Did you know your monthly period says a lot about your health, especially your hormonal health? This is important as your hormones play a critical role in keeping your body systems running smooth. Period problems are pretty common but if you know what to watch out for, some of these issues could actually be red flags that you need a visit your gynaecologist. Sometimes, even subtle shifts in your usual pattern can signal a serious problem in the making.
Pain and emotional symptoms are a part of your menstrual cycle. But for some women, menstrual problems can disrupt their quality of life. From heavy bleeding and disabling pain to irregular periods and severe PMS, menstrual problems can be daunting and can manifest in a number of ways.
Why do you get periods?
Each month, a woman’s body undergoes a series of changes to prepare itself for a possible pregnancy. One of the ovaries releases an egg and during this time, the uterus develops a lining (endometrium) to nourish and protect a foetus in event of pregnancy. If there is no pregnancy, the uterus sheds this lining. This is when a woman gets her periods.
And the games that hormones play
To be precise, your period is only a part of the monthly menstrual cycle. And a lot of hormones are at work to orchestrate the events that precede and follow your menstrual cycle. Let’s have a quick look at the two milestone phases in a normal, healthy menstrual cycle.
The first day you get your period is day one of your menstrual cycle. This is how it starts. The levels of estrogen and progesterone are low, which makes your uterus shed the inner lining.
Your ovaries release egg cells that grow and mature into follicles, tiny fluid filled sacs. Follicles release estrogen, whose levels continue to rise for about the first half of your cycle. It could be 14 days if you have a 28-day cycle; or 17 days if your cycle is 35 days long. With many roles under its belt, estrogen also triggers the uterus to form a lining of blood vessels and soft tissue. The follicles continue to grow up to a certain size and then the most mature follicle will release an egg, which is swept away in the fallopian tube where it waits to become fertilized by a sperm (this is called ovulation phase).
Once the follicle releases the egg it secretes progesterone, which makes the lining swell and prepares the uterus to receive a fertilized egg. If the egg is not fertilized, the levels of progesterone and oestrogen take a dip. And this is the cue for the uterus to expel the lining. And the cycle continues, unless there is something wrong with the body. And this is when you experience menstrual issues.
Fast Facts on Menstrual Cycle
- A girl typically starts her periods from anytime between 9-13 years of age.
- A normal, average cycle typically lasts 25-35 days, with a period lasting three to seven days.
- The intensity, frequency and symptoms can all vary from woman to woman. They can even change for the same woman from cycle to cycle.
- It is common to have long and even infrequent cycles during the first few years when you start your periods. These tend to get shorter and more regular as you age.
- Once you reach the ‘45-55’ age bracket, your body makes less estrogen and your period will become irregular and shorter until it stops completely. This is menopause.
5 Menstrual Problems That You Should Not Ignore
- Heavy bleeding or menorrhagia
During a normal period, a woman may bleed between 20 ml and 60 ml of blood in a month. This amounts to six to eight teaspoonfuls. Chronic blood loss of more than 80 ml is considered to be heavy menstrual bleeding. It is common to experience heavy flow during your teen years and in your late 40s and 50s.
Since it is not possible to measure the blood loss, how do you know you are bleeding more than normal?
- If you have to change your sanitary pad every 1-2 hours
- If your blood flow lasts longer than 7 days
- If your bedclothes get soaked
- If it interferes with your daily routine such as work, taking care of your kids or going out
Don’t ignore these signs. Abnormal heavy bleeding could lead to severe anemia. These signs could be an indication of underlying problems. Some drugs can also make you bleed excessively during this time.
- Imbalances in hormones, especially progesterone and estrogen
- Fibroids in the uterus
- Small fleshy lumps or polyps in the uterus
- Underactive thyroid gland
- Issues with an IUD (intra-uterine device)
- Polycystic ovary syndrome (PCOS) – this may cause heavy though irregular periods
- Vaginal infections
- Ectopic pregnancy, which occurs when a fertilized egg starts growing in your fallopian tubes
- Bleeding disorders, such as leukemia, platelet disorders, clotting problems. (Having a von Willebrand disease may also contribute, though it is not a very common cause. Von Willebrand disease is a genetic disorder caused by a lack of or dysfunctional protein that helps in clotting and controls bleeding.)
- Blood thinning drugs like warfarin
- Stopping contraceptive pills
- Painful periods or dysmenorrhea
During periods, some pain and cramping in the lower abdomen is normal. The cells in the uterine lining produce prostaglandin, a hormone like substance that is associated with pain and inflammation. The job of prostaglandin here is to make uterus contract so that it can shed and expel the lining that has built-up in the anticipation of a potential pregnancy. Your pain is a result of these intense contractions, that temporarily shut off in the blood supply. Higher levels of prostaglandins may also cause other symptoms such as nausea, diarrhea and light-headedness.
What is not normal, however, is when your cramps are extremely painful. If your period pain is not relieved with an over-the-counter pain killer, makes you miss work or interferes with your daily routine, it could be sign of:
- Uterine fibroids
- Pelvic inflammatory disease
- Endometriosis (where the lining of the uterus grows outside of the uterus)
- Problems with IUDs
- Sexually transmitted infections such as chlamydia or gonorrhoea
- Adenomyosis (where the lining on the uterus begins to grow in the uterine muscle wall)
- Pre-menstrual Syndrome (PMS)
PMS is a cluster of symptoms that can range from physical (such as cramps, bloating and headaches) to psychological (such as mood swings, depression and crying spells). More than half of women experience mild symptoms 7 to 10 days before their period starts. Usually, these signs go away once the flow begins, or sometimes soon after.
Some common PMS symptoms are:
- Headaches and migraines
- Swollen, painful breasts
- Anger and irritability
- Stress, anxiety and confusion
- Mood swings and depression
- Excessive tiredness
- Constipation or diarrhea
- Crying and depression
- Abdominal cramps
PMS can be complicated. You may experience some or all of these symptoms. You may experience a different set of symptoms each month. And even the intensity of these signs may vary from month to month. So, it is hard to keep a tab on what to expect. But to some degree, PMS is normal and is a result of fluctuating levels of estrogen and progesterone.
It is time to worry when you get severe pre-menstrual symptoms that make it difficult to keep up with your daily activities. Heightened amounts of stress, mood swings, fatigue and depression before your periods is a cause of worry and may be sign that there is something else at play other than your hormones.
- No Periods at All (Amenorrhea)
It is normal to miss your periods after menopause and of course, when you are pregnant. If you are not expecting or have not reached menopause, a missed period might be a reason to investigate. It could be even more worrisome if you have been regular but haven’t had your periods in the last 6 months or more. This is called secondary amenorrhoea. Primary amenorrhoea is when a girl doesn’t start her periods by the age of 16.
Possible causes of a missed period other than pregnancy or menopause may include but not limited to:
- Stress or sudden shock (stress has a direct affect on how your hormones work)
- Sudden and extreme weight loss
- Too much exercise
- Ovarian cysts
- Ovaries removal surgery
- Thyroid problems
- Abnormal functioning of the pituitary gland
- Cancer treatment, such as radiotherapy or chemotherapy
- Premature ovarian failure (when ovaries show loss of function before 40 years of age)
- Eating disorders such as anorexia nervosa
- Certain types of contraception
- Surgical procedures like D&C (dilation and curettage)
- Early menopause
- Irregular periods
Your monthly periods may become irregular when you are approaching menopause. But if you have periods that come irregularly, this could be due to birth control pills you might be taking. If not, it could be a sign of:
- Thyroid problems
- Perimenopause (the time that preceded menopause; generally, in the late 40s and early 50s)
- Increased levels of prolactin, a hormone that helps the body to milk
Treating Menstrual Problems
There is a lot you can do to keep your menstrual problems in check. For example:
- Birth control pills can provide relief in PMS and even control heavy flow.
- If your problem is due to thyroid dysfunction, you may get relief once you start therapy to get your thyroid hormones in under control.
- Using a heating pad or good old hot water bottle can help relieve some pain and PMS symptoms. Mild heat helps relax blood vessels in the uterus and improve blood circulation, which helps to get rid of prostaglandins from the bloodstream a lot faster.
- A course of antibiotics can be used to treat vaginal infections or pelvic inflammatory disease, which may have been the cause of heavy bleeding or painful periods.
- Nutrients like vitamin D, vitamin B12 and iron comes handy in maintaining healthy hormonal balance.
- Using a magnesium oil spray can help reduce pain associated with periods.
- Cut back on salt and alcohol.
- Stress not only increases your sensitivity to pain but also disturbs the hormonal balance even further. Yoga, mindful mediation and other relaxation exercise can help lower your stress levels.
While these measures are good, you must also schedule an appointment with your gynaecologist and get a thorough analysis of your symptoms. Your period health is as important as the other aspects of your health. Don’t assume abnormal pain, depression, excessive bleeding or absence of periods as a normal part of your menstrual cycle. These could be a warning of something wrong that needs immediate attention.
If not addressed in time, menstrual issues and their underlying causes can lead to a host of other health problems including anemia and reduced chances of pregnancy. Endometriosis, for example, can increase your risk of several other chronic diseases such as cancer, heart disease and auto immune disorders including lupus, multiple sclerosis, rheumatoid arthritis and inflammatory bowel diseases. Take your menstrual health seriously!!
- Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign. Committee Opinion No. 651The American College of Obstetricians and Gynecologists. 2015
- FAQ: Abnormal uterine bleeding. American College of Obstetricians and Gynecologists (ACOG). 2012.