Problem with Menstruation

Pain During Menstruation

This is a very common problem. Known as dysmenorrhea, it is often severe enough to cause absences from work or inability to perform other responsibilities. Symptoms include lower abdominal cramping, nausea, vomiting, and headache during menstruation.

In one type of painful menstruation, called primary dysmenorrhea, doctors cannot find any problem with the reproductive organs. This disorder tends to affect young women fairly soon after they first begin to menstruate. Painful contractions may occur as the uterine walls release natural substances called prostaglandins. Psychological factors may play a role.

Primary dysmenorrhea can be treated with ibuprofen (Advil, Nuprin, others) or aspirin, both of which help block production of prostaglandins. In severe cases, birth control pills or other medications containing hormones can help. Exercise, good nutrition, and reducing stress also are important.

Secondary dysmenorrhea develops after years of normal menstruation and results from disease of the uterus, fallopian tubes, or ovaries. Among the possible causes are tumors and other abnormal growths, pelvic infection, uterine cancer, and endometriosis (in which uterine tissue is found outside the uterus, in the fallopian tubes, ovaries, and abdominal organs). Endometriosis is a serious disease that can cause infertility.

When you see your doctor, he or she will ask you about your periods and the timing and severity of the pain. The doctor will also do a pelvic exam. Since treatment for secondary dysmenorrhea depends on its cause, he or she may do additional tests or refer you to a specialist.

Menstruation Stopping
(or Never Starting at Puberty)

Women who have had normal periods that stop for 6 months or more are said to have amenorrhea, or the absence of menstruation. This is called secondary amenorrhea. Girls who have not begun to menstruate by the age of 16 have primary amenorrhea.

The definition of secondary amenorrhea clearly excludes minor lateness of a period and it's important to remember that 5- or 6-week cycles are normal for some women. Stress — including worrying about whether you will get your period or whether you are pregnant — can cause your period to be 1 or 2 weeks late. Severe physical or emotional stress or mental health problems can cause periods to stop for a longer time.

Full-blown amenorrhea is most commonly due to problems with the hormones that regulate menstruation. The glands that produce the hormones that affect menstruation include the pituitary gland at the base of the brain, the adrenal glands on top of the kidneys, the thyroid gland in the neck, and the ovaries.

It can take 6 months to a year for normal periods to resume after a woman stops taking birth control pills. This is because the pill blocks certain hormones involved in menstruation and it can take that long for those hormones to return to normal. Menstruation also stops during pregnancy.

In some women, menstruation stops or never starts because their ovaries do not respond properly to the hormones that normally trigger release of an egg. These women cannot ovulate on their own and menstruation is not possible without ovulation. Some women do not produce enough estrogen to ovulate. Other causes of amenorrhea are ovarian cysts and obstructions or other problems in the reproductive tract.

A variety of other factors can cause menstruation to stop, including:

• Vigorous exercise (sometimes not the only cause—periods should return as the training schedule is reduced)
• Obesity
• Poor nutrition (including anorexia)
• Diabetes
• Chronic, nonalcoholic liver disease
• Any chronic illness
• Tuberculosis
• Medications such as birth control pills, narcotics, major tranquilizers, and cancer chemotherapy drugs

In rare cases of primary amenorrhea, there is no opening in the hymen through which blood can flow. About one-third of girls with primary amenorrhea have a genetic disorder or a congenital problem with their reproductive tract.
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