steady hormones thin the lining and blunt prostaglandin surges; therefore pain and bleeding fall; but early spotting can occur, so follow-up is planned.
  

1. Procedures (when a structural cause drives symptoms)
   

• Hysteroscopic removal for fibroids that bulge into the cavity, myomectomy when indicated, or LNG-IUD for adenomyosis may be advised, because targeted treatment removes or suppresses the source; therefore symptoms can improve quickly.
  

Red flags that need prompt review

• Bleeding that soaks pads or tampons hourly for 4–6 hours, because this suggests significant blood loss; therefore same-week assessment is appropriate.
  
• Severe or worsening pain, pain with deep intercourse, or bowel/bladder bleeding during periods, because these raise concern for endometriosis, adenomyosis, or infection; so timely evaluation is important.
  
• No periods for three months when not pregnant, because long gaps can harm bone and hide endocrine issues; therefore escalation is reasonable.
  
• Bleeding between periods or after intercourse, because cervical or uterine causes need exclusion; so examination is arranged.
  
• Fever, foul-smelling discharge, or pelvic tenderness, because infection is possible; therefore urgent care is considered.
  

A simple monthly tracker that shows progress

Bottom line