Common issues associated with menstruation include:
There are many etiologies of absent, irregular, heavy, or intermenstrual vaginal bleeding; for example, polycystic ovary syndrome is a common cause of oligomenorrhea or amenorrhea. (For a description of the normal menstrual cycle, see Menstrual Cycle.)
Menses and menstrual abnormalities occur in nonpregnant reproductive age women. Abnormal uterine or vaginal bleeding in pregnant or postmenopausal patients may appear to be menses, but the etiologies and evaluation of abnormal bleeding are different in these patients.
Pregnancy testing should be done in all reproductive-aged female patients with abnormal genital tract bleeding. Pregnant patients should be evaluated for obstetric complications (see Vaginal Bleeding During Early Pregnancy and Vaginal Bleeding During Late Pregnancy).
Evaluation of menopausal status based on history and, sometimes, hormone level blood tests should be done if menopause is suspected based on age or symptoms and if primary ovarian insufficiency is suspected based on associated autoimmune diseases or menopausal symptoms. Postmenopausal patients with genital tract bleeding should be evaluated for gynecologic malignancy.
Pelvic venous disorders (formerly called pelvic congestion syndrome), a common cause of chronic pelvic pain, is sometimes accompanied by abnormal menstrual bleeding.
