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Menstrual Disorders

Normal Physiology

Menarche is the onset of menses in females.  Menarche occurs between 11-14.5 years in 95% of females.

Menses bleeding usually lasts 3-5 days but anywhere from 2-7 days is normal.  Average interval between cycles is 28 days but anywhere from 23 to 35 days is considered normal.

Menopause defined as one year after the last menstrual cycle.  Average onset of menopause is age 51 years old.


Menstrual Disorders:

  • Anovulation (failure to ovulate) is the most common cause of infrequent menses (oligomenorrhea), irregular menses, and excessive bleeding.  50% of menstrual cycles are anovulatory in 1st year after menarche.  By third year after menarche, 95% if cycles are ovulatory.
  • Oligomenorrhea is infrequent bleeding with more than 45 day intervals.
  • Menorrhagia is prolonged bleeding more than 7 days duration.
  • Metrorrhagia is bleeding at irregular but frequent intervals.
  • Menometrorrhagia is prolonged bleeding at irregular intervals.
  • Dysfunctional Uterine Bleeding (DUB)- Bleeding may be irregular, prolonged, very heavy and contain clots.
  • Amenorrhea is the absence of menses.
  • Primary amenorrhea is defined as no onset menarche by age 16.
  • Secondary amenorrhea is defined as absence of menses from 6 months after menarche onset. 

Abnormal bleeding may result in complications such as an Increased risk for hyperplasia (thickening of uterine lining) which can increase risk of endometrial cancer, anemia due to excessive blood loss, pain and cramping with menses, interruption in normal daily routines such as school, work and social life and sometimes surgery may be required.

    Diagnosis and Treatment May Include:

    • Physical Exam
    • Blood Testing
    • Pelvic Ultrasound
    • Endometrial Biopsy
    • Hysteroscopy
    • Dilatation and Curettage (D&C)
    • Medications
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