menstrual irregularities

For most women, a normal menstrual cycle ranges from 21 to 35 days. However, 14% to 25% of women have irregular menstrual cycles, meaning the cycles are shorter or longer than normal; are heavier or lighter than normal; or are experienced with other problems, like abdominal cramps. Irregular cycles can be ovulatory, meaning that ovulation occurs, or anovulatory, meaning ovulation does not occur.

The most common menstrual irregularities include:

Amenorrhea or absent menstrual periods: When a woman does not get her period by age 16, or when she stops getting her period for at least 3 months and is not pregnant.
Oligomenorrhea or infrequent menstrual periods: Periods that occur more than 35 days apart.

Menorrhagia or heavy menstrual periods: Also called excessive bleeding. Although anovulatory bleeding and menorrhagia are sometimes grouped together, they do not have the same cause and require different diagnostic testing.
Prolonged menstrual bleeding: Bleeding that exceeds 8 days in duration on a regular basis.
Dysmenorrhea : Painful periods that may include severe menstrual cramps.

Additional menstrual irregularities include:

Polymenorrhea : Frequent menstrual periods occurring less than 21 days apart
Irregular menstrual periods with a cycle-to-cycle variation of more than 20 days
Shortened menstrual bleeding of less than 2 days in duration
Intermenstrual bleeding: Episodes of bleeding that occur between periods, also known as spotting

References

American College of Obstetricians and Gynecologists (ACOG). (2012). FAQ: Abnormal uterine bleeding. Retrieved on May 24, 2016, from http://www.acog.org/Patients/FAQs/Abnormal-Uterine-Bleeding (PDF 464 KB)
Whitaker, L., & Critchley, H. O. D. (2016). Abnormal uterine bleeding. Best Practice & Research Clinical Obstetrics & Gynaecology, 34, 54–65. Retrieved June 23, 2016, from http://www.sciencedirect.com/science/article/pii/S1521693415002266
Sweet, M. G., Schmidt-Dalton, T. A., Weiss, P. M., & Madsen, K. P. (2012). Evaluation and management of abnormal uterine bleeding in premenopausal women. American Family Physician, 85, 35–43.
Munro, M. G., Critchley, H. O., & Fraser, I. S. (2012). The FIGO systems for nomenclature and classification of causes of abnormal uterine bleeding in the reproductive years: Who needs them? American Journal of Obstetrics and Gynecology, 207(4), 259–265.
Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician, 73, 1374–1382.
Practice Committee of the American Society for Reproductive Medicine. (2008). Current evaluation of amenorrhea. Fertility and Sterility, 90, S219–S225. doi:10.1016/j.fertnstert.2008.08.038.
Apgar, B. S., Kaufman, A. H., George-Nwogu, U., & Kittendorf, A. (2007). Treatment of menorrhagia. American Family Physician, 75, 1813–1819.
French, L. (2005). Dysmenorrhea. American Family Physician, 71, 285–291.

What can I do about period pain?

To help ease your period pain, you can try:

Using a heating pad or hot water bottle on your lower abdomen
Getting some exercise
Taking a hot bath
Doing relaxation techniques, including yoga and meditation

You might also try taking over-the-counter pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs include ibuprofen and naproxen. Besides relieving pain, NSAIDs reduce the amount of prostaglandins that your uterus makes and lessen their effects. This helps to lessen the cramps. You can take NSAIDs when you first have symptoms, or when your period starts. You can keep taking them for a few days. You should not take NSAIDS if you have ulcers or other stomach problems, bleeding problems, or liver disease. You should also not take them if you are allergic to aspirin. Always check with your health care provider if you are not sure whether or not you should take NSAIDs.

It may also help to get enough rest and avoid using alcohol and tobacco.

When should I get medical help for my period pain?

For many women, some pain during your period is normal. However, you should contact your health care provider if:

NSAIDs and self-care measures don’t help, and the pain interferes with your life
Your cramps suddenly get worse
You are over 25 and you get severe cramps for the first time
You have a fever with your period pain
You have the pain even when you are not getting your period

How is the cause of severe period pain diagnosed?

To diagnose severe period pain, your health care provider will ask you about your medical history and do a pelvic exam. You may also have an ultrasound or other imaging test. If your health care provider thinks you have secondary dysmenorrhea, you might have laparoscopy. It is a surgery that that lets your health care provider look inside your body.

What are treatments for severe period pain?

If your period pain is primary dysmenorrhea and you need medical treatment, your health care provider might suggest using hormonal birth control, such as the pill, patch, ring, or IUD. Another treatment option might be prescription pain relievers.

If you have secondary dysmenorrhea, your treatment depends upon the condition that is causing the problem. In some cases, you may need surgery.