Important Definitions Used In Gynecological Practice.

Menarche – first menstrual period.

Menopause – date of final menstrual period. This can only be defined with certainty after a year has elapsed since the final menstrual period. It is also useful to ask about menopausal symptoms and hormone replacement therapy (HRT) use. The classic menopausal symptom is vasomotor flushes, but a myriad of other symptoms can also be experienced.

Perimenopause – the years of transition where irregular cycles occur. For most women, this lasts for 4 years before the final menstrual period occurs.

Menorrhagia – heavy periods. This is one of the commonest reasons that women are referred to gynecology.
You should ask for how long and how often bleeding occurs. The passage of clots and flooding through sanitary protection are signs that the menstrual flow is excessive. It can also be useful to ask about frequency of changing sanitary protection and whether ‘double’ protection is required, that is, having to wear a sanitary towel and tampon at the same time.

Abnormal Bleeding
Postcoital bleeding – bleeding occurring after intercourse.
Intermenstrual bleeding – bleeding between periods.
Postmenopausal bleeding – bleeding more than one year since LMP.

Irregular Bleeding
Primary amenorrhoea – failure to menstruate by age 16.
Secondary amenorrhoea – no menstruation for 6 months after periods are established.
Oligoamenorrhoea – infrequent, erratic periods.

Remember that anovulatory cycles occur at the extremes of menstrual life. It is therefore physiological to have erratic infrequent periods in the first few years after menarche and in the perimenopause.


Dysmenorrhoea refers to painful menses, usually of a crampy nature. This is usually central low abdominal cramp but can be referred to the thighs and lower back.
Primary dysmenorrhoea – periods have been painful since established menstruation has occurred.
Secondary dysmenorrhoea – periods have become painful. This is thought to be more likely to be associated with pelvic pathology.
Mittelshmertz – mid-cycle pain related to ovulation.

Dyspareunia – Pain or exacerbation of underlying pain during sexual intercourse is an important symptom.

Vaginismus is also a common cause of dyspareunia, where the vaginal muscles tense during attempted penetration. It can affect tampon insertion and smear taking and can usually be demonstrated with vaginal examination