For a girl, getting her first period is a physical milestone and a sign of becoming a woman. But it can also be confusing and scary, particularly if she encounters certain problems like irregular periods or premenstrual syndrome. Many menstrual problems are innocent, even though they may cause significant distress and discomfort. Sometimes they can be warning signs that something more serious is wrong.

Common Menstrual Problems

Most issues teens confront when they start menstruating are completely normal. In fact, many girls and women have had to deal with one or more of them at one time or another:

Premenstrual Syndrome (PMS)
PMS includes both physical and emotional symptoms that many females get right before their eriods, such as:

• acne
• bloating
• fatigue
• backaches
• sore breasts
• headaches
• constipation
• diarrhea
• food cravings
• depression or feeling blue
• irritability
• difficulty concentrating
• difficulty handling stress

Different girls may have some or all of these symptoms in varying combinations. PMS is usually at its worst during the 7 days before the period starts and disappears soon after it begins. But girls usually don’t develop symptoms associated with PMS until several years after menstruation starts.

Amenorrhoea

This is the complete absence of periods. If an otherwise normal girl of 16 has never menstruated, this is called primary amenorrhoea. The same diagnosis is given to a girl of 14 who has never had a period if she also fails to show any signs of sexual development, such as breast or pubic hair growth.

Secondary amenorrhoea is when menstruation has stopped for six consecutive months in a woman who has previously had regular periods.

Excluding pregnancy as a cause, about 20%-30% of women experience amenorrhoea at some time during their reproductive life.

The underlying cause is usually hormonal. Secondary amenorrhoea can occur for a time after a woman stops using hormonal contraceptives.

Other causes of amenorrhoea include stress, excessive exercise or being very underweight or malnourished, as found in anorexia. Very rarely, there may be some inherited problem to blame.

The treatment depends on the underlying cause and what the woman wants. Some women may not view their condition as a problem unless they want to start a family .

Conversely, a woman with amenorrhoea may still be fertile and should be advised to use a contraceptive if she does not want to become pregnant.

Oligomenorrhoea

This is irregular or infrequent periods. Menstruation can occur anywhere between every six weeks and six months.Many of the causes are the same as those for amenorrhoea. A common cause is a condition called polycystic ovary syndrome (PCOS).

This is an inherited hormonal disorder that affects the ovaries. The ovaries have an abnormally large number of follicles - little swellings that develop each month to release an egg.

In PCOS, the follicles remain immature meaning that eggs are often not released and the woman rarely ovulates and so is less fertile.
In addition to irregular periods, women with PCOS may also have excess body hair and be overweight.
As with amenorrhoea, treatment of oligomenorrhoea depends on the underlying cause and what the woman wants.

Dysmenorrhoea

Period pains, or dysmenorrhoea, affect 40-70% of women of reproductive age. For about one in 10 women the discomfort and pain is bad enough to interfere with their daily lives.

A certain amount of discomfort around the time of ovulation and menstruation is normal and it has been proposed that it is related to the movements of the womb and the hormones and chemicals that circulate around the body at that time of the month.

However, sometimes dysmenorrhoea is a sign of an underlying disease.The pain typically occurs in the lower abdomen and/or pelvis and can radiate to the back and along the thighs, lasting somewhere between eight and 72 hours.

It can occur before or during menstruation or both. Headaches, diarrhoea, nausea and vomiting may accompany it.When there is no underlying cause, simple analgesia with a non-steroidal anti-inflammatory drug such as ibuprofen might be all that is needed.

Some women find that going on the combined oral contraceptive pill lessens the discomfort. Others have reported being helped by acupuncture, TENS therapy (a painless way of stimulating the nerves using pulsed energy) or a hot water bottle applied locally to the area of discomfort.

If there is an underlying disease causing the dysmenorrhoea then this should be treated. Often there will be other symptoms too, such as heavy bleeding or pain or bleeding after intercourse.

Menorrhagia

Menorrhagia is recurrently heavy bleeding during menstruation. About a third of women describe their periods as heavy. The average blood loss during menstruation is typically about 40ml. With menorrhagia the loss is 80ml or more.
Women with menorrhagia may have to use double sanitary protection - towels and tampons - and the heavy bleeding may stop them from doing normal activities because of flooding through clothes.

In most cases no cause can be found. However, there may be an underlying cause such as endometriosis or fibroids.It is important to investigate the bleeding and check that it is not due to something more sinister like cancer of the uterus or cervix.

The treatment depends on the cause. If there is no underlying problem that needs treating, the bleeding can often be reduced with non-hormonal tablets (tranexamic acid), oral contraceptives or by fitting a contraceptive coil into the womb.

If these do not work, a woman might want to consider surgery to remove the uterus completely or have the womb lining stripped. She may also need to take iron or folic acid supplements if the blood loss has made her anaemic.