Menstrual Disorders Definition

Menstrual disorders consist of changes in the normal menstruation process.

Normal Menstruation

Menorrhagia

Amenorrhea

Other Types of Abnormal Bleeding

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Normal Menstruation
Menstruation, also called menses, is just one part of the menstrual cycle in which your body
prepares for pregnancy each month. A menstrual cycle is counted from the first day of one period
(the first day of bleeding) to the first day of the next period. An average cycle is 28 days, but
anywhere from 23-35 days is normal.
At the beginning of your cycle, the hormones estrogen and progesterone are at very low levels.
During menstruation, levels of estrogen, which is made by your ovaries, start to rise and make
the lining of your uterus grow and thicken. In the meantime, an egg (ovum) in one of your
ovaries starts to mature. It is encased in a sac called the Graafian follicle, which continues to
produce estrogen as the egg grows.
At about day 14 of a typical 28-day cycle, the sac bursts and the egg leaves your ovary, and the
egg remains near the entrance to the fallopian tube until fertilized by a male sperm after which it
begins traveling through one of the fallopian tubes to the uterus. The release of the egg from the
ovary is called ovulation.
After the egg is expelled, the follicle sac (now called a corpus luteum) remains in the ovary,
where it continues producing hormones, but now mainly progesterone. The rising levels of both
estrogen and progesterone help build up the uterine lining to prepare for pregnancy.
The few days before, during, and after ovulation is your "fertile period"-the time when you can
become pregnant. Because the length of menstrual cycles varies, you may ovulate earlier or later

than day 14. It's even possible for you to ovulate while you still have your period if that month's
cycle is very short. (Stress and other things can sometimes cause a cycle to be shorter or longer.)
Regardless of what day in the cycle ovulation occurs, the corpus luteum will continue producing
hormones only for 14 days, unless the egg is fertilized. It is during this fertile period that
conception and pregnancy can occur. Sperm from a man fertilizes the egg.
The fertilized egg attaches to the uterus, the growing pregnancy releases a hormone (hCG),
which stimulates the corpus luteum. The corpus luteum makes all the progesterone needed to
keep the egg implanted and growing until a placenta (an organ connecting the fetus to the
mother) develops. The placenta then makes hormones and provides nourishment from the mother
to the growing embryo.
If an egg is not fertilized and you don't get pregnant, the corpus luteum stops making hormones
(in 14 days) and gets reabsorbed in the ovary. Estrogen and progesterone levels drop again, the
lining of the uterus breaks down (in an orderly way), menstruation (bleeding) begins, and the
cycle starts all over again.
This cycle will continue every month starting from about age 11-16 years old to an average age
of 52 years old when menopause signals the end of menses and the ability to become pregnant.

Heavy Menstrual Bleeding

Most women lose an average of about 2 ounces (60 milliliters [ml]) of blood or less during
normal menstruation. However, in up to 14% of women, menstrual bleeding can be significantly
heavier and/or longer. This is called Heavy Menstrual Bleeding , which can be caused by a
number of conditions and can lead to Iron-Deficiency Anemia , Infertility In Women , and other
complications.

Absence of Menstruation
The absence of menstruation, is categorized as primary or secondary. Primary amenorrhea occurs
when a girl does not start to menstruate within the normal time frame of sexual development.
This usually occurs by age 14; definite primary amenorrhea is diagnosed if there is no menses by
age 16.
Secondary amenorrhea occurs when previously normal menstrual periods are absent for at least
three cycles (for reasons other than menopause).
Amenorrhea can be caused by:

Hormonal imbalances

Hypothyroidism

Eating disorders

Psychiatric disorders

Low or high body fat

Rapid weight loss

Excessive exercise or intense physical training

Other conditions

Due to the underlying low estrogen, prolonged amenorrhea can lead to a decrease in bone density
and an increased risk of Osteoporosis and infertility.

Other Types of Abnormal Bleeding

In addition to menorrhagia and amenorrhea, other types of abnormal bleeding may occur, such
as:

Metrorrhagia-usually light bleeding in between periods (during an otherwise regular

cycle)
o Light bleeding in between periods can have many causes. It can be the result of a
hormonal imbalance (causing lack of ovulation), medications (birth control pill),
infections, abnormal growths on the cervix or uterus, or Miscarriage.

Menometrorragia-bleeding irregularly in between periods, then bleeding heavily at

expected menses
o When a woman loses greater than 80 ml of blood during menses and also bleeds
irregularly in between periods, it is called menometrorragia. This can be caused
by a number of factors including hormone imbalance.

Hypomenorrhea-very light periods

o Female athletes often have light periods and/or fewer periods due to the hormonal
changes associated with extreme exercise and low body mass index. Anorexia and
other conditions may also be associated with hypomenorrhea, oligomenorrhea
(too few menses), or amenorrhea (no menses).

Anolulatory cycle-because ovulation does not occur, no corpus luteum is formed; the
cycle may be of any length and may be unpredictable
o In a normal ovulatory cycle, ovulation occurs. The cycle is regular whether or not
it is the usual 28-day cycle (ovulation on day 14); or, say, a 35-day cycle
(ovulation on day 21). When ovulation does not occur, the corpus luteum is not

able to produce the hormones (for 14 days) that prepare the uterus and stop it
from shedding. Flow can happen at any time.
Less commonly, women may ovulate, but changes in the length of the follicular phase or other
conditions can cause:

Polymenorrrhea-too many menses close together (less than typical 28 days)

Oligomenorrhea-too few cycles (ie, menses far apart)

Possible Causes of Abnormal Bleeding

There are many causes of abnormal bleeding. Examples of causes include:

Complications of pregnancy

Trauma

Infection

Abnormal growth

Medications (including intrauterine devices and birth control pills )

Treatments and conditions (eg, cancer, in rare cases)

Stress, exercise, and other conditions-These can stop the normal cycle of ovulation.

This indepth report focuses on menorrhagia and amenorrhea.