Common menstrual disorders

In short: Menstrual disorders are problems with your periods that go beyond the usual ups and downs: periods that are very heavy, very painful, irregular, missing, or come with severe mood changes. The most common ones are heavy periods, painful periods (dysmenorrhoea), irregular or missed periods, PMS and PMDD, and conditions behind them such as PCOS, endometriosis and fibroids. Many are common and manageable, but they're not something to "just put up with". If your periods affect your daily life, see a doctor.

First, let's see what a normal period looks like, so you know what isn't.

What is a normal period?

According to ACOG (the American College of Obstetricians and Gynecologists):

• a normal cycle (from the first day of one period to the first day of the next) is usually 21 to 35 days
• a normal period usually lasts up to 7 days

The NHS says the average cycle is around 28 days, and that periods are often less regular in the first few years after they start and in the years before menopause.

ACOG lists these as abnormal bleeding:

• bleeding or spotting between periods
• bleeding or spotting after sex
• heavy bleeding during your period, or soaking through one or more pads every hour
• bleeding that lasts more than 7 days
• cycles longer than 35 days or shorter than 21 days
• cycle length that changes by more than 7 to 9 days from month to month
• no period for 3 to 6 months
• any bleeding after menopause

1. Heavy periods (menorrhagia)

Heavy periods are one of the most common menstrual problems. The NHS says you may have heavy periods if you:

• need to change your pad or tampon every 1 to 2 hours, or empty your menstrual cup more often than recommended
• need to use two products together, like a pad and a tampon
• have periods lasting more than 7 days
• pass clots larger than about 2.5 cm
• bleed through to your clothes or bedding
• skip school, college, work or daily activities because of your period
• feel tired or short of breath a lot

Possible causes, according to the NHS, include PCOS, fibroids, endometriosis, adenomyosis, pelvic inflammatory disease and bleeding disorders such as Von Willebrand disease. Rarely, heavy periods can be a sign of womb cancer.

Why it matters in India: heavy periods are a common reason for losing iron. The National Family Health Survey (NFHS-5, 2019–21) found about 57% of Indian women aged 15 to 49 were anaemic. If your periods are heavy and you feel tired or breathless, ask your doctor about a blood test. You can read more about iron deficiency due to heavy periods and how it is checked.

2. Painful periods (dysmenorrhoea)

Some cramping is normal. The NHS says period pain often starts just before or at the start of your period, can spread to your back and thighs, and usually lasts up to 3 days.

ACOG describes two types:

• Primary dysmenorrhoea: common cramps caused by prostaglandins, chemicals made in the lining of the womb. Pain is usually worst on day 1 and eases as the period goes on. For many women it gets better with age.
• Secondary dysmenorrhoea: pain caused by a problem in the reproductive organs, such as endometriosis, adenomyosis or fibroids. It often gets worse over time, may start a few days before your period, and can last longer than normal cramps.

Period pain that stops you going to college or work, or that doesn't ease with rest and heat, is not something to accept as "normal". It's a reason to see a doctor.

3. Endometriosis

Endometriosis is when tissue similar to the womb lining grows outside the womb, causing inflammation and scarring. The WHO estimates it affects about 10% of women of reproductive age worldwide, around 190 million women.

Signs include:

• very painful periods
• heavy periods
• long-term pelvic pain
• pain during or after sex
• pain when pooing or peeing, especially during your period
• trouble getting pregnant
• tiredness, low mood or anxiety

The WHO notes that long delays in diagnosis are common. Many women are told for years that their pain is normal. If this sounds like you, ask for a referral to a gynaecologist.

4. Irregular, missed or absent periods

Irregular periods are when the gap between periods changes a lot, or is shorter than 21 days or longer than 35 days. When periods stop completely for months, doctors call it amenorrhoea.

The NHS lists common causes:

• pregnancy (always rule this out first)
• stress and anxiety
• sudden weight loss, being overweight, or exercising too much
• breastfeeding
• PCOS and thyroid problems
• perimenopause, the years before menopause, which usually start in your 40s

Big changes in routine can play a part too. A long trip, jet lag or a move to a new city can shift your cycle for a month or two; here's more on how climate and travel affect your period. If your cycle has been thrown off by stress or a change in routine, these everyday steps to reset a disrupted cycle naturally may help while you wait for it to settle.

See a doctor if you miss 3 periods in a row, or if your periods haven't started by 15.

5. PCOS

Polycystic ovary syndrome (PCOS) is a common hormone condition. The WHO says it affects an estimated 10–13% of women of reproductive age, and up to 70% of women with it don't know they have it.

Common signs:

• irregular or missed periods
• extra hair on the face or body
• acne
• difficulty getting pregnant
• weight gain, often around the tummy

PCOS also raises the risk of conditions like type 2 diabetes, so a diagnosis matters for long-term health, not just periods.

6. PMS and PMDD

PMS (premenstrual syndrome) is the mix of symptoms many women get in the days or weeks before a period. The NHS lists mood swings, irritability, anxiety, tiredness, trouble sleeping, bloating, breast tenderness, headaches, spots and food cravings.

PMDD (premenstrual dysphoric disorder) is a much more severe form. The NHS says its symptoms are similar to PMS but far more intense, with a much bigger impact on daily life, including feeling very angry, anxious or depressed, and sometimes thoughts of suicide. PMDD is a real medical condition, not "being dramatic".

7. Very light or short periods

Some women have very light periods, or periods that last only a day or two. Doctors call this hypomenorrhea. It can be normal for you, or it can happen with stress, weight change, thyroid problems or other conditions. A sudden change from your usual pattern is worth mentioning to a doctor.

How menstrual disorders are diagnosed

Your doctor will usually ask about your periods and symptoms, and may suggest:

• a pregnancy test
• blood tests for anaemia, thyroid and hormone levels
• a pelvic ultrasound to look at your womb and ovaries
• other tests depending on your symptoms

The most useful thing you can bring is a record of your periods: start and end dates, how heavy they were, pain levels and other symptoms for at least 2 or 3 cycles. A period tracker makes this easy. The NHS suggests keeping a symptom diary for at least 2 cycles for PMS. Femease's free health checks can also help you put your symptoms into words before your appointment.

Treatment depends on the cause and on what you want, for example whether you're trying to get pregnant. A doctor can explain the treatment options that suit you.

When to see a doctor

Book a doctor consultation if:

• you soak a pad every 1 to 2 hours, pass large clots, or bleed for more than 7 days
• your period pain stops you from doing daily activities, or doesn't ease with rest and heat
• you have pain during sex, or when peeing or pooing
• you bleed between periods or after sex
• your cycles are shorter than 21 days or longer than 35 days, or keep changing
• you've missed 3 periods in a row and you're not pregnant
• your periods haven't started by 15
• you feel very low, anxious or angry before your period
• you have any bleeding after menopause

Get help straight away (call 112 in India or go to hospital) if you have very heavy bleeding with dizziness or fainting, or sudden severe tummy pain. See a doctor the same day for a fever with pelvic pain. If you're having thoughts of suicide or of harming yourself, call Tele-MANAS on 14416 or go to the nearest emergency (112).

Questions women ask

What are the most common menstrual disorders?

Heavy periods, painful periods, irregular or missed periods, PMS and PMDD. Conditions that often cause them include PCOS, endometriosis, fibroids and thyroid problems.

How do I know if my period is abnormal?

ACOG says a normal cycle is 21 to 35 days and a period lasts up to 7 days. Bleeding between periods, after sex or after menopause, very heavy bleeding, or no period for 3 to 6 months are reasons to see a doctor.

Is it normal to have very painful periods?

Some cramping is normal, but pain that stops you from studying, working or doing daily activities is not something to just bear. It can be a sign of conditions like endometriosis or fibroids.

Can stress cause period problems?

Yes. The NHS lists stress and anxiety as common causes of irregular and missed periods. If your periods don't settle once the stress eases, see a doctor.

Can menstrual disorders affect fertility?

Some can. PCOS and endometriosis are common causes of difficulty getting pregnant. Early diagnosis helps, so talk to a doctor if your periods are irregular and you want to get pregnant.

Sources

• ACOG: Abnormal uterine bleeding; Dysmenorrhea: painful periods
• NHS: Heavy periods; Period pain; Irregular periods; Missed or late periods; PMS (premenstrual syndrome)
• WHO: Endometriosis fact sheet; Polycystic ovary syndrome fact sheet
• National Family Health Survey (NFHS-5), 2019–21