24 January 2023

A normal menstrual cycle involves a period occurring every 24 to 42 days, and the bleeding lasts for five to seven days. If you experience heavy period bleeding that affects your normal day-to-day activities or cramps that do not go away even with the help of painkillers, you may have a menstrual disorder. 

However, it is important to note which one you are experiencing to treat it appropriately. So here are the four (4) common menstrual disorders you may experience with some pain during a heavy flow at the start of your menstrual period.



Dysmenorrhea refers to painful menstrual cramps. It is further subdivided into two types: primary and secondary dysmenorrhea.

Primary dysmenorrhea is the usual menstrual cramps that begin during your teenage phase and are recurrent. Symptoms may be experienced one to two days before the start of the period:

  • Mild to severe lower abdominal cramps
  • Dizziness
  • Nausea
  • Vomiting
  • Fatigue
  • Diarrhea

Secondary dysmenorrhea refers to having menstrual cramps when previously you did not experience any pain during periods. It is often caused by pelvic infection or a disorder in your reproductive organs. The pain from this type is experienced earlier and lasts longer than normal menstrual cramps. It may also come at the end of or just after your menstrual period. Symptoms include the following:

  • Pain during bowel movement
  • Severe backache
  • Chronic pelvic pain


Causes of dysmenorrhea

During menstruation, your body produces a substance that causes your uterus to contract. Primary dysmenorrhea happens when your body produces a significantly high amount of this substance.

Secondary dysmenorrhea occurs if you have an underlying condition, such as:

  • Endometriosis
  • Pelvic inflammatory disease
  • Fibroids or ovarian cysts
  • Use of an intrauterine device
  • Sexually-transmitted diseases


Treatment options for dysmenorrhea

For primary dysmenorrhea, you can take antispasmodics medications and NSAIDs. You can also do hot baths, use heating pads, and get plenty of rest and fluids. Other changes to lifestyle you can make to reduce cramps are:

  • Avoiding cold drinks
  • Diet rich in complex carbohydrates
  • Regular exercise
  • Maintaining a healthy weight

Secondary dysmenorrhea needs an in-depth treatment targeting its underlying cause.



Menorrhagia refers to prolonged menstrual periods lasting more than eight to ten days or excessive bleeding that requires changing sanitary pads or tampons every hour or two. Other symptoms of menorrhagia include:

  • persistent lower abdominal and pelvic pain
  • Large blood clots during discharge
  • Dizziness
  • Fatigue
  • Shortness of breath due to anaemia


Causes of menorrhagia

Menorrhagia occurs when there is an imbalance of the oestrogen and progesterone (hormones produced to regulate the lining of the uterus) levels, causing excessive or abnormal growth of this lining that results in heavy blood flow. Other underlying causes include:

  • Anovulation (when an ovum or egg does not release from your ovary)
  • Uterine fibroids
  • Uterine polyps
  • Using non-hormonal intrauterine device (IUD)
  • Endometrial cancer
  • Miscarriage or ectopic pregnancy
  • Pelvic infection
  • Thyroid disease
  • Liver or kidney disease; and
  • Use of blood-thinning medications


Treatment options for menorrhagia

The treatment will depend on the patient’s age and the cause and extent of the underlying condition. Treatment options for menorrhagia include the following:

  • Iron supplements
  • Medication
  • Surgery
  • Radiological/hormonal treatment

It is crucial that you openly discuss your concerns with your gynaecologist about the severity of bleeding to obtain accurate assessments and diagnosis.



Oligomenorrhea refers to irregular menstrual cycles – when your periods are less than 21 days apart or more than 35 days apart. You may only have six to eight menstrual periods a year. Your periods are unpredictable. Around 12% to 15 % of people who menstruate experience oligomenorrhea at some point. It usually happens alongside polycystic ovary syndrome. Symptoms of oligomenorrhea include:

  • Missed and delayed periods
  • Acne
  • Headaches
  • Hot flashes
  • Abdominal pain
  • Vaginal discharge
  • Impaired vision
  • Excessive growth of hair on your face and body


Causes of oligomenorrhea

Your reproductive organs and glands in your brain generate various hormones that regulate your menstrual cycle. When they are balanced, your cycle is more predictable as imbalanced hormones interfere with the regularity of periods. Infections and abnormalities in your reproductive organs can also disrupt your menstrual cycle. Certain conditions that can cause hormone imbalances in your body include:

  • Polycystic ovary syndrome
  • Androgen-secreting tumours
  • Cushing’s syndrome
  • Prolactinoma
  • Primary ovarian syndrome
  • Hyperthyroidism
  • Congenital adrenal hyperplasia
  • Pelvic inflammatory disease
  • Asherman’s syndrome
  • Diabetes
  • Eating disorders
  • Extreme physical activity


Treatment options for oligomenorrhea

The treatment will depend on the cause, but there are three options to treat oligomenorrhea:

  • Hormone therapy: if caused by hormone imbalance
  • Surgery: if there are tumours producing excessive amounts of androgens
  • Changes in lifestyle: adjustments to diet and physical activity to address nutritional deficiencies and overexertion



Amenorrhea refers to the absence of any menstrual period. It can be further subdivided into two types: primary and secondary.

Primary amenorrhea occurs if you are older than 15 and have not gotten your first period, while secondary amenorrhea happens when you have missed a period for a few months. The symptoms of amenorrhea depend on the cause. You may experience the following:

  • Hot flashes
  • Vaginal dryness
  • Discharge of milk from your nipples
  • Headache
  • Acne
  • Changes in vision
  • Excessive growth of hair on your face and body

As you can notice, its symptoms are pretty similar to oligomenorrhea. Thus, it is best to consult your gynaecologist to discuss your symptoms.

Causes of amenorrhea

Common causes of primary amenorrhea include the following:

  • A genetic problem with the ovaries
  • Hormonal issues as a result of problems with the hypothalamus or the pituitary gland
  • Missing a part of the reproductive system

Common causes of secondary amenorrhea include:

  • Pregnancy
  • Breastfeeding
  • Menopause
  • Some birth control methods (e.g., intrauterine devices and certain pills)
  • Chemotherapy and radiation therapy (for cancer)
  • History of uterine surgery


Treatment options for amenorrhea

Your treatment depends on the cause of the absence of periods. Options include:

  • Maintaining a healthy weight (if excessive weight is the cause)
  • Gaining weight through an individualised diet plan (if extreme weight loss is the cause)
  • Stress management techniques
  • Hormonal treatment (medication)
  • Surgical intervention (in rare cases)


When should I seek medical attention?

Immediately reach out to a recommended women’s clinic in Singapore if you experience severe pain during your period or in between, unusually heavy bleeding, abnormal vaginal discharge, or any menstrual irregularity.