Menstrual Problems

Menorrhagia and dysmenorrhea

Do you experience heavy period bleeding to the point that it affects even your normal daily activities? Or cramps that are so severe that even painkillers do not help? Menstruation is a woman’s constant companion but it is also often something viewed with dread as the time of the month approaches. Every individual has a different menstruation process and experience, with various degree of discomfort or problems during menstruation. Here’s how you can spot and better manage menstrual disorders such as menorrhagia and dysmenorrhea.


What is menorrhagia?

Menorrhagia refers to the condition where there is an abnormally heavy and prolonged bleeding during your menstrual periods. On average, blood loss during the menstruation cycle is around 30-40 millilitres. An individual with menorrhagia may suffer over 80 millilitres of blood loss, or twice the amount one normally has, resulting in the need to change tampons or sanitary pads almost every hour. Other symptoms include constant lower abdominal and pelvic pain, large blood clots during discharge as well as dizziness, fatigue and shortness of breath due to anaemia.

Causes of various types of menorrhagia

Oestrogen and progesterone are hormones produced to regulate the build-up of endometrium (the lining of the uterus). Menorrhagia occurs when there is an imbalance of these hormone levels causing excessive growth or abnormal growth of the endometrium. This results in heavy blood flow due to the shedding of this lining.

Other underlying causes of menorrhagia also include:

  • Anovulation (when ovulation does not take place)
  • Uterine fibroids
  • Uterine polyps
  • Use of non-hormonal Intrauterine Device (IUD)
  • Endometrial cancer
  • Miscarriage or ectopic pregnancy
  • Pelvic infection
  • Genetic bleeding problems
  • Thyroid disease
  • Liver or kidney diseases
  • Use of blood-thinning medications

Treatment options for menorrhagia

Intervention for menorrhagia depends on the individual’s age, cause and extent of the underlying medical condition. Treatment may vary from iron supplements, medication, surgical intervention as well as radiological or hormonal treatment. It is important to discuss any concerns about heavy bleeding with a gynaecologist to get the appropriate assessments and diagnosis.


What is dysmenorrhea?

Dysmenorrhea is the medical term that refers to period or menstrual cramps. There are two types of dysmenorrhea – primary and secondary.

Primary dysmenorrhea are normal menstrual cramps that begin during the teenage phase and are recurrent and not due to any underlying diseases. Symptoms of primary dysmenorrhea may vary from mild to severe lower abdominal cramps, dizziness, nausea, vomiting, fatigue and/ or even diarrhoea. Most women experience these symptoms one to two days before or at the start of the menstrual period.

Secondary dysmenorrhea is when a woman notices menstrual cramps when previously she was relatively pain free during her periods. This is often caused by pelvic infection or a disorder in the female reproductive organs. Pain from secondary dysmenorrhea usually begins earlier and last longer than normal menstrual cramps. It may even come on at the end of the period or just after the period. It may be associated with deep pelvic pain, severe backache or tenesmus (pain when) trying to defecate.

Causes of dysmenorrhea

During menstruation, your body produces a substance called prostaglandin which causes your uterus to contract. Primary dysmenorrhea occurs when your body produces a higher-than-normal amount of prostaglandin.

Secondary dysmenorrhea occurs when there are underlying conditions such as:

Other factors contributing to dysmenorrhea may include:

  • Family history of dysmenorrhea
  • Long menstrual periods
  • Early onset of puberty
  • Smoking
  • Stress

Treatment options of dysmenorrhea

Fortunately, treatment for primary dysmenorrhea mainly consist of medication and lifestyle changes. Simple NSAIDs or antispasmodics medication, oral contraceptives, hot baths or heating pads, exercise, plenty of rest and fluids, massage or acupuncture can help relieve some of the pain.

Other lifestyle changes to aid in reducing cramps are:

  • Avoiding cold beverages
  • Adopting a diet rich in complex carbohydrates (e.g. whole grains, fruits)
  • Taking supplements containing vitamin B6, calcium or magnesium
  • Maintaining a healthy weight and exercising regularly

Secondary dysmenorrhea requires a more in-depth treatment that targets the underlying cause and needs gynaecological advice. Do seek consultation from a gynaecologist if the pain is persistent and occurs at times outside of your menstruation period.

It is important to consult a gynaecologist to check for any underlying conditions. Taking active steps to recognise menstrual problems and receive proper treatment are keys to minimise the effects. With a wide range of medication and surgical options, let your monthly companionship be the least of your worries.

Contributed by: Dr Sheila Loh Kia Ee, Obstetrician and Gynaecologist and Reproductive Medicine Specialist.

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