Common Period Problems

Getting your monthly period is inconvenient enough without the myriad of extra problems that often accompany it, like pain, heavy bleeding and erratic timing. All you really want is to know when it’s coming, and to be able to deal with it for a few days with as little fuss as possible.

Menstrual disorders can be debilitating. While some are manageable, others will require a visit to your doctor to get to the root of the problem. It’s best to find out sooner rather than later whether your symptoms are easy to clear up, or are a symptom of a bigger issue. Either way, there is no need to suffer in silence.

Let’s review a list of menstrual problems and see which ones could be affecting you.

Common period problems

Whatever issue you are facing, it helps to jot down a list of symptoms of various menstrual disorders and see how they do or don’t align with your regular period. After this initial step, your doctor may investigate further with a variety of options, including a pelvic exam, blood test, biopsy, hysteroscopy or ultrasound.

Period Pain

Generally, there are two types of period pain – one is common and usually eases over time; the other is a sign of a medical issue that requires more attention.

In the case of primary dysmenorrhoea, you feel uncomfortable as your uterus contracts to get rid of its lining. Most women find this more painful during their teenage years, then report having it less severely as they age. However, for some women it never clears up completely. The risk is usually higher if you started menstruating before you turned 11, have long or heavy periods, smoke, or have a lot of stress in your life.

If you have pain that gets worse with age or lasts longer than monthly cramps, you may be experiencing Secondary Dysmenorrhoea:

• Endometriosis – Swelling and pain caused by the lining of the uterus growing outside the uterine wall. As your oestrogen levels change each month, the lining breaks down and bleeds.
• Uterine Fibroids – If you have pelvic pain or bleeding after your period ends, you may have these (usually non-cancerous) tumours in or on the wall of your uterus.
• Ovarian cysts – These fluid-filled sacs can be painful during your period or ovulation.

You should see your doctor if your pain becomes unmanageable and begins to interfere with your ability to work or go to school. Track your symptoms and how they coincide with your periods to help your doctor to get to the bottom of what is causing your pain.

You should definitely make an appointment if your menstrual flow contains blood clots larger than the size of a 10p coin or if your pain persists after your period ends.

Some possible treatments are hormonal or surgery-based methods of contraception.

If your mum has experienced heavy and painful periods, whether due to hormonal or other causes, then you are more likely to suffer from Primary and Secondary Dysmenorrhoea as well.

Irregular Periods

If the time between your periods lasts 24 to 38 days, then you are on track. However, if your cycle changes from month to month by more than 20 days, you may be new to menstruation or facing perimenopause (the transition into menopause).

If you don’t fit into either of these groups, you may be facing one of these issues related to irregular periods:

• Eating disorders
• Thyroid problems
• Increased amount of prolactin, the hormone that stimulates breast growth and breastmilk production
• Medicines treating epilepsy or anxiety
• Polycystic ovary syndrome, a condition that affects 1 in 10 women, causing multiple ovarian cysts and hormonal imbalance
• Primary ovarian insufficiency, a condition where your ovaries stop working normally
• Pelvic inflammatory disease, an infection of the reproductive organs often caused by a sexually transmitted infection (STI).
• Stress
• Uncontrolled diabetes
• Obesity

Call your doctor if your periods become irregular, or if your cycle is shorter than 24 days or longer than 38 days.

Heavy Periods

Heavy bleeding makes periods more painful and more likely to disrupt your day-to-day activities. However, they are also a sign that your body is producing and releasing a lot of life-giving blood.

Some possible causes of heavy periods are:

• Ovulation or uterine lining problems that lead to build-up or irregular bleeding of the uterine lining from month to month
• Thyroid problems
• Uterine fibroids, as described above
• Uterine polyps
• Blood thinners or other medications
• Miscarriage or an ectopic pregnancy
• Inherited bleeding disorders that affect 1 in 5 white women and 1 in 20 black women
• Obesity
• Chronic fatigue syndrome

You should see your doctor if:

• Your period lasts longer than eight days
• You bleed enough to use one or more pads or tampons every hour or two
• You feel dizzy, lightheaded, weak or tired, or show other signs of anaemia
• You notice menstrual blood clots larger than the size of a 10p coin
• Your period is starting to impact significantly on your personal or professional life.

Your doctor may prescribe over-the-counter pain medication to alleviate inflammation, hormonal contraceptive methods or, in extreme cases, surgery.

Missed Periods

If you have missed three periods in a row or have not started menstruating by age 15, you may have a condition called amenorrhoea. This affects 3 to 4 percent of women who produce lower levels of oestrogen. You should see a doctor if you fall into this category, if breast growth has not started by age 13, or if your period has not started within three years after breast growth.

Possible causes of a missed period are:

• Pregnancy
• Breastfeeding during the first six months after giving birth
• Eating disorders or extreme weight loss or gain
• Stress
• Hormonal problems
• Other serious health problems, including birth defects or brain tumours
• Premature menopause/premature ovarian insufficiency

Abnormal Bleeding

You should see your doctor if:

• You bleed during or after sex, more than once
• You spot or bleed outside your menstrual cycle for more than 3 consecutive months
• Your period lasts longer or is heavier than usual for more than 3 consecutive months
• You experience bleeding after menopause on any occasion

You may be experiencing hormonal changes, endometriosis, ovarian cysts or cancer. Your doctor will reach a diagnosis by looking at the most common likely cause for your age group.

PMS and mood swings

Few women do a happy dance when they get their period, but many also face mood swings caused by a drop in oestrogen and progesterone levels just before their period. The most serious form of this is known as premenstrual dysphoric disorder (PMDD).

You may have this condition if:

• You experience severe mood swings, irritability, anger, a lack of enjoyment in hobbies or the company of loved ones.
• These symptoms appear during the week before your period, then start getting better in the first few days of bleeding and disappear after your period.
• These symptoms are having a significant impact on personal and professional relationships, disrupting your life and causing conflict – many women experience milder versions of these issues as part of the PMS which is a much more common diagnosis.

You should see your doctor if these symptoms worsen within the timeframe described above. You may need to be prescribed antidepressants or a hormonal contraceptive to stabilise your oestrogen and progesterone levels.

Treatment for PMDD

Medication and psychotherapy can be helpful in cases of PMDD but treatment is rarely straightforward and it is essential that specialist medical advice from a gynaecologist with expertise in this area, is obtained. Not all women will respond to antidepressants, mood stabilisers and hormonal medication, hence the need for specialist involvement.

Migraines

While 4 in 10 women get migraines, half of them face these painful headaches during their periods, possibly due to the hormonal changes experienced at this time of the month.

You should see your doctor if:

• Previous treatments are no longer working
• You are experiencing side effects from your medicine
• You see bright flashing lights or spots that aren’t real and are taking a contraceptive pill
• Your headaches change or worsen when you lie down

Most treatments aim to manage the pain or avoid the triggers, but they cannot eliminate the headaches entirely.

Disclaimer: This information aims to answer some of your questions or concerns. If you are worried about your health, talk to your family doctor or your gynecologist for professional medical advice.