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Menstrual Problems

  • Severe cramps with periods
  • Infrequent periods
  • Heavy periods
  • Lack of menstrual periods
  • Abnormal bleeding 

Many women will experience menstrual problems sometime in their lives. Often a change in the usual menstrual pattern can be a symptom of an underlying medical concern. This brochure will briefly outline the most common menstrual problems and discuss when medical treatments may be needed. Your health care provider will be glad to answer any questions you have. You can use the calendar in this brochure to help track your menstrual cycles or an app such as iperiod, period tracker or period diary.

Severe cramps with periods—Dysmenorrhea

Menstrual cramping and painful periods are common problems for women, but they can be severe enough to interfere with normal daily living. Cramping may also be accompanied by headache, nausea and vomiting, diarrhea, dizziness, leg and back pain and fatigue. Most dysmenorrhea is caused by substances produced in the uterus called prostaglandins. Prostaglandins cause contractions of the uterus which produce a cramping sensation. Occasionally, menstrual cramps are caused by other medical problems such as fibroids, endometriosis (overgrowth of uterine lining) or infection. Birth control pills may reduce menstrual cramps and shorten the length of your period. Ibuprofen prevents the production of prostaglandins. It can prevent cramps if you start taking it a day or two before your cramps start and continue through your period. Painful periods should not make your life miserable.

Infrequent Menstrual Periods-Oligomenorrhea

Young women commonly experience differences/changes in their menstrual cycles. These may be harmless but may also signal an underlying problem. The menstrual cycle is regulated by a complex system of hormones. This system can be easily upset by stress; changes in diet or exercise routine; weight changes or other factors. Infrequent periods are often related to problems with ovulation (the release of an egg from your ovary). If you skip more than three months of your menstrual cycle, please talk to your health care provider to determine the cause of infrequent periods. Missing periods for more than three months in a row can lead to changes in the cells lining your uterus which could become endometrial cancer.

Heavy Menstrual Periods-Hypermenorrhagia

Menstrual bleeding usually lasts 2-8 days and totals 4-5 tablespoons of fluid (1/3 of which is blood). Heavy menstrual bleeding may be caused by problems with your body’s normal hormonal cycle or by a variety of underlying medical problems. Anemia (“low iron” with symptoms of fatigue or dizziness) can result from continued heavy menstrual bleeding. Your practitioner will need to do a pelvic examination and take a health history to determine possible causes of heavy menstrual bleeding. These causes may be related to your body’s production of hormones or problems with the uterus such as fibroids (non- cancerous growths in the uterus). Treatment for heavy periods may include an iron supplement to help prevent anemia or possibly hormones (such as birth control pills) to help control the bleeding. Your practitioner will work with you to determine treatment options for your heavy periods.

Lack of Menstrual Periods-Amenorrhea

If you are between 15 and 45 years old, one of the main causes of not having periods is pregnancy. A pelvic examination and pregnancy test are sometimes a necessary parts of your evaluation. However, almost every woman can expect to miss a few periods in her lifetime for other reasons. Illness or stress (such as starting college) may cause minor disruptions in your periods. Eating disorders such as anorexia may also cause periods to stop. Also, women athletes in strenuous training may experience a lack of menstrual periods. Most of the possible causes for this disruption in your cycle are related to a change in your body’s production of hormones. Because temporary amenorrhea is so common, your clinician may not recommend any diagnostic tests. Sometimes symptoms do require further evaluation. If you are experiencing any of the following symptoms follow up with your health care clinician to discuss possible diagnostic testing: (1) you have missed more than three periods in a row; (2) you are experiencing breast discharge, headache, vision changes, and difficulty with coordination or excess growth of body hair.

Abnormal Bleeding

The normal menstrual cycle varies from 24-48 days. Normal flow may last from 2-8 days and range from light to heavy. Bleeding which occurs between periods may signal a medical problem, especially in women over 40. Menstrual bleeding which is prolonged (more than 8-10 days) or very heavy or painful bleeding as these symptoms may also signal a medical problem. Bleeding after intercourse may be a symptom of infection or STI. If you notice a marked change in your periods, or if you have bleeding between periods or any unexplained vaginal bleeding, consult your health care provider as soon as possible.