Having problems that affect your normal menstrual cycle? This could mean you may have a menstrual disorder. And what does normal even mean when it comes to your menstrual cycle? We’ll define what typical menstruation is, different menstrual disorders, and what you can do to manage your cycle.

What’s menstruation?

The menstrual cycle is a process that helps make pregnancy possible. It’s split into three phases in which hormonal changes occur. During the follicular phase, your body prepares for egg implantation. The egg is released when you ovulate, this is usually around day 14 of your cycle. In the luteal phase, also known as the premenstrual phase, your body stimulates a blanket of blood vessels to prepare for egg implantation. Menstruation occurs in women between puberty and menopause. On average, a menstrual cycle lasts 28 days. The typical range of a full menstrual cycle is about 21 to 35 days. Most women bleed 3-5 days, but the normal bleeding range is 2-7 days. Risk factors that may lead to menstrual disorders include:

• Age you begin to menstruate (higher risk at age 11 or younger)
• Weight
• Cycle and flow (if you have more pain with longer and heavier periods)
• Pregnancy history
• Smoking (may cause heavy bleeding)
• Stress
• Exercise
• Changes to your routine

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Types of menstrual disorders

Hormonal imbalances, genetics, clotting disorders, or pelvic diseases can trigger menstrual disorders. There are different symptoms for various menstrual disorders. These symptoms can be physical and emotional. Common symptoms include:

• Abnormal bleeding
• Pain
• Depression
• Headaches
• Emotional distress
• Bloating or fullness in the abdomen

Menstrual disorders include:

• Amenorrhea: You might have amenorrhea if you don’t get your period for 90 days unless you’re pregnant, breastfeeding, or going through menopause. If you haven’t started menstruating by age 15 or 16, or within three years of your breasts developing, you can also be diagnosed with amenorrhea. Amenorrhea might be due to hormonal irregularities, eating disorders, stress, or medical conditions like thyroid problems.
• Oligomenorrhea and Hypomenorrhea: Infrequent menstruation (when your period doesn’t happen every month) may be a sign of a menstrual disorder. With hypomenorrhea, the amount of blood is abnormally low when menstruation occurs.
• Dysmenorrhea: When pain during your menstrual cycle is severe, you may be experiencing dysmenorrhea. Most women experience some discomfort during their menstrual cycle, such as cramps or bloating. Uterine muscle contractions caused by prostaglandins may lead to dysmenorrhea. Medical conditions like endometriosis or uterine fibroids may also cause dysmenorrhea.
• Heavy menstrual bleeding: Heavy bleeding occurs when levels of bleeding interfere with everyday activities. Usually this can present itself as not going to school or work because of how frequently you need to change a pad or tampon. Hormonal imbalances, fibroids, and thyroid problems can lead to this problem. There are several types of abnormal uterine bleeding, sometimes occurring at irregular intervals.
• Premenstrual Syndrome (PMS): About a week before you begin bleeding, you might experience symptoms such as bloating, headaches, and mood swings. These symptoms are associated with your menstrual cycle. If PMS symptoms are severe, you may be experiencing premenstrual dysphoric disorder (PMDD).

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Different menstrual disorders can lead to complications like anemia, osteoporosis, and infertility. Make sure to seek medical attention when you experience:

• Severe pain during or between periods
• Heavy menstrual bleeding, sometimes with large blood clots
• Abnormal or foul-smelling discharge
• Fever
• More than seven days of bleeding
• Bleeding or spotting between periods or after menopause
• Irregularities in your cycle after you’ve started having regular periods
• Nausea or vomiting during your period
• Toxic shock syndrome

Diagnosis and treatment of menstrual disorders

If your menstrual period doesn’t occur for one month, it doesn’t necessarily mean you’re dealing with a menstrual disorder. Circumstances in which you might naturally miss a period include pregnancy, breastfeeding, and perimenopause. Some disorders aren’t directly related to the menstrual cycle but can cause similar symptoms. So, how do you find out whether what you’re experiencing is a menstrual disorder? The diagnosis process often begins with a pelvic exam, sometimes including a pap smear. Blood tests help rule out conditions and get a more accurate diagnosis. Other diagnostic measures include imaging techniques like ultrasound and diagnostic procedures such as endometrial biopsy.

Your treatment plan will depend on the type of menstrual disorder you’re experiencing and its severity. Medication might include birth control pills to help regulate hormones or nonsteroidal anti-inflammatory drugs (NSAIDs) for pain management. Surgery might be necessary for more severe menstrual disorder cases. Ask your primary care provider to help find the right option for your situation.

You may be able to manage your menstrual disorder by making some lifestyle alterations. If you think you have a menstrual disorder or have already been diagnosed, speak to your primary care provider about your options. Reasons to look into the issue include having no period, experiencing severe pain, or bleeding heavily. Reduce your risk of irritation during menstruation by changing sanitary products every 4-6 hours. Eating a healthier diet, exercising, applying heat, and following proper menstrual hygiene can help with some conditions.

By keeping a menstrual diary, you may be able to get an earlier diagnosis and help manage your condition.