Your period – Dr. Jessica Farren

Your period is something you have to put up with 400 times in a lifetime. No woman should have to dread a week out of every month. What’s more, your menstrual cycle can tell you lots about what might be going on inside – and what fertility issues you could encounter. Here we go through some common period problems, what they might mean, and what you can do to treat them.

Heavy periods

There is a lot of variation in the amount women bleed – so what is normal for you may not be normal for others. However, if you notice that your periods seem to be getting heavier, then there may be a physical reason (though your period is usually heavier off hormonal birth control – so expect to see a change coming off these).

Other signs that you are bleeding ‘too’ heavily include:

  • Needing to get up more than once in the night to change your protection
  • Not being able to leave the house (or even the bathroom) on the heaviest days
  • Having to use double protection
  • Becoming anaemic – which may result in symptoms like tiredness, breathlessness, your skin appearing pale

Sometimes there is no clear reason why women bleed too much. It may be more common just after you start your periods as a teenager, or as you approach the menopause. Sometimes, however, it can be because of physical changes in the womb. Fibroids are knots of muscle in the wall of the womb. Approximately  one in every three women have them, and they tend to grow over time. When they sit close to the lining of the womb, or indent into the womb cavity, they may cause your bleeding to become heavier. Similarly, polyps, which are little out-pouchings of the lining of the womb (the endometrium) can be the cause.

A simple ultrasound scan is all that you need to tell you if you have fibroids or polyps.  Depending on exactly where they are in the womb, surgical treatment may be a very effective way to make your periods more manageable. Surgery can often be done via the natural opening to the womb (the cervix – so these procedures are called trans-cervical resections). It occasionally may also be advisable to remove them before trying for a pregnancy (theoretically, if a pregnancy implants on or near a fibroid or polyp, the risk of miscarriage could be higher).

Even if no cause is found, heavy periods can also be managed with a variety of medications. Tranexamic acid is a useful tablet that you only take on days when you are bleeding (so it is fine to take while you are trying to conceive). It helps the blood to clot – so reduces the amount of blood you lose. Hormonal medications, including birth control, can be very helpful in reducing the amount of bleeding when you are not trying to conceive.

Painful periods

Most women experience a little bit of cramping while they bleed without it causing too much disruption to their lives. However, if you are reliant on painkillers, or need to remain tucked up in bed, it could be a sign that something else is going on.

Two very common conditions are endometriosis and adenomyosis. In endometriosis, the same cells that make up the lining of your womb sit outside the womb, and respond to the hormones of the menstrual cycle. This means they bleed, and cause inflammation – but in spaces where this is really sore. In adenomyosis this process happens in the muscle wall of the womb (rather than in the lining).

Both of these conditions can be very effectively managed with hormonal treatment – and doing so may benefit not only your current quality of life, but may also help your fertility in the future. If you are actively trying to conceive and have symptoms suggestive of endometriosis, a test to see that your fallopian tubes are open may be worthwhile. Your fertility may also improve with surgical treatment (see our module on “Beyond the hormone test.”)

Very light periods

Rarely, very light periods can be a sign that scar tissue has built up inside the womb (known as Asherman’s syndrome). It may be related to previous surgery to the womb, including multiple surgical procedures to treat miscarriage or to terminate pregnancies, or to a previous infection in the womb.

A scan is usually able to reassure you that the lining of your womb looks healthy. Sometimes a look inside the womb with a camera (a hysteroscopy) is necessary: scar tissue can often be removed at the same time.

Irregular periods

Most women have cycles that last from 21 to 35 days (that is the length of time between the first day of one period and the first day of the next). It is common to miss periods occasionally. A regular period is a very good sign that you are ovulating.

Missing periods for more than 90 days, or a persistently irregular cycle, can be a sign of other issues. Of course pregnancy is the first thing to consider – and it just takes some pee on a stick to exclude that one!  At times of high stress, weight loss or intense physical activity, your brain may send signals to suppress your menstrual cycle – and some rest and relaxation, or putting on some weight, may start everything back up. It may also be indicate a condition called polycystic ovarian syndrome (PCOS) (see our module on “Common Conditions”). Occasionally other conditions, such as an over- or under-active thyroid gland, may be to blame.

Bleeding between your periods

A minority of women (about 3 in every 100) experience a light, regular bleed in the middle of their cycle – which coincides with a drop in hormones right after ovulation. This is nothing to worry about.

Other causes of bleeding in between your period include changes to the cervix (the neck of the womb) – you should make sure your smear test is up to date and that you have had a sexual health screen – or polyps – both of which can be treated. It is worth having a check-up for these before trying to conceive.