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Period problems

Menstruation is the periodic vaginal bleeding that gets the uterus ready for pregnancy by shedding the endometrium, or lining of the womb, and allowing a fresh one to grow in its place.

For most women, menstruation is nothing more than a minor discomfort, but it can cause serious and sometimes debilitating problems for others. These problems are becoming more common in Western industrialised countries where women are putting off childbearing and having smaller families.

Most women will live with menstruation for around 40 years of reproductive life. Menopause, the time when periods stop, occurs around the age of 50 but can occur anywhere between 45 and 55.

The menstrual cycle

Most girls get their first period, or menarche, around the age of 12 years, although anything between eight and 16 years is normal. The age of menarche is affected by genetic and environmental factors, and research around the world has shown that girls in Western countries are getting their periods earlier than their grandmothers did because of improved nutrition and health.

The menstrual cycle is usually described as a monthly event but this is only the case for about 12 per cent of women, or one in nine. Most women's cycles last somewhere between 21 and 35 days, with day one being the day that bleeding begins.

Four key hormones control menstruation. They are oestrogen and progesterone, produced by the ovaries, and follicle stimulating hormone (FSH) and luteinising hormone (LH), released by the pituitary gland in the brain.

This is how the cycle works:

1. Halfway through a woman's cycle FSH levels rise, triggering egg-containing follicles in the ovaries to grow and produce oestrogen.
2. The oestrogen causes the lining of the uterus to thicken and develop a rich supply of blood in readiness for a fertilised egg.
3. The oestrogen also causes the vagina to secrete sugars, which local bacteria convert into lactic acid, helping reduce the risk of infection.
4. Mucus from the cervix becomes thinner to allow sperm easy passage.
5. As oestrogen levels peak, the pituitary releases a surge of FSH and LH, triggering ovulation, or the release of an egg from one of the follicles in the ovary.
6. The ovary now starts producing progesterone, which helps prepare the endometrium to nourish a growing embryo.
7. If an embryo implants and begins to grow, the placenta takes over production of oestrogen and progesterone from the ovary, keeping the endometrium in good condition until the baby is born.
8. If there's no embryo, the ovary stops producing oestrogen and progesterone. This causes the endometrium to break down, triggering a period and resetting the cycle.
9. We think of menstrual fluid as blood but it's actually a mixture of tissues and secretions from inside the uterus. It includes water, mucus, blood and glandular tissue.
10. Most women menstruate for two days to a week and lose between 20 and 80 millilitres of blood.

Painful periods

Most women experience period pains (dysmenorrhoea) at some time. This can range from mild discomfort to excruciating pain with nausea and vomiting. Dysmenorrhea falls into two categories: primary and secondary.

Most of what we think of as period pain is primary dysmenorrhoea. This occurs when there is an increased sensitivity to the prostaglandins, hormone-like fatty acids that are produced around the period that cause contractions of the uterine muscles or myometrium.

Primary dysmenorrhoea also seems to lessen with age and after having children. It's not entirely clear why this occurs but it may be related to the dilation of the reproductive organs or changes in the way the uterus responds to the body's biochemistry.

Secondary dysmenorrhoea occurs when there is a pathological cause for the pain, such as endometriosis. This needs further investigation by a doctor and treatment of the underlying problem.

Irregular periods

Irregular periods (oligomenorrhea) are common in the first two or three years after periods start, after childbirth, miscarriage or termination and in the lead-up to menopause.

Some women never establish a regular cycle, although the reasons for this are unclear. This can make planning holidays and other activities difficult, but it can also make it harder to fall pregnant because it makes ovulation tricky to predict.

Irregular periods can be caused by:

• Stress
• Starting or changing contraception
• Pregnancy, miscarriage or an ectopic pregnancy, where the baby grows in the fallopian tube or somewhere else outside the uterus
• Polycystic Ovarian Syndrome (a hormonal disorder that causes small cysts to grow on the ovaries)
• Change in diet or sudden weight loss or gain
• Hormonal imbalance

Pre-menstrual syndrome (PMS)

Also known as PMT (pre-menstrual tension), most women notice some symptoms of PMS around the time of their period.

Common complaints include breast tenderness, headache, backache, abdominal bloating or food cravings (often carbohydrates or chocolate). Other PMS symptoms include acne, anxiety, fatigue, insomnia, fainting, altered sex drive, swelling of fingers or feet and ankles, depression and mood swings.

In extreme cases PMS can lead to aggressive behaviour or suicidal thoughts. Symptoms can vary from month to month and underlying depression and stress can make symptoms worse.

Periods can be a drag but they don't have to make your life a misery. At Healthy Women Medical Centre, all our Doctors are Female with a particular interest and training in Women's Health issues, they completely understand your period related problems and can organise any treatment specifically suited to you.

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