Menstrual Dysfunction.

A normal period is one that lasts between 4 and 6 days and occurs approximately every 28 days (24-35 days). This normal cycle length does not always happen in girls who are just starting their periods, or in women who are reaching the end of menstruation. Periods may be associated with mild pelvic cramping but serious pain is not normal and needs to be investigated and managed.

Menorrhagia (Heavy Periods).

Many women experience heavy periods. Even during the heavy part of the period a tampon or pad should provide adequate protection for 2-3 hours. If you need to change the protection more frequently than this or are scared to carry out normal activities in case of an accident you should seek medical advice.

Causes of heavy periods include fibroids (a benign growth in the muscle of the womb), adenomyosis (abnormal growth of the lining of the womb within the muscle), endometrial polyps (thickening of the lining of the womb), or rarely bleeding disorders, but often no specific cause is found.

Usual investigations performed when a woman has heavy periods include a blood test to exclude anaemia or iron deficiency, a pelvic examination to assess the size of the uterus and a pelvic ultrasound scan to look for causes such as fibroids, polyps etc. Hormonal investigations are often necessary.

After these investigations are performed treatment options include tablets to reduce the blood loss (Tranexamic Acid), hormonal treatments such as the contraceptive pill or Mirena IUS or surgery to remove polyps etc. If these treatments are ineffective then hysterectomy may be appropriate.

Irregular Periods.

Irregular periods usually indicates that a woman is not ovulating properly. This is quite common at puberty and before the menopause but if a woman is experiencing irregular or infrequent periods it is important she seeks treatment as it may be a sign of a hormonal problem.

Usual investigations will include blood tests to check hormonal levels to ascertain the underlying cause. An ultrasound scan of the pelvis may also be indicated to assess the ovaries.

There are a number of differing causes of irregular menstruation. A common one is Polycystic Ovarian Syndrome (PCOS). The treatment depends on the underlying cause and the fertility wishes of the woman. A woman who is not seeking pregnancy may be offered the pill to regulate her periods but if she wants to get pregnant then ovulation induction may be suitable.

Painful periods.

Periods should not be painful although most woman experience slight discomfort at the start of the period. However if there is pain which is severe enough to stop normal activities it is likely that the woman has an underlying condition such as endometriosis or adenomyosis.

Women with period pain should seek medical advice as these potential underlying conditions can deteriorate and cause further gynaecological problems.