Menstrual disorders may not mean anything and, in fact, usually correct themselves. However, it is always important to consult a doctor about them. I cannot remind you too often to be sure to consult a doctor if there is bleeding between periods or after the menopause.

Absence of menstruation (amenorrhoea)

The term primary amenorrhoea is used if menstruation has not occurred, although the age of puberty has been reached. If it begins and then ceases, it is called secondary amenorrhoea. This type of amenorrhoea is normal during pregnancy and often while the mother is nursing. It is quite apt to occur sporadically in the first and last months of a woman’s child-bearing years.

In rare cases, primary amenorrhoea is caused by malformed or underdeveloped female organs. For example, the hymen may completely block the vagina, causing retention of the menstrual blood. It may also be due to glandular disorders, in which case it can often be cured or at least partially corrected by taking the proper hormones—but never do so without a doctor’s prescription. Primary and secondary amenorrhoea can be caused by general poor health, a change in climate or living conditions, and by emotional factors, such as the fear or hope of being pregnant.

Menstrual flow that may be so slight as to amount to little more than staining occasionally results from the same causes. It is sometimes due to anaemia.

Excessive menstruation (menorrhagia)

This means an exceptional amount of menstrual flow at the regular periods. The term ‘irregular endometrial shedding’ is used for extra menstrual periods. It is not easy to describe the amount of menstrual flow that constitutes menorrhagia. However, if ordinary pads do not afford protection or if the menstrual blood forms into large clots, be sure to consult a doctor.

Irregular menstruation

Irregularity may be due to a harmless change in nature’s timing, which will correct itself spontaneously, or to changes in climate or living conditions, or to emotional factors. On the other hand, it may result from a disease in some other part of the body, such as the thyroid gland, which should be diagnosed and treated as soon as possible. It may be caused by a tumour of the uterus (womb) or the ovaries. Most important of all, bleeding between periods can be a warning of cancer. It should be reported immediately to a doctor.

Painful menstruation (dysmenorrhoea)

Many women experience discomfort at the onset of their periods. For practical purposes, I would say that a woman has dysmenorrhoea if her menstrual cramps do not yield to aspirin or some other mild pain reliever, and if they prevent her from engaging in her work.

Often dysmenorrhoea cannot be accounted for by any organic condition. This kind of painful menstruation is almost never found in women who have had a number of children, and it is found only occasionally in married women. In many cases, there is conclusive evidence that it is caused by emotional factors.

I do not mean that this pain is imaginary. It is quite real, and can be relieved by such medicines as anti-spasmodics, analgesics, and various brand-name sedatives.

Pain between periods

Some women experience pain approximately midway between their periods, at the time of ovulation. It may be accompanied by leukorrhoea or a slight show of blood. As a rule, the pain is brief and moderate. Sometimes, however, when the ovum breaks through the wall of the ovary to start its journey towards the uterus, it causes quite severe pain.

Premenstrual difficulties

Headache, depression, irritability, slight nausea, and puffiness of the abdomen, skin, and other parts of the body may precede menstruation. The reasons for premenstrual tension are not fully understood, but we know that they are associated with a disturbance of the salt balance, resulting in the accumulation of water in the tissues. Often these symptoms vanish with medication or a salt-free diet.


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