Menstrual problems

Most women experience relatively regular menstrual cycle ranging between 24 to 40 days, with each period lasting between 2-8 days. Some women may experience some pain during their periods and can tend to have heavier bleeds in the first 2 days.

However the process of menstruation can sometimes present with a few problems which can be distressing for women. These problems could include:

Heavy periods

Heavy periods occur commonly in women and there is sometimes no underlying cause for this. It is not always easy to quantify the amount of blood a woman loses during menstruation but most women have an idea what is normal for them and can tell if there has been a change in their menstrual flow.

If you have to change your sanitary pads every 1 to 2 hours or if you are passing clotted blood, this might be an indication that you are suffering from heavy menstrual bleeds.

What are the causes heavy periods?

In very many women, there is no identifiable cause for their heavy periods, however in other women, heavy periods could be the sign of some conditions or the result of the use of certain medication.

Some of the conditions are discussed below:

  1. Fibroids: These are growths around the wall of the womb. They vary in size and location within the womb.
  2. Vaginal infections: Although would likely cause vaginal discharge, pain during intercourse or during urination, it can also result in heavy menstrual bleeding.
  3. Underactive thyroid: The thyroid gland is a gland which produces a hormone called thyroxine. When the thyroid gland is underactive, it can result in heavy menstrual bleeds.
  4. Medications: Some medication can cause heavy menstrual bleeds. For example, medications used to thin the blood.

What should I do if I experience heavy menstrual bleeds?

Sometimes women who have heavy menstrual bleeds can lose so much blood each cycle and this can make them anaemic (low level of blood cells). If your menses lasts more than 8 days or if you have to change your pads every 1 to 2 hours, then you need to see your doctor so that you can be assessed further. Your doctor would ask you questions so as to ascertain the cause of your heavy periods. They may also need to examine you and request blood tests and ultrasound scan.

What is the treatment if heavy periods?

The treatment for this condition will be dependent on the particular cause. Where there is no specific cause, the following could be helpful in reducing menstrual blood loss:

  1. Intrauterine System (coil): This is normally used as a means of contraception (preventing pregnancy) but can also help in reducing menstrual blood loss. If you require contraception, this will be the ideal treatment for you.
  1. Contraceptive tablets: Tablets used for preventing pregnancy (contraceptives) can also be used.
  1. Medicines that reduce menstrual blood loss: An example of these include Tranexamic acid.

In individuals whose causes of heavy bleeding is uterine fibroids-the options available can be medication or surgery to shrink the fibroids. In women who have completed their childbearing, it is a possibility to also remove the womb by surgery.

What are the complications of heavy menstrual bleeding?

A direct complication of heavy menstrual bleeding is anaemia (low blood count) which can result in symptoms such as dizziness, difficulty in breathing, generalized fatigue. If it carries on for a long time, it can affect the heart.

Painful Periods

Pain is the most common problem most women experience during their periods. This pain is usually described as crampy pain in the tummy and can spread to the back and the thighs.

The pain can vary from one woman to another and also with every cycle. However most of the time, it is often relieved by simple painkillers such as paracetamol or ibuprofen.

What causes period pain?

A lot of the time, pain during periods is part of a natural process which causes the womb to contract so as to be able to expel the lining which comes out as the menstrual flow. However, this pain can be worsened by conditions such as fibroids and other conditions affecting the womb.

What can I do to manage this problem?

Taking pain medication such as Ibuprofen, Aspirin or Naproxen can help to reduce the pain. You can also ask your doctor about Mefenamic acid which is a similar medication as the above but can also help to reduce the menstrual blood loss.

If you are do not experience relief with the usual pain medication, you should see your doctor who will assess your further and might request a few tests.

Contraceptive tablets can also be helpful to reduce period pain in addition to reducing menstrual blood loss.

Irregular periods

This occurs when the length of your menstrual cycle (the gap between one period and the next) changes frequently.

Having irregular periods is not always a sign that something is wrong. It is usually common in the teenage years and as women are near menopause.

What are the causes of irregular periods?

Aside puberty and menopause, the following can also cause irregular periods:

  1. Stress which could both be physical or emotional, excessive weight gain or weight loss, excessive physical exercise.
  2. Medical conditions such as polycystic ovarian syndrome, thyroid problems, or uncontrolled diabetes.
  3. Infections: Occasionally an infection of the vagina or the female reproductive organs can cause irregular periods.
  4. Contraceptives (Birth control medicines) can sometimes be the cause of irregular menses in women

What should I do about this problem?

You do not need to do anything if your periods have always been irregular or you are still going through puberty or approaching menopause.

However if you you do not fall into this categories and your periods have suddenly become irregular after having normal cycles you should see your doctor.

You should use the following criteria as a guide:

  • you have periods more frequently than every 21 days or less frequently than every 38 days
  • your periods last longer than 7 days
  • You are having difficulty getting pregnant

What is the treatment?

The treatment will depend on the cause of your irregular periods. Your doctor might carry out examinations and tests to check for any cause. They may refer you to a gynaecologist if required.

Absent periods

This occurs when a girl hasn’t had her first menstrual period by age 16 or when a woman fails to menstruate for 3 to 6 months.

What are the causes of absent periods?

Pregnancy: This is the most common reason periods may stop so if you are sexually active, even if you have never menstruated before, it is important to first carry out a pregnancy test to check for pregnancy.

Stress: This can be either physical or emotional stress and can include problems like exercising excessively.

Weight gain or loss: Sudden excessive weight gain or loss has the potential of causing absent or irregular menses. If your change in weight is deliberate then adjustments can be made. If it cannot be explained it might be useful to see a doctor.

Medical conditions such polycystic ovarian syndrome or thyroid problems can be a cause of absent menses

Contraceptive (Birth control) Medication If you taking birth control medication of any type, this could result in irregular or absent menses.

When should I see a doctor?

You should consult your doctor if you have not had your periods in the last 3 months and you are not pregnant or breastfeeding.

You should also see your doctor if you are 16 years old and haven’t had any periods yet.

What will the doctor do?

First as with most visits to the doctor, they will ask you certain questions related to your health and lifestyle. They may carry out some examinations and tests to find the cause and they may refer you to a specialist if they feel there is an underlying cause that requires specialist treatment.