A painful period
It's supposed to be the most natural thing in the world, but for many women menstruation is the cause of much pain and discomfort. Deirdre Nolan reports
ON the rag, time of the month, the curse, Aunt Flo, periods – we have many names to describe menstruation. It's something that happens to most women every month, and yet many of us are still in the dark when it comes to menstrual problems, what can cause them and what can be done about them.
A ' normal' period occurs on a regular cycle, the length of which can vary anywhere between 23 to 35 days ( the average is 28), and can last between two days and a week. The average blood loss is 35ml, although amounts as low as 10ml and as high as 80ml are not uncommon. The onset of periods ( or menarche) usually occurs between the ages of nine and 16, and ends with menopause, between the ages of 42 and 58.
Of course, as readers will be well aware, pregnancy is the one time of your adult life when you don't have to think about periods!
" It takes six to 12 weeks for menstruation to recommence after childbirth and for breastfeeding mothers it may take much longer – their periods might not return until they stop breastfeeding," says Dr Yvonne Rafter, a GP based in Churchtown, Co Dublin.
Problem periods arise when something causes them to become painful, heavy or irregular.
One of the most common problems associated with periods is cramping and pain, or dysmenorrhoea, caused by contractions of the uterus (womb) as it sheds its lining. The best remedy is to reach for the painkillers.
" The first option for treatment is a non-steroidal anti-inflammatory medication – these come from the aspirin family, but the preparations that are available now are much easier on the stomach," says Rafter.
" The reason they work is because they're antiprostaglandin. Prostaglandin is a hormone that's produced around the time of menstruation and can cause the cramps, heavy bleeding and other physical symptoms that women get – nausea, vomiting and, occasionally, diarrhoea. Anti-prostaglandins tend to counteract that. Examples are Ibuprofen and Ponstan."
If you don't want to visit your GP for a prescription, other forms of anti-prostaglandins are available from your pharmacist. Nurofen and Feminax are both overthe-counter, non-steroidal anti-inflammatories.
" Painkillers would be the first line of attack. After that we sometimes use the oral contraceptive pill, which can be used as a cycle regulator and for dysmenorrhoea," explains Rafter.
" Progesterone may be used, especially for women with very heavy periods. It can reduce the flow and can often help with the pain associated with dysmenorrhoea.
" If these approaches don't work, you may have to look into other causes of dysmenorrhoea that could be more serious, for example endometriosis. This might require gynaecological assessment, laroscopy, etc, if there was concern that there was an underlying problem."
Endometriosis occurs when tissue similar to uterine tissue grows outside the womb, causing pelvic pain and sometimes infertility. It is estimated to occur in five to 10pc of menstruating women.
" Endometriosis is one of the commoner problems and it can be very hard to diagnose," says Rafter. " Quite often it will cause heavier periods, but the main characteristic is dysmenorrhoea. It can also cause pain at the time of ovulation, and during intercourse."
While some women reach for their hot-water bottle at the onset of period pain, and others believe getting active will bring relief, Rafter believes relaxing and taking things easy could be the best advice.
" If it eases the pain, by all means use a hot water bottle – just don't burn yourself! It's not necessary to do extra exercise either. Sometimes women, especially teenagers, have very heavy periods and the best advice can be just to take it easy if your period is heavy or painful," she says.
Menstruation usually occurs in monthly cycles, so an interference in the pattern or a lack of periods ( anovulation) can indicate a problem.
" Normally, if a woman is ovulating each month her periods tend to be regular, so anything that causes anovulation can be associated with irregular periods," explains Rafter. " There are numerous different causes. One of the commonest conditions that would cause irregular bleeding is something called dysfunctional uterine bleeding, where ovulation doesn't occur, maybe due to stress or because the woman may be travelling or doing exams, or might have recently lost a lot of weight."
Irregular periods can also be caused by a hormonal imbalance. " Hormonal causes would include overactive or under-active thyroid disease and excess prolactin hormone," says Rafter.
"Another reason would be polycystic ovarian syndrome ( PCOS), also known as Stein-Leventhal syndrome, which causes an imbalance in the ratio of luteinising hormones and follicle-stimulating hormones." Other symptoms of PCOS include acne, weight gain and excess hair in a male pattern ( on the face, chest and stomach). PCOS can also cause infertility.
Other causes of irregular periods would be early menopause, delayed menarche ( in the case of teenagers), extreme exercising and anorexia.
Whatever the causes or symptoms, if you are experiencing problem periods don't suffer in silence – talk to your GP.
Mother & Babies