Menstrual disorders

IRREGULAR PERIODS:

You have irregular periods if the length of your menstrual cycle keeps changing. The average menstrual cycle is 28 days, however, it’s normal for it to be a bit shorter or longer than this.

Irregular periods may occur at puberty, the perimenopause or with weight loss or gain, excessive exercise or stress.  Medical conditions such as polycystic ovaries or syndrome (PCOS) or a problem with your thyroid may also cause irregular periods.  Contraceptive pills are often used to regulate your bleeding as the womb lining can over thicken if the lining is not shed at least at six monthly intervals.

Irregular periods – NHS (www.nhs.uk)

Sexually transmitted infections, early pregnancy and changes to your cervix (neck of the womb) can also cause irregular bleeding.

HEAVY PERIODS (MENORRHAGIA)

You may have heavy periods if you:

• Need to change your pad or tampon every 1-2 hours, or empty your menstrual cup more often than is recommended.
• Need to use two types of sanitary protection simultaneously such as a tampon and a pad or bleed through your clothes or bedding.
• Pass blood clots larger than 2.5cms, a 2p coin.

Taking medications such as blood thinners or being overweight can also contribute to heavier periods, as can fibroids; growths in the wall of the womb. Rarely it can be a sign of womb cancer so it should be taken seriously and reported to your Doctor who will arrange an ultrasound scan. Dr Summerhill can refer for ultrasound scans at Starlight Ultrasound, 8 Crown Passages, Hale, WA15 9GN.

Heavy periods can be treated with a variety of medications such as contraceptive pills or a Mirena ® coil. Gynaecologists may offer a procedure such as an endometrial ablation or even a hysterectomy where the above methods have failed or are not tolerated.

PAINFUL PERIODS (DYSMENORRHOEA)

Period pain is common and sadly a normal part of your menstrual cycle when the womb contracts to release the blood. It’s usually felt as pelvic cramps which can radiate to the back and thighs and lasts from 48-72 hours. It’s unknown why some women experience more period pain that others, it may be due to a buildup of pain-producing chemicals known as prostaglandins or less commonly can be caused by an underlying medical condition. These include endometriosis where cells that normally line the womb grow externally and bleed at menstruation causing pain and scarring. Similarly adenomyosis where the same tissue migrates within the muscular wall of the womb and also bleeds, stretching the cavity. Fibroids can also make your periods heavier and more painful.

Primary care treatments for period pains may include anti-inflammatory prescriptions, contraceptive pills or coils. Dr Summerhill can refer for ultrasound scans at Starlight Ultrasound, 8 Crown Passages, Hale, WA15 9GN.

PRE-MENSTRUAL SYNDROME

Many women experience mild physical and emotional symptoms premenstrually which are manageable. However, when severe these symptoms can lead to a breakdown in interpersonal relationships and to an interference with one’s normal daily activities. The cause of PMS remains unknown but is felt to be due to fluctuating levels of hormones throughout the menstrual cycles. Symptoms can include tension, irritability, tiredness, low mood, anxiety and tearfulness. Physical symptoms may be breast swelling or pain, bloating, swelling of the hands and/or feet and headaches.

In order to diagnose PMS, symptoms must be logged, ideally over two cycles. Please take a look at the menstrual diary below to enable you to record your symptoms;

NAPS-MENSTRUAL-DIARY.docx (live.com)

Various herbal products, vitamins and minerals are sold for the treatment of PMS. The ones which have been studied most include magnesium, vitamin B6 (pyridoxine), calcium, and agnus castus. The evidence is mixed and it is not clear yet if they have any effect. Some studies suggest some of them are helpful, whereas others suggest they are not. There is not enough evidence yet to know if they can be recommended, and if so, in what dose. They are unlikely to do much harm as long as you do not exceed the dose suggested on the label, so you may wish to give one or more of these treatments a try.¹

Evening primrose oil or simple painkillers such as ibuprofen or paracetamol may help with breast tenderness.¹

Dr Summerhill is able to advise on the initial treatment options for PMS sufferers such as the newer contraceptive pills and hormonal patches/coils as well as some antidepressants.

References:

1. Premenstrual Syndrome (PMS, PMT) | Symptoms and Treatment | Patient