🩸 Men's Health

Menstrual Disorders in Nigeria — Heavy, Painful & Irregular Periods

Understanding and treating abnormal periods in Nigerian women

Menstrual disorders are one of the most common reasons Nigerian women attend gynaecology clinics, yet many suffer in silence for years — attributing heavy or painful periods to 'it's normal for our family' or spiritual causes. Normal menstrual cycles occur every 21–35 days, last 2–7 days, and result in 20–80mL blood loss. Any significant deviation from this warrants assessment. The common menstrual disorders — heavy menstrual bleeding (HMB), dysmenorrhoea (painful periods), and irregular bleeding — all have identifiable, treatable causes in most cases.

Signs and Symptoms

✓ Heavy menstrual bleeding (HMB): soaking a pad or tampon every 1–2 hours, passing clots larger than a 50 kobo coin, bleeding for > 7 days, flooding onto clothes or bedding

✓ Dysmenorrhoea (painful periods): cramping pain in the lower abdomen, back, or thighs — primary (no underlying cause) or secondary (endometriosis, fibroids, adenomyosis)

✓ Oligomenorrhoea: periods more than 35 days apart — may suggest PCOS, thyroid disease, or perimenopause

✓ Amenorrhoea: no periods for 3+ months (primary: never had periods by age 16; secondary: previously regular periods stopped)

✓ Intermenstrual bleeding (IMB): bleeding between periods — needs investigation for cervical, endometrial, or hormonal causes

✓ Premenstrual syndrome (PMS): physical and emotional symptoms in the week before the period

Risk Factors

Heavy periods: fibroids (especially submucosal), adenomyosis, coagulopathy (von Willebrand disease), thyroid disease, copper IUD, hormonal imbalance
Painful periods: endometriosis (secondary dysmenorrhoea), adenomyosis, fibroids, PID, IUD use
Irregular periods: PCOS (most common), thyroid disease, hyperprolactinaemia, extreme weight loss or gain, exercise, stress, perimenopause
Absent periods: pregnancy first (always test), PCOS, hypothalamic amenorrhoea (anorexia, excessive exercise), premature ovarian insufficiency, thyroid disease, hyperprolactinaemia

When to Seek Help

Heavy periods causing anaemia symptomsFatigue, pallor, breathlessness — iron deficiency anaemia from chronic blood loss. Urgent FBC and gynaecological assessment

Any intermenstrual or postcoital bleedingBleeding between periods or after sex — must be assessed for cervical cancer, endometrial pathology, or STI

Postmenopausal bleedingAny vaginal bleeding more than 12 months after the last period is endometrial cancer until proved otherwise — urgent referral

Periods absent for 3+ months (not pregnant)PCOS, thyroid disease, or premature ovarian insufficiency — needs investigation

Dysmenorrhoea affecting school/work attendanceSecondary dysmenorrhoea (endometriosis) must be excluded — don't accept 'severe periods are normal'

Tests & Diagnosis

🧪 Pregnancy test

First investigation for any menstrual irregularity — always exclude pregnancy first

🧪 Full blood count

Anaemia from chronic blood loss. Thrombocytopaenia causing HMB (rare but important)

🧪 Thyroid function tests (TSH)

Hypothyroidism causes heavy periods; hyperthyroidism causes light, infrequent periods

🧪 Coagulation screen and von Willebrand factor

Up to 20% of women with heavy periods from adolescence have an underlying bleeding disorder — especially von Willebrand disease

🧪 Pelvic ultrasound (transvaginal)

Uterine fibroids, polyps, adenomyosis, ovarian pathology — the most informative investigation after FBC

🧪 Hysteroscopy

Direct visualisation of the uterine cavity — diagnoses and treats polyps, submucous fibroids, and endometrial lesions

🧪 FSH, LH, oestradiol, prolactin, testosterone

For oligomenorrhoea/amenorrhoea — assesses hormonal axis

🧪 Endometrial biopsy (pipelle)

For women over 40 with irregular or heavy bleeding — excludes endometrial hyperplasia and cancer. Quick outpatient procedure

Treatment Options

Heavy periods — medical management

Tranexamic acid 1g three times daily during periods (reduces blood loss by 50%). NSAIDs (mefenamic acid) — reduce loss and pain. Mirena (levonorgestrel IUS): most effective medical treatment — reduces blood loss by 90%, avoids surgery. COCP: regulates and lightens periods

Heavy periods — surgical management

Endometrial ablation: destroys the lining — very effective for dysfunctional uterine bleeding, day case. Myomectomy: fibroids removed surgically. Hysterectomy: definitive treatment — for completed family, refractory to other treatments

Painful periods — primary dysmenorrhoea

NSAIDs started 1–2 days before period (ibuprofen 400mg TDS, mefenamic acid 500mg TDS). COCP for ongoing management

Painful periods — secondary (endometriosis)

See endometriosis guide — hormonal suppression and laparoscopic surgery

Irregular periods (PCOS)

Lifestyle: weight loss in overweight women restores ovulation in many. COCP for cycle regulation. Metformin in insulin-resistant PCOS

Absent periods — hypothalamic amenorrhoea

Treat underlying cause: weight restoration for anorexia, reduce excessive exercise, manage stress. Hormonal replacement until natural periods return to prevent osteoporosis

Frequently Asked Questions

Is it normal to have very painful periods?

Mild discomfort that responds to paracetamol is common. Pain that requires you to stay in bed, take strong medication, or miss school or work is NOT normal and should be investigated — especially pain that starts a day or two before the period (classic of endometriosis). Accept assessment, not suffering.

How do I know if my periods are too heavy?

Practical markers: soaking through a pad in 1–2 hours, passing clots larger than a 50-kobo coin, flooding through to clothing or bedding, lasting more than 7 days. If you're regularly buying extra pads or managing your life around your period, your bleeding is abnormally heavy and treatable.

Can fibroids cause both heavy periods and infertility?

Yes. Submucosal fibroids (growing into the uterine cavity) cause heavy periods and significantly impair implantation of embryos — they should be removed before fertility treatment. Intramural and subserosal fibroids have a smaller effect on fertility but can cause heavy periods, pressure symptoms, and pregnancy complications.

Will a hysterectomy affect my hormones or cause early menopause?

Hysterectomy alone (removing the uterus but leaving the ovaries) does not cause menopause — the ovaries continue to produce oestrogen until their natural age of failure. Total hysterectomy with bilateral oophorectomy (removing both ovaries) causes surgical menopause — with immediate hot flushes, vaginal dryness, and osteoporosis risk. Hormone replacement therapy is recommended when oophorectomy is done before natural menopause age.