MENSTRUAL IRREGULARITIES

Normal menstruation is the monthly cycle of blood loss per vagina that occurs from menarche to menopause; loss is about 25 ml per day for 4-5 days per month. Flow varies between individuals but tends to get heavier with age. To assess irregularities, a good detailed history of bleeding patterns is required. Physical examination and referral may be necessary, depending on the problem and the findings. Abnormalities in menstruation may include:

• menorrhagia: too heavy a loss (>80 ml per menstruation); may cause anaemia.

• polymenorrhoea: >1 period per calendar month.

• oligomenorrhoea: infrequent periods or amenorrhoea (no periods).

• abnormal duration of bleeding: normal range is 3-7 days.

• early or late onset, i.e. before 10 years, or after 16 years of age (average age of onset is 12.4).

In women presenting with heavy menstrual bleeding, take a full blood count (FBC). Consider coagulation disorders in women with a history of heavy bleeding since menarche and/or with a history of coagulation disorders. Consider thyroid tests if other signs and symptoms of thyroid disease present.