Period Problems

The menstrual cycle is controlled by hormones that generally cause a regular bleed, often called a ‘period’. How long it lasts and how heavy it varies for each person.

It can be bright red, dark red or dark brown in colour, and may contain small clots (dark firmer pieces of blood).

On average a woman will lose 20-80 mL of blood during a period.

20mL = 4 teaspoons

80mL = ⅓ cup

Though it’s not quite so easy to measure that.

In the first two to three years after a person’s period has started, the periods may be irregular and can take a while to regulate.

On average the periods begin about the same time each month (26-29 days apart) but can be as often as every 3 weeks, or as far as 8 weeks apart. Ovulation can still occur regularly or irregularly until menopause.

Most women will menstruate for about 40 years and can expect to have about 500 period cycles in their lifetime.

Heavy periods (menorrhagia)

Heavy menstrual bleeding (also known as menorrhagia) is excessive and/or prolonged. The amount varies from person to person and can change at different stages in your life, for example, approaching menopause. It is defined as blood loss greater than 80mL (equal to 1/3 of a cup) per cycle, or periods lasting more than seven to eight days. Heavy menstrual bleeding affects about one in five women and is a common problem in the 30 – 50 year old age group.

How do you know if your bleeding is too heavy?

It is very difficult to determine whether your bleeding is too heavy. The best guide is to decide whether your period is impacting your quality of life, causing you to be housebound, interrupting your daily activities or causing you stress and anxiety. The following signs may indicate you are experiencing heavy bleeding:

• Bleeding or ‘flooding’ not contained within a pad/tampon (especially wearing the largest size)
• Changing a pad/tampon every hour or less
• Changing a pad overnight
• Clots greater than a 50-cent piece in size
• Bleeding for more than 7-8 days

How can heavy bleeding affect you?

You may:

• feel fatigued, exhausted, dizzy and look pale
• have low iron levels because of the blood loss
• have cramping and pain in the lower abdomen
• have to change sanitary products very frequently
• fear bleeding through to your clothes and this affects your daily activities

Period Pain (dysmenorrhoea)

While some women experience minimal or mild discomfort during menstruation, other women suffer from severe, debilitating pain that prevents them from doing their day-to-day activities. None of us knows what another woman’s pain is like, so it is useful to understand what periods should feel like and then decide if all is normal. Some women may have always experienced painful periods, others may develop pain. Period pain is more common in adolescents and women in their 20s, but can also occur in older women.

Period pain happens when the muscles in the uterus contract or tighten. Pain may include cramping and heaviness in the pelvic area, as well as pain in the lower back, stomach or even legs. Some women also experience nausea, vomiting, paleness, diarrhoea or lose bowels.

Women who experience painful periods may have higher levels of prostaglandins – a natural body chemical that causes contractions of the uterus, bowel and blood vessels.

Period pain is the most common cause of pelvic pain.

What is normal period pain?

Period pain should only be considered ‘normal’ if:

• the pain is only there on the first one or two days of your period
• it goes away if you use the contraceptive pill or take period pain medications
• your ability to do your normal activities is not impaired

If the pain is not like this, it is not normal.

What causes period pain?

Painful periods can be due to:

• pain in the uterine (womb) muscle (myometrium) especially if the pain is on the first one or two days of a period
• pain from endometriosis and/or adenomyosis, especially if the pain is there for more than one to two days before the period starts

Many women with strong period pain have both these problems and women with adenomyosis have a more painful uterus than other women, even if it looks normal.

Adenomyosis is a condition where the cells which normally form a lining on the uterus also grow in the muscle wall of the uterus.

Endometriosis is a condition where tissue, like the lining of the uterus, grows outside the uterus where it shouldn’t be. It used to be thought of as an uncommon problem for women in their 30s and 40s. We now know it is a common problem that usually starts in teens (see our page on Endometriosis).

Irregular periods

Premenstrual syndrome (PMS)

In the days leading up to a period (menstruation) up to 30% of women experience emotional and physical symptoms, often called premenstrual syndrome (PMS). Most women experience one or two premenstrual symptoms that can be managed. Symptoms start about four to ten days before a period and usually stop after bleeding begins.

What are the symptoms of PMS?

Symptoms of PMS vary in intensity from woman to woman and can vary from one cycle to the next. The most common symptoms include:

What is premenstrual dysphoric disorder (PMDD)

Premenstrual dysphoric disorder (PMDD) is a more serious form of PMS. Women who have PMDD experience severe PMS symptoms that interfere with daily life. PMDD affects about three to eight per cent of menstruating women.

Causes of PMS & PMDD

It’s not clear why some people develop PMS and PMDD. There appear to be very complex interactions between certain chemicals in the brain and progesterone that lead to symptoms. PMS does not occur if there is no ovulation or post menopausally. Stress levels, psychological state, poor physical health, genetic makeup, cultural and social environment and changes in neurotransmitters (like serotonin) may all influence the development of PMS symptoms. Having a high body mass index (BMI) and smoking are also risk factors.

How is PMS & PMDD different to depression?

PMS and PMDD have similar symptoms to depression but with PMS and PMDD, the symptoms get better completely as soon as menstruation begins, but those of depression do not.

PMS and PMDD need to be distinguished from underlying depression because the treatments are different.

Management & treatment of PMS symptoms

There are several things you can do yourself to manage and reduce your PMS symptoms.

Things to keep in mind:

Premenstrual syndrome (PMS) refers to the range of emotional and physical symptoms some women experience in the lead-up to their period, which may interfere with their quality of life
Most PMS symptoms can be managed with lifestyle modifications, such as exercise, diet and supplements
If symptoms persist and interfere with daily activities see your doctor or seek a referral to a gynaecologist with expertise in PMS
It may be useful to keep a detailed daily diary of at least two menstrual cycles to see if there is a pattern with your symptoms so you and your doctor to talk about the best treatment options for you

When to see your doctor

It is important to see your doctor if you experience any issues with your period which worry you. Keeping a menstrual diary, including when you get your period, the length, heaviness and anything else you notice, will help your doctor work out how best to help you.

You should consult your doctor if you:

• have not started menstruating by the age of 16-17
• notice your period has suddenly stopped
• are bleeding for more days than usual
• are bleeding excessively or more than you usually do
• bleed between periods or after sexual intercourse
• experience pain during your period that interferes with your quality of life
• have clots that are bigger than a 50-cent piece in size