Menstrual problems

What are the problems associated with menstruation?

Normal menstruation is every 21 to 35 days. The amount and duration of bleeding (2 to 8 days) varies for each woman. The menstrual pattern can change during a lifetime.

 

  • Irregular vaginal bleeding
    When bleeding is irregular, it is no longer clear when menstruation begins and when it ends. Menstrual periods are sometimes not only irregular, there can also be more bleeding than previously.
  • Excessive vaginal bleeding
    Excessive bleeding leads to more blood loss or longer blood loss. Large clots may be sometimes be lost and this can be accompanied by abdominal pain. Bleeding can be so severe that it can become a difficulty during day-to-day activities.
  • Intermenstrual bleeding
    Intermenstrual bleeding is the loss of blood at unexpected times between normal menstrual periods. It will sometimes no longer be clear what normal menstruation is and what is intermenstrual bleeding.
  • Absence of menstruation (amenorrhoea)
    Primary amenorrhoea is when someone has not yet menstruated by the age of sixteen. Secondary amenorrhoea is when there are no menstrual periods for a minimum of six months in women who have previously menstruated, for example because of uterine conditions, conditions affecting the fallopian tubes, hormone imbalances, medication, psychological stress, extreme physical exertion or weight fluctuations.

 

What are the problems associated with menstruation?

Even normal menstruation may be accompanied by complaints such as pain, discomfort, fluid retention, fatigue, impaired concentration and mood swings. Irregular, abundant and intermenstrual bleeding can also cause these symptoms and possibly anaemia in the longer term. A correlation has been found in women with intellectual disabilities between menstruation and self-injurious behaviour. 420


The absence of menstruation itself (amenorrhoea) does not generally result in any complaints but there may be an underlying cause that does do so.

 

How common are menstrual problems in the general population?

In general practice, complaints associated with normal menstruation (painful menstruation, intermenstrual pain and premenstrual complaints) are found in 0.94%. Because these are only the people who see their GP, this is probably an underestimate. 421

 

Abundant, irregular or intermenstrual bleeding is seen in 2.3%. The one-year incidence of amenorrhoea is 0.7% per year in women between the ages of 15 and 24 years, and 0.95% in women aged between 25 and 44. 422

 

How common are menstrual problems in people with intellectual disabilities?

In a survey of 92 women with intellectual disabilities in Taiwan, 50% said they had menstrual problems: 36% of them had pain or cramps, 26% fatigue and 15% changes in arousal. 423


A Dutch study of 298 women found that half used medication to regulate menstruation. In most cases, the reasons were hygiene problems (40.7%), excessive bleeding (26.7%) or behaviour problems (26.7%). 424


Another Dutch study of 234 women aged between 15 and 59 found that 48% had undergone an intervention to regulate menstruation: 78% took medication, 20% had been sterilised and 2% had undergone a hysterectomy. The reasons (sometimes in combination) were: problems with menstruation (57%), behaviour problems (39%) and anti-conception (40%). The behaviour problems mentioned were: mood swings (38%), crying (8%), self-harming (13%), obsessive masturbation (8%), hygiene problems (42%) and compulsive behaviour (4%). 425  

As many as 67% of women with intellectual disabilities undergo therapeutic amenorrhoea during their lifetime. 426
In a group of 107 women with intellectual disabilities who visited a gynaecologist for menopausal disorders, 37% complained about excessive or irregular menstruation, 8% had pain during menstruation, 2% had a cyclical exacerbation of epilepsy, 9% had amenorrhoea and 6% suffered from mood swings associated with menstruation; two women received surgical treatment and the rest were given medication. 427


A case series with four women found that menstruation was the cause of challenging behaviour and that this behaviour was almost completely resolved by a multidisciplinary approach, including medication to remedy complaints. 428


Another case series established a relationship between self-harming and certain phases of the menstrual cycle. 429


A survey of 522 women with intellectual disabilities found that 18% had behaviour problems during menstruation. Behaviour improved in 65% of the women who were given pain-relief medication during menstruation. Behaviour improved in 40% of the women who used oral contraceptives for this purpose and behaviour improved in 66% of the women who received a 'hormonal shot'. 430

 

A study of thirty adolescent girls in an institution showed that girls with intellectual disabilities were more likely to suffer from an irregular cycle and behaviour problems around menstruation than their peers with no intellectual disabilities. 606


A study of young people with Down syndrome established that 58% of girls had menstrual problems. 607


A study of people with Prader Willi syndrome found that 100% had an irregular menstrual cycle. 608

There is no information about this area for the general population.
50% People with intellectual disabilities
58% People with Down syndrome

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Pikora TJ, Bourke J, Bathgate K, Foley KR, Lennox N, Leonard H.Health conditions and their impact among adolescents and young adults with Down syndrome. PLoS One. 2014 May 12;9(5):e96868.

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Sinnema M, Maaskant MA, van Schrojenstein Lantman-de Valk HM, van Nieuwpoort IC, Drent ML, Curfs LM, Schrander-Stumpel CT. Physical health problems in adults with Prader-Willi syndrome. Am J Med Genet A. 2011 Sep;155A(9):2112-24.

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