Most women have a regular menstrual cycle that’s around 28 days long (28 days from the start of one period to the start of the next), and they bleed for three to seven days each cycle. However, some women experience problems with their periods. Before you see your doctor about period problems, it can be useful to keep a diary of your symptoms throughout the menstrual cycle. This can give your doctor a detailed idea of what happens, and when, during your cycle. Various menstrual problems may occur:
Pain during periods is common. It’s caused by the womb contracting to push out the blood. Exercise may help to relieve the pain, and some women find over-the-counter painkillers, such as paracetamol or ibuprofen, work. Ask your pharmacist for advice. If the pain is so severe that it affects your daily life, talk to your doctor. Hormonal contraception – such as the combined pill, the intrauterine system (IUS), the contraceptive patch or the contraceptive injection – can reduce period pain.
Some women naturally have heavier periods than others, but if your periods are so heavy that they impact your life. Talk to your doctor about your bleeding, including how often you have to change your sanitary protection (towels, tampons or menstrual cup). Your doctor can investigate why you’re experiencing heavy bleeding. These investigations may include blood tests and scans.
Your doctor might decide to give you some form of hormonal contraception, such as the intrauterine system (IUS), the contraceptive implant, contraceptive injection or the combined pill, tranexamic acid tablets (taken for a few days around the time of your period), non-steroidal anti-inflammatory drugs or progestogen tablets. In some cases, surgery may be an option if other treatments don’t work, or if there are problems with the womb, such as fibroids (non-cancerous growths). Surgery may include removing fibroids, the lining of the womb, or the womb itself.
A period normally lasts two to seven days, with the average period being five days long. However, some women have an irregular menstrual cycle. Irregular periods can be common during puberty and just before the menopause.
Having no periods may indicate an underlying health problem. If this happens to you, contact your doctor. Periods can also stop as a result of severe weight loss, stress or strenuous exercise.
Premenstrual syndrome (PMS)
PMS is thought to be linked to changing levels of hormones throughout the menstrual cycle. Not all women experience PMS, and among those who do, the range and severity of symptoms can vary. Severe PMS can disrupt a woman’s personal and work life, making it hard to function in the days before her period. Symptoms include mood swings, irritability, depression, headaches, bloating and even breast tenderness. Symptoms appear and can intensify during the second half of the menstrual cycle, and then ease and disappear after the period has started.
Some women who experience PMS can benefit from eating a healthy, balanced diet, reducing their alcohol and caffeine intake, and getting regular exercise to keep fit. Cognitive behavioral therapy (CBT) may also help. CBT is when a counsellor helps you to recognize negative behaviors and work out strategies to change them. Various complementary therapies and vitamin supplements claim to help with PMS.
In some cases, there may be an underlying psychological condition that doesn’t go away when the period finishes. This is an indication that it’s not a symptom of PMS. In such cases, treatment for the psychological condition may help.
This is a condition where the cells lining the womb (endometrium) appear in other areas of the body. This is usually in the abdominal area, including the pelvis, ovaries and fallopian tubes. Period hormones cause the ovaries to release an egg and the womb lining to thicken. If the egg isn’t fertilized, the womb lining breaks down and bleed, and leaves the body as a period. Endometriosis cells elsewhere in the body also break down and bleed, which causes inflammation, pain and adhesions (scar tissue).
Not all women have symptoms, but common symptoms can include painful, heavy or irregular periods, pain during or after sex, infertility, problems in passing stool. These symptoms can signify a range of other conditions. A laparoscopy (a surgical procedure in which the surgeon looks into the abdomen with a small camera) is the only way to make a definite diagnosis.
Different treatment options include painkillers, hormone treatments, hormonal contraceptive methods and drugs that can cause a temporary and reversible menopause by stopping the body producing oestrogen. In severe cases, surgery can be carried out to remove the endometriosis or the ovaries and womb. Some, but not all, women with endometriosis have difficulty getting pregnant. If you have missed a period and think you might be pregnant, find out the signs and symptoms of pregnancy and about doing a pregnancy test.
Some women get a one-sided pain in their lower abdomen when they ovulate. The pain can be a dull cramp or a sharp and sudden twinge. It can last just a few minutes or continue for a day or two. Some women notice a little vaginal bleeding when it happens. Painful ovulation can usually be eased by simple remedies like soaking in a hot bath or taking an over-the-counter painkiller, such as paracetamol.