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health&beauty tbc Periods – what women need to know… T he time between the start of one period and the start of the next is called menstrual cycle. The average length of a menstrual cycle is 28 days; anything between 25 and 35 days is considered normal. The amount of blood loss may vary from period to period, and certainly varies from woman to woman. The flow should normally last between 3 and 5 days. The menstrual cycle is under the direct control of hormones, mainly oestrogen and progesterone, and can be divided in three phases: follicular, luteal and menstruation. Period problems are common during reproductive life but have to be seen in the context of the woman’s chronological age. A period problem in a 30 year old woman is completely different to a 50 year old. Therefore, the investigations to be carried out and the management recommended are different, and there is nothing more appropriate than an evidence-based individualised approach. Women who attend a gynaecology clinic because of period problems may complain of one or more of the following: heavy periods (menorrhagia), painful periods (dysmenorrhea), irregular periods (oligo-menorrhoea), absent periods (amenorrhoea) and unpredictable menstrual bleeding. Some women may also report episodes of bleeding during or after sexual intercourse, but this is a sign of a different Period problems can affect a woman physically, emotionally and socially causing disruption to everyday life. Menstruation starts between the ages of 11 and 15 and continue until the menopause, which starts usually around the age of 51 problem and requires different management. Heavy periods are considered as such if there is flooding, passing clots, need for double sanitary protection, or restricting normal daily activities. Hormone imbalance problems, fibroids and the presence of an endometrial polyp may all cause menorrhagia. Treatment for heavy periods depends on the cause, and appropriate diagnostic tests have to be arranged as first line management. Painful periods are characterised by pain in the lower abdomen, back and top of legs, especially in the first couple of days of a period. The symptoms can be caused by pelvic infection, endometriosis, adenomyosis, fibroids or ovarian cysts, and often are not associated with a serious anatomical problem. To relieve symptoms the treatment has to be tailored to the specific cause. Irregular periods are those that occur at intervals greater than 35 days. The main cause is a hormone imbalance caused by problems in the ovaries or sometimes in the thyroid gland, but can also be linked with an abnormal body weight (either high or very low), excessive exercise and stress. Treatment may require multidisciplinary clinical input. Absent periods can be defined as primary amenorrhoea (failure to start periods) or secondary amenorrhoea (absence of periods for six consecutive months in a woman who used to have regular menstrual cycles). The causes are different and investigations in to anatomical, hormonal, lifestyle and psychological areas have to be done. Pregnancy has to be excluded. Bleeding at abnormal times may occur in women of reproductive age and is often not serious. It can be caused by hormone imbalances, the contraceptive pill, progesterone-releasing coil (Mirena) or an endometrial polyp. If inter-menstrual bleeding continues every cycle referral to a gynaecologist is recommended. n For more information, call 0845 600 9997 or visit: www.gyne-health.co.uk “I cannot find the words to thank you enough for giving me the opportunity to live a normal life again.” “We would like to thank you for the outstanding service we have received while being under your care for our longstanding fertility problem.” Manchester • London • Cheshire Tel: 0845 600 9997 Email: [email protected] www.gyne-health.co.uk IVF • INFERTILITY • GYNAECOLOGY • REPRODUCTIVE MEDICINE • ULTRASOUND • COMPLEMENTARY THERAPY • RESEARCH