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Menstrual Problems

Women can have different experiences about their menstrual cycles. Some may have no problem while others may face menstrual problems. Proper diagnosis and treatment can help alleviate menstrual issues and improve quality of life.

Examples of menstrual problems that you may be facing:

Are you bleeding too much?
MenorrhagiaHeavy or prolonged menstrual bleeding, may be complicated by symptoms of anemia such as giddiness, chest pain or difficulty breathing
Intermenstrual bleeding
Vaginal bleeding between periods
Postcoital bleeding
Vaginal bleeding after sexual intercourse
Postmenopausal bleeding
Vaginal bleeding after cessation of menses for 12 months and longer. There are benign and malignant causes for this. Click here to read more on the malignant causes.
 Are you experiencing severe pain during menses??
DysmenorrhoeaPrimary dysmenorrhea = recurrent lower abdominal pain during menses without apparent cause

Secondary dysmenorrhea = menstrual pain with underlying disorders, often presenting with pain starting earlier and lasting longer than normal menstrual cramps. It may be associated with pain during sexual intercourse or defaecation 
Are you bleeding too little??
Primary amenorrhoea = Period not started by 16 years old

Secondary amenorrhoea = absence of menstrual periods for more than 3 to 6 months in a previously menstruating woman 
OligomenorrhoeaInfrequent periods or less than 6-8 periods a year

Why am I bleeding too much?

Vaginal bleeding outside of the regular menstrual cycles may arise due to a multitude of underlying reasons, ranging from benign causes (such as hormonal changes during the perimenopausal phase, atrophic vaginitis, fibroids, polyps), to serious causes (such as malignancy). It is important that potentially dangerous conditions such as malignancy is excluded prior to commencing treatment. Some of the investigations that may be conducted include:

  • Urine pregnancy test
  • Blood tests to check for anemia, clotting tests, thyroid disorders, liver or kidney issues
  • Pelvic Ultrasound looking for endometrial thickening, fibroids, etc.
  • Cervical cancer screening for women with previous sexual intercourse – PAP smear within past 3 years or HPV testing within past 5 years
  • Endometrial biopsy for women above 40 years old, or in younger women with risk factors for endometrial cancer such as high BMI, chronic anovulation, history of breast cancer, tamoxifen use, or a family history of breast/endometrial/colon cancer
  • Infection screen

Tips to preventing anemia

  • Adequate intake of iron-rich food is recommended. Such food include meat, fish, seafood, whole grains, dark green leafy vegetables such as spinach, kai lan etc.
  • Iron supplementation if needed

Why am I having severe pain during menses?

Primary dysmenorrhea is a generally self-limiting condition and the primary treatment goal is control of symptoms. Secondary dysmenorrhea can be due to underlying conditions such as adenomyosis, endometriosis, fibroids or pelvic infections. Symptoms such as deep abdominal pain during sexual intercourse or during defaecation may also be present in women with endometriosis. Pelvic Ultrasound is generally done to detect underlying problems with the womb or ovaries, but may not be able to detect minimal or mild endometriosis. Treatment is directed to pain control and can range from simple analgesia to hormonal treatment, and to invasive surgery in severe cases.

Why am I bleeding too little?

Irregular periods are generally benign and are commonly seen in extremes of ages. Adolescents, who are just beginning to have their periods, tend to have irregular menses for the first few years before regulating, while perimenopausal women generally also tend to have progressively lesser periods as well. Menopause generally happens in women aged 45 to 55 years old, and women who go through menopause between 40 to 45 years old are termed “early menopause”, and those below 40 years old are termed “premature menopause”. Menopause that occurs in women below 40 years old is a cause for concern and will require further investigations and treatment.

More commonly, irregular periods occur due to lack of anovulation which could be related to external factors such as weight gain, or intrinsic factors such as polycystic ovarian syndrome. Skipping a few menstrual cycles is not usually a cause for concern. Lifestyle changes such as reducing lifestyle stressors, losing weight, if overweight, via healthy eating and exercise, and avoiding excessive weight loss would generally help the periods to resume again.

Take Charge

When to seek help?

You should see a doctor for further evaluation if you experience:

  • Excessive menstrual bleeding, or bleeding outside of your usual menstrual cycles
  • Postmenopausal bleeding
  • Severe pain during periods not relieved with analgesia and affecting quality of life
  • Abdominal pain persisting beyond menstrual flow, sometimes associated with pain felt during or after sexual intercourse, or during defaecation
  • Period not started by 16 years old
  • Absence of menses for more than 3 months, if you are not pregnant

Where to seek help?

Approach a general gynaecologist for further evaluation.