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Menstrual Disorders

Overview :

Typically, a woman of childbearing age should menstruate every 28 days or so unless she is pregnant or moving into menopause. But numerous things can go wrong with the normal menstrual cycle, some the result of physical causes, others emotional. These include amenorrhea, or the cessation of menstruation, menorrhagia, or heavy bleeding, and dysmenorrhea, or severe menstrual cramps. Nearly every woman will experience one or more of these menstrual irregularities at some time in her life.


There are two types of amenorrhea: primary and secondary. Overall, they affect 2-5% of childbearing women, a number that is considerably higher among female athletes (possibly as high as 66%).

Primary amenorrhea occurs when a girl at least 16 years old is not menstruating. Young girls may not have regular periods for their first year or two, or their periods may be very light, a condition known as oligomenorrhea. A light flow is nothing to worry about. But if the period has not begun at all by age 16, there may be something wrong. Amenorrhea is most common in girls who are severely underweight and/or exercise intensely, both of which affect the amount of body fat necessary to trigger the release of hormones that, in turn, begins puberty.

Secondary amenorrhea occurs in women of childbearing age after a period of normal menstruation and is diagnosed when menstruation has stopped for three months. It can occur in women of any age.


Characterized by menstrual cramps or painful periods, dysmenorrhea, which comes from the Greek words for painful flow, affects nearly every woman at some point in her life. It is the most common reproductive problem in women, resulting in numerous days absent from school, work, and other activities. There are two types: primary and secondary.

Primary, or normal cramps, affects up to 90% of all women, usually occurring in women about three years after they start menstruating and continuing through their mid-twenties or until they have a child. About 10% of women who have this type of dysmenorrhea cannot work, attend school, or participate in their normal activities. It may be accompanied by backache, dizziness, headache, nausea, vomiting, diarrhea and tenseness. The symptoms typically start a day or two before menstruation, usually ending when menstruation actually begins.

Secondary dysmenorrhea has an underlying physical cause and primarily affects older women, although it may also occur immediately after a woman begins menstruation.


Menorrhagia, or heavy bleeding, most commonly occurs in the years just before menopause or just after women start menstruating. It occurs in 15-20% of American women.

Premenstrual dysphoric disorder (PMDD)

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, lists premenstrual dysphoric disorder (PMDD) in an appendix of criteria sets for further study. To meet full criteria for PMDD, a patient must have at least five out of 11 emotional or physical symptoms during the week preceding the menses for most menstrual cycles over the previous 12 months. Although the DSM-IV definition of PMDD as a mental disorder is controversial because of fear that it could be used to justify prejudice or job discrimination against women, there is evidence that a significant proportion of premenopausal women suffer emotional distress or impairment in job functioning in the week before their menstrual period. One group of researchers estimates that 3-8% of women of childbearing age meet the strict DSM-IV criteria for PMDD, with another 13-18% having symptoms severe enough to interfere with their normal activities.

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