Issues Magazine

Periods: What’s Normal and What’s Not

By Jean Hailes for Women’s Health

For most women, menstruating is nothing more than a minor monthly discomfort, but for some women it can cause serious, and sometimes debilitating, physical and emotional issues.

Menstruation is when the lining of the uterus breaks down and sheds cells, resulting in vaginal bleeding that occurs approximately once a month. Most women will menstruate for around 40 years, and can expect to have about 500 period cycles over their lifetime.

Period-related problems are a common reason for time off work, school or for visits to the GP, and may have a significant impact on a woman’s quality of life. Periods can cause issues at any age, but more commonly affect teenagers and those approaching menopause.

Is My Period Normal?

The menstrual cycle is a normal part of every woman’s life. How long it lasts, how heavy it is and duration between periods vary for each woman.

Menstrual fluid is mostly made of blood, but also contains mucus, water and tissue. It can be bright red, dark red or dark brown in colour, and may contain small clots (dark pieces of blood) in it. Clots that are greater than a 50-cent piece in size should be investigated further by a doctor. While it may seem like a lot, on average women lose about 20 to 80 mL of blood during each period (20 mL being equal to four teaspoons and 80 mL equalling 1/3 of a cup).

Periods can start in girls as young as nine or as late as 17 (with the average age of menarche – the first period – in Western countries being 12 or 13) and continue until menopause (the last period) is reached between the ages of 45 and 55.

Initially, periods may be irregular, as it can take a year or two for the cycle to regulate. Once regular, periods tend to begin around the same time each month (on average 26–29 days) but they can be as often as three weeks apart or as far as eight weeks apart.

Common Menstrual Issues

“There are a range of issues that women may experience relating to their menstrual cycle,” says Jean Hailes gynaecologist and founding director Dr Elizabeth Farrell AM. “It’s important if you have pain, or feel something isn’t quite right, to have it checked out by your doctor.”

Painful Periods – Dysmenorrhoea

While some women experience minimal or mild discomfort during menstruation, other women suffer from severe, debilitating pain. Some women may have always experienced painful periods, whereas others may develop pain with time. Period pain is more common in teenagers and women in their 20s, but can also occur in older women.

Period pain comes from the muscles in the uterus contracting or tightening. Pain may include cramping and heaviness in the pelvic area, as well as pain in the lower back, stomach or even legs. Some women also experience nausea, vomiting, paleness or diarrhoea.

Women who experience painful periods may have higher levels of prostaglandins, a natural body chemical that causes contractions of the uterus, bowel and blood vessels. Pain may be due to endometriosis (when cells lining the uterus travel to other areas of the pelvis), fibroids (benign tumours made of muscle and tissue that grow inside the uterus), or pelvic infections.

If a woman is experiencing period pain that is affecting her quality of life, it is important to see a health practitioner for further investigation, as there are medications and treatment which can make a difference.

Premenstrual Syndrome

Premenstrual syndrome (PMS) refers to a collection of symptoms that some women experience before each period. Symptoms include physical responses like bloating, headaches, tiredness and food cravings and psychological responses like irritability, anger, depression and low self-esteem. Women who suffer from PMS may find physical activity, dietary changes, yoga, relaxation techniques and herbal remedies helpful in relieving symptoms; however, women with severe symptoms may require specific medications. See your health practitioner for further information.

Irregular Periods – Oligomenorrhoea

Periods may be irregular in the first few years after periods begin, in the lead-up to menopause or following childbirth, miscarriage or termination of a pregnancy. Some women, however, never establish a regular cycle. Irregular periods may be due to:

  • 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 ovary syndrome – a common hormone disorder
  • change in diet or sudden weight loss or gain.

Absence of Periods – Amenorrhea

Amenorrhoea (other than in pregnancy) may occur because of a hormonal disturbance caused by factors including weight gain or loss, over-exercising, anxiety or stress, travel, dietary changes and conditions such as polycystic ovary syndrome. Amenorrhoea may be temporary, with periods returning after some months. Women experiencing amenorrhoea for longer than six months should consult a health practitioner.

Heavy Bleeding – Menorrhagia

A heavy period (more than 80 mL) can significantly interfere with everyday life. While it is difficult to accurately measure the amount of menstrual fluid, having to change your pad or tampon hourly, or needing to change during the night, is a good guide that your period is heavy.

A number of factors (including fibroids, polyps, endometriosis and, rarely, uterine cancer) can cause heavy bleeding. Heavy bleeding may then lead to anaemia (low red blood count), with symptoms of fatigue, paleness, lack of energy and shortness of breath.

When no cause is found (dysfunctional uterine bleeding), hormonal medications to reduce bleeding are usually prescribed. These include the oral contraceptive pill and progestin hormone therapies, including tablets or a progestin hormone-releasing intra-uterine device (IUD).

Spotting – Bleeding between Periods

Bleeding between periods may be caused by diet, stress, being underweight, doing too much exercise, sexually transmissible infections, endometriosis, fibroids, polycystic ovary syndrome, thyroid disorders or gynaecological cancer. It can also be a side-effect of some contraceptives or medications.

Any bleeding between periods should be investigated by a doctor, particularly for postmenopausal women who are at higher risk of endometrial cancer. “When you visit your doctor it helps if you can describe your pattern of bleeding,” says Dr Farrell. “The doctor will also need to know if bleeding occurs after sex or if there is any accompanying pelvic or lower abdominal pain.”

Getting Checked – When to See Your Health Practitioner

It is important to see your doctor if you experience any of these period issues. Keeping a menstrual diary, including when you get your period, the length, heaviness and anything else you notice, will help your doctor work out how best to help you.

You should consult your health practitioner if:

  • you have not started menstruating by the age of 17
  • your period has suddenly stopped
  • you are bleeding for more days than usual
  • you are bleeding excessively
  • you bleed between periods
  • you experience pain during your period that interferes with your quality of life
  • you have clots that are bigger than a 50-cent piece.

Resources

Jean Hailes has a number of web pages and a fact sheet about periods, including information about the menstrual cycle, premenstrual syndrome, period pain and heavy uterine bleeding. These are available at www.jeanhailes.org.au or by calling toll-free on 1800 JEAN HAILES (532 642).

Jean Hailes for Women’s Health is a national not-for-profit organisation combining clinical care, evidence-based research and practical education for women and health professionals. It is dedicated to improving women’s knowledge and understanding of complex women’s health issues by translating the latest scientific and medical evidence in order to inspire positive change in women. This article is republished with permission of Jean Hailes for Women’s Health.