This symptom causes substantial anxiety in the sexually active woman: the first unexpectedly missed period suggests pregnancy; prolonged absence raises the concern that something is seriously amiss. In contrast, management is usually straightforward and helped by acknowledging the anxiety.
This is a common presenting complaint. The average practice of 4 GPs can expect about 400 women to consult each year for menstrual problems (female clinicians rather more) and many of these will be for menorrhagia. Normal menstrual blood loss is 20–80 ML. In practice, measurement is not feasible, so the definition rests on what the woman reports, although some efforts can be made to establish whether or not the bleeding is ‘excessive’.
Irregular vaginal bleeding presents commonly in primary care – particularly to female GPs and nurses, as the patient will often anticipate a pelvic examination. This chapter covers all causes of this symptom throughout life including prepubertal, causes in early pregnancy and post-menopausal (causes in late pregnancy are not covered as they constitute a quite different clinical scenario). The key to appropriate management usually lies in a careful history
Painful periods are extremely common: 50% of women in the UK complain of moderate pain, and 12% suffer severe, disabling pain. Primary dysmenorrhoea is pain with no organic pathology, usually starting when ovulatory cycles begin. Secondary dysmenorrhoea is associated with pelvic pathology, and appears later in life.