Download Periods – what women need to know…

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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
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Tel: 0845 600 9997
Email: [email protected]
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