You, your periods, and your health

Woman with flower on stomach to symbolise her period

“Maybe if period pain burned calories, it would be worth it!” – so states the popular meme. If only that was true! But love them or hate them, periods are here to stay … at least until the menopause!

Read on and see…

What is a period?

Women are designed to bleed once a month. This is because they produce an egg once a month, ready for fertilisation. While the egg is ripening, the lining of the womb is thickening in readiness for pregnancy. After the egg is released, and if no pregnancy occurs, the womb lining is shed. When you shed the lining of the womb it is excreted from the body – and you have a period.

How long do periods last?

The average period lasts for 5-7 days. However there is a wide variation – anything from a light bleed for 1-2 days to a prolonged period lasting perhaps 10 days.

How often do women have periods?

When we count periods, we take day 1 as the first day of bleeding. Day is also the first day of a new menstrual cycle.

The average woman has a period once every 28 days. This means, the first day of the period is day 1, and you keep counting. After 28 days, the next period starts. Day 1 is the first day of the next cycle, and so on. However, again, there is great variation.

Women may have short cycles, say every 21 days, or long cycles, say every 35 days.

Sometimes periods are irregular. Cycles may vary from 21 days one month, to 35 days the next.

Does it matter how often you have a period?

For the most part, irregular periods are not important. If you are having periods, this means you have a womb, ovaries, and a hormonal cycle – so all the equipment is in place for when you want to become pregnant.

However, regular, heavy, painful periods are a sign of ovulation. In women who bleed infrequently and lightly, this can be a sign you are not ovulating, or not ovulating regularly.

If you don’t want to get pregnant, don’t ever assume you are not fertile, as ovulation can occur at any time, and you may just get caught out!

If your periods are heavy and frequent, this can cause tiredness and anaemia. This is a common reason for women to go to see the doctor. Although in fact, it seems many women are reluctant to visit their doctors about this, and are suffering in silence.

After menopause, periods stop. The average age is 51. If you suddenly bleed more than 6 months after your last period, you should see your doctor.

Bleeding in between your periods is called unscheduled bleeding. Although common with different types of contraception and various forms of HRT (hormone replacement therapy), if it persists beyond 3 months, you should discuss this with your doctor.

Are periods healthy?

A period is the result of the rise and fall of your natural body hormones. After ovulation, if there is no pregnancy, the period flushes the old womb lining away, to allow a new healthy womb lining to grow for the following month.

Menstrual cycles will continue until menopause. It is possible however, to halt the menstrual cycle – for example by using certain forms of contraception. When these are discontinued your periods will return. Contraception is just that – contraception – and is always reversible. There is no such thing as ‘post pill amenorrhoea’, for example.

Many women regard having periods as natural. But when you think about it, at the turn of the century there was no available contraception and women were always pregnant or breast feeding. This meant they actually had very few periods in a lifetime. To some extent periods are a feature of modern society.

When are periods not healthy?

Periods are not healthy when they cause symptoms which are interfering with your lifestyle. It’s typical that every time you have something big in your diary – a summer holiday, a wedding, a conference, a big presentation at work – it’s the time of the month! When your period comes round, again, as they do every month, it puts you out of sorts, and often for a week or more. Most women detest their time of the month.

The main complaints about periods are period pain (dysmenorrhoea), and heavy periods (heavy menstrual bleeding).

  • Dysmenorrhoea – 80% of women get period pain at some time in their lives. 5-10% of women have such bad pain it disrupts their lifestyle.
  • Heavy menstrual bleeding (HMB) – the average woman loses 80ml or around 16 teaspoons of blood with each period. It’s not possible to measure this. It’s more helpful to consider more practical issues such as:
    • Are you needing to change your sanitary wear more than every 2 hours?
    • Are you soaking the bedclothes at night?
    • Are you passing clots bigger than a 10p piece?
    If so, your periods are heavier than average.

Are you wondering if your periods are abnormally heavy? – take this short test.

Are your periods negatively affecting your lifestyle?

Heavy, painful periods have a very negative impact on a woman’s life. A 2013 German study questioned more than 6000 women about their periods. Women were then divided into a heavy bleeding and lower bleeding group.

  • 26% of the women felt their periods were abnormally heavy.
  • 83% felt their heavy periods affected their daily activities.
  • 75% said their periods were a major inconvenience in their lives.
  • 68% felt their heavy periods had affected their attendance at work.

Their heavy periods affected their ability to do sport and fitness activities, affected what they could wear, and even affected their ability to play with their children. This was significantly more common in the heavy bleeding group, than in the lower bleeding group.

When women were asked if they knew about the subject of heavy menstrual bleeding, 48% said they were ‘not at all’ or ‘not very,’ knowledgeable about the subject.

39% of the women believed there was no treatment for the condition. 33% had not discussed the condition with their healthcare provider as they were too embarrassed and thought there was nothing they could do.

What can be done to treat heavy periods?

The first step is to get a diagnosis. In about 50% of cases, no specific pathological cause is found. However, it is important to be accurate and then tailor treatment as appropriate.

You can discuss your periods with your GP, or at the Sexual Health Clinic.

After taking the history, there are likely to be some tests. For example:

  • Blood tests – a full blood count, and hormone profile.
  • Ultrasound scan – often an internal transvaginal scan to assess the size of the uterus (womb) and the thickness of the endometrium (womb lining), plus the ovaries.
  • Endometrial biopsy – a small sample is taken from the endometrium and examined under the microscope.
  • Hysteroscopy – the endometrium is examined using a long thin telescope.

Any cause can then be addressed. However, in the vast majority of cases, no specific cause is found for the problem. For medical conditions causing heavy periods see WHC: Heavy periods – causes.

What are the treatment options?

First, it’s a good idea to look any lifestyle factors which you might be able to change.

Periods are affected by –

  • Stress in one medical study, 44% of women who reported high stress levels in their preceding menstrual cycle had dysmenorrhoea, compared to 22% in those with lower stress levels.
  • Smokingnumerous studies have demonstrated that smokers are far more likely to suffer dysmenorrhoea than non-smokers. In addition, the amount of pain is associated with the number of cigarettes smoked.
  • Alcohol – this can increase premenstrual symptoms and worsen premenstrual syndrome (PMS).
  • Exercise – this has been shown to improve period pain.
  • Diet – there are certain foods which to avoid, and certain foods recommended to help reduce period pain – see Dietary Solutions for Menstrual Cramps. Generally the advice is to follow a Mediterranean Diet.

What are the medical treatment options?

These are listed below:

Non steroidal anti-inflammatories (NSAIDs)

Drugs such as ibuprofen, taken during a period can reduce menstrual flow between 20–46%. They work by reducing the production of prostaglandins – substances which cause inflammation. For example, ibuprofen may be taken up to 1200mg in 24 hours (400mg three times a day). It should be started as soon as the period starts.

An alternative is naproxen but this requires a doctor’s prescription. Naproxen is taken as a 500mg starting dose, then 250mg three times a day.

Tranexamic acid

This drug stops blood clots dissolving in the womb. The dose is 500mg three times a day. It may reduce blood loss by up to 58%. Available from pharmacies without prescription.

Cyclical progestogens

Taking additional progesterone during your monthly cycle can control and reduce blood loss. These are taken either on days 15–26 of each menstrual cycle (short course), or days 5–26 (long course). These are more effective than tranexamic acid.

Combined hormonal contraception (CHC)

In medical studies, taking the Combined Pill has been shown to reduce menstrual loss between 35–69%. The pill appears to be the third best treatment for HMB after the hormone coil (IUS), and cyclical progestogens. By stopping ovulation, there is less endometrial build up during the month, and periods are significantly lighter.

Women are now encouraged to take the pill not just for contraception, but because of the long list of non-contraceptive benefits. These include, improved Premenstrual Syndrome, improved acne, reduced period pain, and treatment for endometriosis. The pill seems to reduce the risk of rheumatoid arthritis, pelvic inflammatory disease, and multiple sclerosis. There is also a reduction in ovarian, uterine, and bowel cancers in pill users. The pill is also associated with improved asthma control, and maintains bone mineral density.

Similar effects on period control may be obtained from use of the contraceptive patch, or the vaginal ring. These methods contain both estrogen and progesterone. They now regarded as positive choices, as alternatives to the Combined Pill. The pill, the patch, and the ring make up three different forms of combined hormonal contraception.

The pill, patch, and the vaginal ring can be taken continuously, or tricycled.

Use of other forms of contraception may also result in no periods, such as –

Intrauterine system (IUS)

IUS – this is a special type of intrauterine device. Unlike the traditional IUD – which contains copper, the IUS contains the progesterone hormone, levonorgestrel. Once inserted into the uterine cavity, the progesterone is released in a continuous manner, and bathes the endometrium with hormone. As a result, the endometrium does not thicken as it does in a normal menstrual cycle. Hence when it is time for a period, there is very little, if any, endometrium to be shed. The IUS will reduce your periods by 80-90% and in fact 20% of users have no periods at all. The IUS also gives very reliable contraception – the failure rate is less than that of being sterilised. However, once removed, these effects are very quickly lost and it is quickly reversible if fertility is desired.

The contraceptive injection

50% of users of contraceptive injection will have no periods at all. This is a very welcome non-contraceptive benefit – however after stopping, it can take up to a year to reverse.

The Progesterone-Only Pill (POP)

With Cerazette, after 1 year of use, 50% of users will have no periods or infrequent bleeding. However usually the POP is notorious for causing irregular bleeding. Cerazette has a positive effect to reduce period pain.

Contraceptive implant

20% of contraceptive implant users have no periods. However this effect is unpredictable. Around half of implant users report troublesome bleeding, and this is the commonest reason for removal.

Different options to reduce menstrual blood loss – a comparison of effectiveness

Different options to reduce menstrual blood loss – a comparison of effectiveness, Matteson et al, 2013
Treatment optionReduction in menstrual blood loss
IUS – The Hormone Coil71-95%
Cyclical Progestogens87%
The Combined Pill35-69%
Tranexamic Acid26-54%
NSAIDs10-52%

What are the surgical treatments for heavy periods?

Endometrial ablation

This is a surgical procedure where you are usually given a general anaesthetic, and while you are asleep a hot metal wire is inserted into the cavity of the uterus (womb) and used to destroy the endometrium (womb lining). Sometimes this can be done using a fluid filled balloon.

Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus, sometimes with the ovaries. This not undertaken lightly because of the possible risks involved.

Final thoughts

Don’t be embarrassed about seeing your doctor to discuss your periods. There are many successful ways to treat your symptoms, and improve your quality of life. There is no need to suffer in silence.

Related