What to do about abnormal periods
What’s a “normal” period?
The majority of women of reproductive age have a monthly cycle known as the ‘menstrual cycle’. This is usually a 28-day cycle, during which the womb undergoes the changes necessary for pregnancy: the ovaries release an egg cell and then if there is no pregnancy, the lining of the womb comes away to prepare for the next cycle. A period is a time when the womb lining comes away, resulting in bleeding and abdominal cramping. A period can last from 2-7 days, but most women have a period that lasts for 5 days.
The overall length of the cycle, as well as duration of periods, amount of bleeding and amount of pain varies greatly between women, so it can often be tricky to know if there are any problems or abnormalities. Irregular periods can be expected throughout puberty, when changing contraceptive methods or when approaching the menopause.
What would be considered to be abnormal?
Periods can be considered abnormal when:
- There is pain which is not manageable day to day
- Bleeding is so heavy that it disrupts your daily activities
- When they are delayed, stop or come earlier than normal
Once you have an established cycle, the main sign of a problem would be a change in what is normal for you. Every woman has a different cycle, but a change from the norm or symptoms that start to interfere with your day-to-day activities should warrant medical help or investigation. If you have any concerns regarding your period, you should make an appointment to see a specialist or GP. This article will outline some of the most common period problems and some strategies to help you get back to enjoying life!
Strategies for painful periods
Pain is very common during periods and is usually described as a cramping sensation in the lower abdomen, although some women also experience some lower back pain around their periods too. These menstrual cramps are caused by the activity of the muscles in the womb, constriction of blood vessels in the womb and the shedding of the womb lining.
Here are some strategies you can try at home to combat period pains:
- Pain-killing medications like ibuprofen or aspirin (known as ‘NSAIDs’) have been shown in studies to be very effective in relieving bad period pain. However, you should not take them if you have asthma, stomach or kidney problems, and they can cause problems if you take them for a long time. You should check with your GP if you are not sure about taking ibuprofen. Paracetamol can be used as an alternative if you cannot take ibuprofen
- Regular exercise (even during a period) and holding a hot water bottle over the painful area have both been shown to give good relief of menstrual pain. They work especially well in conjunction with appropriate painkilling medications
- Several contraceptive methods have also been shown to help manage period pains. Oral contraceptive pills are usually a popular option, but patches, IUDs (intrauterine devices) and implants work to reduce pain too
- TENS (transcutaneous electrical nerve stimulation) is a device that you can use to manage pain in several settings, including period pain. TENS works by making a tingling sensation over the skin that can help to block pain signals
Whilst pain during periods is very common, sometimes excessive pain can be caused by an additional underlying problem such as endometriosis, fibroids or pelvic inflammatory disease. You may require some extra investigations to rule out any of these conditions, as well as more specific further management from a specialist.
Managing heavy bleeding
Heaving bleeding (known medically as menorrhagia) can be classed as >80ml blood loss per cycle. As this is difficult to measure, it is usually something diagnosed subjectively when a woman feels that her periods are excessively heavy and causing a significant impact on her daily life.
The most appropriate medication for managing heavy menstrual bleeding depends mainly on your fertility wishes:
- Hormonal therapies such as the combined oral contraceptive pill and intrauterine systems (IUS) are both good options for reducing heavy bleeding, however they also act as contraceptives. The IUS is generally considered the most effective treatment for reducing bleeding in women not seeking to become pregnant. This is a small T-shaped device that sits inside the womb and releases hormones locally
- Tranexamic acid is a medication that can be useful if you wanted to reduce heavy bleeding whilst maintaining normal fertility
Some women find that medications are either not suitable for them or not effective enough. In these cases, there are several surgical options available:
- Endometrial ablation is a minor surgical procedure that permanently removes the lining of the womb
- Hysterectomy is a major surgery that involves complete removal of the womb, which can be done both as an open operation or using key-hole surgery (known as a laparoscopic procedure)
Both of these surgical procedures will also result in an irreversible loss of fertility.
Sometimes heavy periods can be an indication of an underlying bleeding disorder or conditions like fibroids. If you are experiencing very heavy periods, you may need a blood test or special ultrasound scan to rule out an underlying cause.
Dealing with irregular cycles
Although the duration of the whole cycle and period itself may vary from woman to woman following puberty, these cycles should remain fairly consistent for each individual. If your periods stop, begin to vary in duration, or you get any spotting mid-cycle, this can be a sign that your periods have become irregular. There are several reasons that your periods may stop or become irregular, including:
If a woman has never had a period, this can be due to an underlying anatomical or hormonal problem, which often requires some investigations like an ultrasound scan or blood test to assist with diagnosis.
A good way to get on top of irregular periods is by keeping track of your cycles and bleeding. This can be done by making a small note in a diary of the days you have your period each month, or by tracking using a smartphone app. This can be helpful in working out how long your cycles are and whether they are consistent; it can also provide useful information for your doctor should you require further advice.
Whatever your age, if you become worried about a change in your normal periods and cycle, you should seek the advice of your GP or gynaecology specialist. They will ask you questions about your normal cycle and the changes that have happened, including whether you are currently using any contraception. They may also order some tests, such as an ultrasound scan, to help find the cause.
There are a lot of options for managing ‘abnormal’ periods, particularly if they are having a significant impact on your everyday life. Your GP, practice nurse or gynaecological specialist will have a lot of further advice on dealing with common problems such as excessive period pain or bleeding, or irregular cycles, and the most suitable strategies for you.
The first step is identifying if there is a problem and going to see a clinician for further advice, so they can get you back to enjoying life!