This introduction discusses the aetiology of menstrual problems, their presentation and investigation as well as medical and surgical management. Specific problems such as fibroid-associated bleeding, adolescent and perimenopausal bleeding and breakthrough bleeding are covered, as are other critically important problems such as premenstrual disorders, pelvic pain and dysmenorrhoea. The most common presenting menstrual problem is heavy menstrual bleeding (HMB). A woman's approach to her periods will vary through her reproductive life. After childbearing is completed, the view of the menses will alter dramatically. The longest intermenstrual interval occurs at the menarche. Menstrual irregularity is most likely to occur at the extremes of reproductive life, the incidence of anovulation increasing as the menopause approaches. Classical primary spasmodic dysmenorrhoea occurs at the onset of the menses and gets better after 1 or 2 days, whereas secondary dysmenorrhoea tends to start prior to the menses and worsens as it proceeds.

This chapter presents a case study of a 42 year old female (Alison), who suffered from heavy painful periods. Alison's situation is far from unusual for this age group, where the risk of relationship breakdown is high. It is apparent that Alison's first priority is a highly effective contraceptive method. However, she requires much more from her method: effective control of bleeding and dysmenorrhoea; restoration of menstrual predictability and/or amenorrhoea. A bimanual examination for Alison is undertaken to assess for uterine enlargement (fibroids, adenomyosis), uterine mobility and adnexal masses and/or tenderness. Alison was advised about how the levonorgestrel-releasing intrauterine system (LNG-IUS) works by profound endometrial glandular and stromal suppression, cervical mucus changes and a foreign body effect within the endometrium. Progestogen-only pills (POPs) would be an option for Alison if she has contraindications to taking oestrogens.

Excessive or abnormal vaginal bleeding are the most common symptoms when women present to a gynaecologist. Undiagnosed bleeding disorders, especially Von Willebrand's disorder, can be the under-lying cause of menorrhagia in a significant proportion of women. This chapter aims to increase awareness and provide basic information about these relatively uncommon disorders. Immune idiopathic thrombocytopenic purpura (lTP) in adults is usually a chronic disorder with an insidious onset of minor bleeding symptoms. Menorrhagia and dysmenorrhoea adversely affect women's quality of life and may have a major influence on lifestyle and employment. DDAVP (1-desamino-8-D-arginine vasopressin) nasal spray increases von Willebrand factor (VWF) and FVIII and can be used as a home treatment for some women with bleeding disorders. Increased awareness among clinicians of these problems and the treatment options available are essential to improve quality of life and avoid unnecessary surgical intervention.