The topic of menstrual disorders (hereafter abbreviated MD) is one I have wanted to write about for many years and many reasons, some of them very personal:
- MD are common and have been around since the dawn of time.
- MD are life altering and disruptive to normal functioning.
- MD are changeable, but many girls/women don’t know this and continue to suffer.
- Many healthcare providers are unaware of all that can be done to help MD.
- The root causes of MD, left unresolved, can be the precursor to other problems.
- MD have plagued me for the majority of my life.
First let’s define the topic. MD include a host of issues with all kinds of intimidating names and symptoms such as:
- Amenorrhea – the absence of menstruation
- Dysmenorrhea (primary and secondary) – frequent, severe cramping and pain
- Hypermenorrhea or Menorrhagia – heavy, prolonged bleeding
- Hypomenorrhea – light menstruation
- Oligomenorrhea – infrequent menstruation
- Polymenorrhea – periods at intervals of less than 21 days
- Precocious puberty – beginning to have periods at age 7 or younger
- Premenstrual Syndrome (PMS) – a host of physical and emotional/mental symptoms
Let’s unpack each of these, beginning with amenorrhea. This is the absence of menstruation, which is pretty straightforward and clear (I’ll address the “why’s” in a future post). But many of the other MD definitions beg further clarification. What is considered frequent and severe cramping? What is heavy bleeding versus light? I’ll try to tackle all this below.
Dysmenorrhea – the presence of frequent, severe cramping and pain – is one that merits more discussion. Some would limit this definition to cramps only during menstruation. My perspective is that cramping can occur outside of menstruation, and may still signal a MD. I would also suggest that the pain may not just be cramping in the abdominal region, but can also be lower back pain. What is considered frequent and severe? Good question, and one that is not readily answered. I have heard many females speak of seeking help due to severe menstrual pain, only to have it dismissed by a provider (often but not always male) as normal. Truth is, setting a standard for a “normal amount of pain” is practically impossible, even if you resort to a pain scale. That’s because pain is such a multifaceted and personal event, completely subject to the perception of the person experiencing it. One person’s 8/10 pain may be 2/10 to another. That doesn’t mean they’re a wimp. It just means they perceive it differently. I make it a practice to try to never dismiss someone’s problem just because it’s not my reality.
So here’s what I propose be considered abnormally frequent and severe:
- Pain that is present throughout the majority of the day, and continues for more than 2-3 days.
- Pain that requires frequent, repeated, and high doses of medication.
- Pain that incapacitates the sufferer, causing her to modify or miss work, school, sports, social events, and even normal daily activities.
Certainly my definitions are not absolute, research driven, or above scrutiny. But they are based on my years of personal and professional experience. A one-time occurrence of any or all of these pain elements may not necessarily warrant action. But when they recur with regularity and ferocity it’s time to pay attention. To me this should never be considered “normal,” and should not be dismissed. Before moving on I’ll mention that dysmenorrhea can be categorized as primary or secondary. In the primary type there is no other potential source for the pain and it is attributed solely to the menstrual cycle. Secondary dysmenorrhea arises from a problem or infection in the reproductive organs.
Next let’s look at what is meant by heavy and prolonged bleeding, termed hypermenorrhea or menorrhagia. Most women will lose less than 16 teaspoons of blood (80ml) during their period, with the average being around 6 to 8 teaspoons. Heavy menstrual bleeding is defined as losing 80ml or more in each period. The Mayo Clinic website definition of heavy and prolonged bleeding is a bit easier to grasp:
- Soaking through one or more sanitary pads or tampons every hour for several consecutive hours
- Needing to use double sanitary protection to control your menstrual flow
- Needing to wake up to change sanitary protection during the night
- Bleeding for longer than a week
- Passing blood clots larger than a quarter
- Restricting daily activities due to heavy menstrual flow
- Symptoms of anemia, such as tiredness, fatigue or shortness of breath
Again, the presence of one or more of these without regularity does not necessarily signal MD. But their recurrence and intensity in any combination deserves scrutiny.
Hypomenorrhea or light menstruation is the polar opposite of menorrhagia. By default, it would involve lower than average blood loss of 6-8 teaspoons of blood per period. While this may seem desirable, it can signal a problem which we’ll look at later.
Oligomenorrhea is the tongue twister name for infrequent menstruation. There is variability in the menstrual cycle, which is counted from the first day of one period to the first day of the next. Menstrual flow normally occurs every 21 to 35 days and last 2-7 days. Environmental and personal factors can impact this, such as heavy exercise or the extreme stress as with a death or move. While there is certainly a range of normal, oligomenorrhea is defined as having fewer than 6-8 periods per year.
Polymenorrhea, or frequent menstruation, is the term describing the menstrual period as normal in terms of volume of blood flow, but occurring at intervals of less than 21 days.
Precocious Puberty is an interesting term for a girl (we could say child) who begins to have periods at or before age 7. The average age of onset is 12, but anytime between ages 8-15 is considered normal. For a girl who has not started by age 16, the diagnosis of amenorrhea is applied.
Lastly we come to premenstrual syndrome, or PMS. There is no shortage of PMS jokes, which serve as great comedy club material. PMS is a combination of symptoms that many women get about a week or two before their period, when ovulation typically occurs. Again, what is “normal” versus “abnormal” for PMS? That is impossible to quantify. According to the U.S. government Office on Women’s Health, over 90% of women report having PMS symptoms which can occur in any combination and intensity:
- Appetite changes or food intolerance
- Back pain
- Bloating, gas
- Breast tenderness and swelling
- Depression, feelings of sadness, or crying spells
- Difficulty concentrating or remembering
- Irritability or hostile behavior
- Mood swings
- Nausea and vomiting
- Sleep problems (sleeping too much or too little)
- Tension and/or anxiety
So what’s the point of all this? Kind of depressing if all we do is analyze, commiserate, and carry on. But that’s exactly why I’m writing this: I want to heighten awareness of all that can be done to address MD, and be part of the solution for millions of suffering girls and women everywhere. It’s my goal that maybe as you read this you will recognize your MD or someone else’s, realize there’s hope for change, and be empowered to pursue it.
“It’s my dream to reach a girl suffering with MD when she first manifests the problem, and potentially alter the trajectory of her health and well-being – maybe even her life story – by intervening early and appropriately.” Colleen Whiteford
I’ll share with you an even deeper dream of mine: to reach a girl suffering with MD when she first manifests the problem. It’s sad how often I listen to people’s past medical history – their story – and think to myself, “Gosh, I wish I’d seen you sooner.” And I’m typically thinking years earlier. On the topic of MD it often sounds like this: she’s seeking help for pelvic pain, urinary incontinence, low back pain, IBS, hip pain, dyspareunia (pain with intercourse), neck pain, knee pain, headaches, foot pain – there is no end to this list. As I dig and dig through their history looking for those old-is-gold problems (as discussed in linked post) I often hear about a young girl who currently has or in the past had MD. She suffered from it, struggled through it, and carried on in spite of it. She may have had difficulties with pregnancy, labor, and delivery (or maybe is yet to). Perhaps she had/is having difficulty conceiving. She may have pursued care that involved invasive procedures, surgeries, and medications, or simply had her symptoms dismissed as “normal” and just lived with them. As I listen to these heartbreaking stories year after year I ponder the same gnawing question: what could it have looked like for her if we had intervened when that young girl began manifesting MD? I believe there’s potential to change the trajectory of her health and well-being – maybe even her life story – by intervening early and appropriately.
In future posts I’ll explore proposed causes for MD, options in treatment, and share more of my own personal journey with MD. Until then,
Wishing you health and joy!