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Menstrual dysfunction is common, with approximately 9–30% of reproductive-aged women presenting with menstrual irregularities requiring medical evaluation. The causes are diverse and multiple treatment options are available. Appropriate management relies on relevant investigation and accurate diagnosis. This article reviews the most common causes of menstrual dysfunction using case histories for illustration. The conditions covered in this review include menstrual dysfunction around the time of menarche, ovulatory and anovulatory dysfunctional uterine bleeding, polycystic ovarian syndrome, uterine fibroids and dysfunctional bleeding around the perimenopause. Appropriate investigations and current management strategies are also discussed.