Module 7: Menstrual disorders

Now we will look at various aspects of menstrual disorders. We will be looking at menorrhagia or heavy menstrual bleeding (HMB, also known as menorrhagia) along with other cycle changes such as infrequent periods (oligomenorrhoea) and intermenstrual bleeding (bleeding in between periods).  It is always important to ask about cervical smear history and whether the woman is up to date with her smears.

We will also be thinking about the reasons why a woman, in the reproductive age group, might stop having periods (secondary amenorrhea). The most important question to consider in any woman of reproductive age who presents with amenorrhoea or abnormal bleeding (and/or pain) is: Could this woman be pregnant?  This is vital to establish early on because your management is going to be completely different if bleeding is realted to pregnancy, and, critically this could represent an ectopic pregnancy.  Early pregnancy complications such as ectopic pregnancy and miscarriage will be addressed in more detail in another area of your teaching.

During this section we will also talk briefly about period pain, termed dysmenorrhoea, as well as postmenopausal bleeding.  Postmenopausal bleeding is concerning and should always be investigated.  In addition to the readings given with this section remember to also have a look at the appropriate chapters from Introduction to Obstetrics and Gynaecology.

We recommend you start this module by watching this video "Taking a Gynaecological History" with Dr Ngaire Anderson. 

Menstruation is variable for individual women but on the whole will last anything between 2-7 days with a cycle length of 21-35 days. The volume of blood loss is between 20 and 80 mls. 

In New Zealand, 2 to 4% of all primary care consultations by premenopausal women are for menstrual problems.

Objectives