Navigating the medical world can be confusing with the number of different terms used by health professionals to describe what is going on inside your body. Reports sent between specialists or jargon used in appointments might not make any sense so it is important that we are equipped with knowledge to understand what is happening in our own body so that we can retain autonomy over our choices.
Women who struggle with menstrual cycle challenges are often confronted with a number of different terms to explain why they are struggling or what they are diagnosed with but without truly knowing what this information means, how can you be expected to make an informed decision for your treatment.
Here is a list of some of the most common menstrual cycle challenges that women experience and what they mean in terms that can help you understand your own body.
Dysmenorrhoea: Painful periods
Periods are not meant to be painful which will come as a surprise to many women. A small amount of discomfort or mild aching in the lower abdomen or back that resolves with simple interventions is considered normal. Anything that is more severe or does not respond to ibuprofen or paracetamol would be considered abnormal pain and therefore should be investigated further. There are a number of causes for painful periods such as endometriosis, adenomyosis, fibroids, hormone imbalances, pelvic inflammatory disease, or an increase in prostaglandins.
Amenorrhoea: Absent periods
If your cycle has not arrived at its usual time, you have never gotten a menstrual cycle, or it has not returned after giving birth, taking the pill or undertaking a medical treatment, you may be experiencing amenorrhoea. Women should experience cyclical bleeds when they are ovulating and producing adequate sex hormones. There are a number of reasons why this might not be occurring including malnutrition/low body weight, polycystic ovarian syndrome, medications, hormonal contraceptives, stress, thyroid conditions, pregnancy, menopause, or a pituitary adenoma.
Menorrhagia: Heavy periods
It can be hard to judge if your period is considered normal flow or heavy if that is all you have ever experienced. Heavy periods are considered anything that is over 80mL of blood loss during that period which can be difficult to measure. Standard menstrual cups hold around 20mL which can be one of the easiest ways to measure your blood flow. Regular tampons and pads hold approximately 5mL when completely soaked, super tampons can hold up to 12mL and overnight pads approximately 10-15mL. This means that if you are going through more than 16 regular tampons or pads during the duration of each cycle then you have a heavy period. Some causes include fibroids, polyps, endometriosis, excess estrogen, perimenopause, or some cancers.
Metrorrhagia: Bleeding between periods
Metrorrhagia bleeding comes any time between the last day of your usual period and the next. For some women this can be just a couple of drops of blood and for others it can warrant the use of sanitary products. Light bleeding around the time of ovulation is often nothing to be concerned about and is a response to hormonal changes during the release of an egg. Some other causes of bleeding between periods include pregnancy, hormonal contraceptives, perimenopause, sexually transmitted infections, polyps, fibroids, or endometriosis.
Oligomenorrhea: Irregular periods
Menstrual cycles are considered normal if they fall anywhere between 23-33 days from bleed to bleed. They might not arrive on the exact same day every single cycle but they should be fairly consistent. If you have a period that arrives outside of the 23-33 day window or is different every cycle than this is considered irregular. Some common causes include PCOS, anovulatory cycles, perimenopause, thyroid issues, change of hormonal contraception or other medication, rapid weight loss/gain, or chronic stress.
This means that you had a menstrual cycle but did not ovulate. Most women will experience an anovulatory cycle at some point in their life, particularly around the adolescent and menopausal times due to the hormonal adjustments within the body. These rare occurrences are nothing to be concerned about and would often go unnoticed, however, frequent anovulatory cycles can lead to struggles with fertility (as you need to ovulate to conceive). The main causes are malnutrition/low body weight, PCOS, hormonal contraceptives, perimenopause, and chronic stress.
PMS: Premenstrual Syndrome
For the days leading up to the menstrual bleed many women will experience a number of symptoms such as breast tenderness, mood changes, fatigue, food cravings, and bloating that are often relieved once their bleed begins. While it is totally normal to notice an internal shift or mild symptoms as your hormones change throughout your menstrual cycle, they should not be impacting on your quality of life. The causes and extremities are mainly due to hormonal imbalances, stress and other lifestyle factors such as diet, exercise and sleep.
PMDD: Premenstrual Dysphoric Disorder
While PMS can be inconvenient and uncomfortable, PMDD is severe and debilitating. If your normal life has been impacted to the point where you are taking days off work, school or other commitments because of your symptoms or they are drastically affecting your relationships, you may be experiencing PMDD. Causes are similar to PMS, however, those who experience anxiety or depression may be at a greater risk of PMDD.
PCOS: Polycystic Ovarian Syndrome
Previously PCOS was diagnosed via ultrasound and finding multiple cysts on the ovaries, however, these cysts are actually follicles and should be numerous in number for women in their fertile years. PCOS is now understood to be a condition of excess androgen hormones identified by a blood test and symptoms such as male pattern balding, excess facial hair, acne and/or missing/long menstrual cycles. Once all other causes of excess androgens have been ruled out, a diagnosis of PCOS can be given. Some of the causes of PCOS include insulin resistance, hormonal contraception changes, and chronic stress.
As a fairly under-researched condition, new evidence over the last few years has found that Endometriosis is not considered a hormonal condition and is instead associated with inflammation and the immune system. Lesions of tissue similar to what is found inside the uterus start to grow outside of the uterine walls, resulting in the body sending immune cells to the site, similarly to autoimmune conditions. These lesions can be found on the outer walls of the uterus, the ovaries and fallopian tubes, the bladder, the bowel and in rare instances all the way up the lungs. The main symptoms are pain, heavy bleeding, and difficulty conceiving. The main causes are not fully understood yet.
Adenomyosis is a condition similar to Endometriosis where lesions of tissue that are usually found inside the uterus are found within the muscle walls of the uterus called the myometrium. This causes the walls to grow thicker and symptoms such as pain and heavy bleeding to occur. Again, the main causes are not fully understood yet.
Non-cancerous growths inside the walls of the uterus that can form and grow to different sizes. Some women will never know they have fibroids and won’t experience symptoms, whereas other women can experience severe pain, heavy bleeding, and even an enlargement in the pelvis or lower abdomen. Causes are unknown, however, there are some risk factors that increase your chances of developing fibroids such as insulin resistance, hormonal imbalances, nutrient deficiencies, and a family history.
PID: Pelvic Inflammatory Disease
An infection of the female reproductive organs often originating from the vagina and moving up into the cervix, uterus, fallopian tubes and ovaries. The main symptoms are pain, abnormal bleeding, unusual discharge, fever, and burning during urination and/or sex. It can stem from an untreated sexually transmitted infection, however, it can also be from other sorts of chronic vaginal infections or bacterial overgrowths including changes to the genital microbiome from IUD insertion. This is not an emergency but should be treated as soon as possible without delay.
Premature Ovarian Failure
This is basically a fancy term for early menopause or the decline in ovarian function before the age of 40. When your ovaries slow down the production of hormones or cease their usual activity, the menstrual cycle becomes disrupted. This is something that occurs naturally for women around the ages of 45-55 with common symptoms such as irregular periods, hot flushes, mood fluctuations, and fertility challenges. Those with premature ovarian failure will experience these symptoms and go into an early menopausal state much before this time. Some of the main causes are toxins or medications such as chemotherapy, autoimmune conditions, genetic conditions such as Turner’s syndrome, and surgical removal of the ovaries.
In the words of Nelson Mandela "knowledge is the most powerful weapon you can use to change the world". I hope that this has been helpful to breakdown some of the terms you may come across on your journeys with fertility, menstrual cycle health, hormonal balance and general wellbeing.