Your guide to decode menstrual period problems

Menstrual cycle is not just about pregnancy or birth control pills, your cycle can say a lot about your state of health.

Heavy, infrequent, longer lasting periods

If you have a heavy, longer lasting but infrequent flow and you are overweight, it means you are stocking up on estrogen. Excess fat cells prevent ovaries from releasing the egg while the endometrial lining keeps thickening. Your risk for endometrial cancer increases if this goes on for an extended period of time. Check with your doctor and take steps to reduce weight.

Scanty periods

Scanty periods, or hypomenorrhoea as it is known medically, means the blood flow during periods is less than two days or the blood flow decreases to less than 80ml. It can be genetic, so if your mother or sister too have a decreased blood flow, you don’t have to worry. This type of hypomenorrhoea usually does not interfere with pregnancy.

Long term use of oral contraceptives too can be the reason for scanty periods. Stop taking pills for some time and check if flow returns to normal.

However, scanty periods can also occur when ovulation does not take place. This is called anovulation. Chronic anovulation can lead to infertility. Problems with hormones such as low thyroid hormone level, high insulin levels, high androgen level, or high prolactin levels can cause anovulation.

Not so common cause of scanty periods can be Sheehan’s Syndrome. During pregnancy the pituitary gland secretes large amount of pregnancy hormones. So it enlarges in size and of obviously requires increased blood supply. If there is heavy bleeding during pregnancy or after childbirth, blood flow to pituitary lobe is inadequate and as a result, a part of pituitary lobe dies off (necrosis). This results in hormone deficiencies.

If the scanty periods are not due to genetic reasons or contraceptives, you need to see your obstetrician and gynaecologist (OBGYN).

Amenorrhoea or loss of periods

It is normal to have no periods during pregnancy, breast feeding, after menopause, or before attaining puberty.

It is not normal at all if a woman never experiences menses. This is called primary amenorrhoea and it could be due to chromosomal defect or maybe a defect in the development of the reproductive tract. It is very difficult to treat this condition.

Secondary amenorrhoea is if a woman had experienced menses at least once before the loss of periods. There are many causes for loss of periods –

• Inflammation in the brain tissue because of diseases such as encephalitis or meningitis can lead to loss of menses.
• Tumours near the pituitary gland can suppress its action and cause amenorrhoea.
• Mental disorders such as depression, or emotional upsets such as death of a loved one could stop menses temporarily.
• Eating disorders such as anorexia is one major reason for loss of periods in girls trying to be ultra-thin.
• Exercise related amenorrhoea such as long distance running.
• Surgical removal of ovaries or exposure to radiation can cause less production of oestrogen and progesterone. Hence the loss of periods.
• Polycystic ovarian syndrome (PCOS) is a condition that can lead to loss of periods.
• Other conditions include diabetes mellitus, especially type-1 diabetes, thyroid problems, severe obesity, Sheehan’s Syndrome, and chronic diseases such as tuberculosis.
• Stress.

It is important to talk a gynaecologist and get treatment if you have any of the above mentioned problems.

Dysmenorrhoea

Dysmenorrhoea is the technical term for menstrual cramps in the lower abdomen. It is a very common occurrence, and most women have some pain for a day or two. Common menstrual cramps are caused by the hormone prostaglandins produced in the lining of the uterus (which you shed during the periods). Right before the start of periods, prostaglandin levels increase and cause the pain. Pain usually decreases as prostaglandin levels decrease as menstruation continues.

However, if the cramps are severe and prolonged, you may be suffering from secondary dysmenorrhoea. Sometimes it does not go away even after the periods end. Secondary dysmenorrhoea is caused by a disorder in the reproductive system such as –

Endometriosis: This is a condition in which the endometrium or the lining on the inside of the uterus forms outside the uterus. The most effective method to control pain is laparoscopic surgery. Gonadotropin-releasing hormone (GnRH) agonist therapy is also used as treatment in women but it is not advisable for younger women because the drug causes significant reduction in bone mineral density. [1]

• Adenomyosis: Here, the lining of the uterus grows into the muscle of the uterus.
• Cervical stenosis: It is a condition in which the opening to the uterus is narrow.
• Pelvic inflammatory disease: PID, caused by bacteria, is one of the most common diseases of the reproductive tract.
• Uterine fibroids: Uterine fibroids are benign uterine tumours found in 20 to 40 percent of women in their reproductive years. A study reported that your risk for fibroids increases [2] if you are around the age of 35, if you started your periods at an early age, if you consume lots of alcohol and caffeine, or if you are perpetually stressed.

Abnormal uterine bleeding

Abnormal uterine bleeding (AUB) is when you bleed between your periods, or you bleed after sex, bleeding heavier or more than normal, spotting when you are way off your time. If you have a cycle that is longer than 35 days or shorter than 21 days, that too constitutes abnormal uterine bleeding. If you don’t have periods for 3 to 6 months, then that too is abnormal.

Abnormal uterine bleeding is not life threatening and in most cases the main burden of symptoms is its impact on quality of life. Researchers, Kristen Matteson and Melissa Clark, from Rhode Island gathered opinions from women with AUB through group discussions and questionnaires to explore the effects of AUB on their lives. [3] Some of the responses were –

• It comes out in clots and gushes.
• I can’t even visit anybody because I think I will sit down and leak right through. That’s what’s heavy to me. I sit there thinking ‘can I even cough’ and I sit to the side.
• Women reported using towels and incontinence briefs to contain their bleeding. ‘Even to sit on my couch, I put a towel down just in case’.
• It comes when it feels like it.
• One month it comes not at all, another month it comes three times during the month.
• You never know when it’s going to come or when it’s going to stop.
• You get a pain when you feel the clot passing through you. It’s like labour pain.

The researchers discovered five major themes that reflected the participants’ experiences with bleeding and quality of life: (1) irritation and inconvenience, (2) bleeding-associated pain, (3) self-consciousness about odour, (4) social embarrassment, and (5) ritual-like behaviour.

As if that’s not enough, AUB can have other causes too. Infection of the cervix or uterus; cancer of uterus, cervix, or vagina; problems with blood clotting; polyps; fibroids; PCOS; and even miscarriage.

Talk to your doctor if you think you have AUB. Hormonal medication are often used to control AUB. Sometimes, however, surgery may be required to remove growths and fibroids. Endometrial ablation is used to control bleeding. When all treatments fail, hysterectomy has to be performed. It is a major surgery. You won’t get pregnant or have periods ever again.

Periods and your emotional health

Let’s not forget that periods can have a marked impact on our thinking, mood, and behaviour, also.

‘The menstrual cycle is a direct communication between your brain and your body,’ says Dr Christina Hibbert, a clinical psychologist at Los Angeles.

Estrogen influences positive moods, motivation, memory, appetite, sex drive, perception, thinking, and your response to stress. It gives you a feeling of well-being. During the first half of the cycle, oestrogen levels rise and more endorphins (neurotransmitters) are released. No wonder you feel so calm, have higher motivation and energy, and find yourself thinking clearly!

You are at your best on day 14, because oestrogen, testosterone, and endorphins are highest on that day.

In the luteal phase, or the second half of the cycle, you may find your motivation and energy levels going down, yours moods decline, and you don’t feel so perky. This is because of the hormone progesterone. Progesterone levels are highest and estrogen levels are correspondingly lowest in the last week of the cycle. This is when you are PMS-ing with all its symptoms.

In the end, if you don’t get your periods for three months or more, or you have erratic periods check with your gynaecologist.

You may also like to read:

• 10 things you should eat during periods to make life easier
• Say ‘no’ to these 6 foods while suffering from menstrual cramps
• 10 natural remedies to reduce pain during your menstrual periods

Photo source: Shutterstock

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Reference:

1. Harada T. Dysmenorrhea and Endometriosis in Young Women. YonagoActaMedica. 2013;56(4):81-84.

2. Khan AT, Shehmar M, Gupta JK. Uterine fibroids: current perspectives.International Journal of Women’s Health. 2014;6:95-114. doi:10.2147/IJWH.S51083.
3. Matteson KA, Clark MA. Questioning our Questions: Do frequently asked questions adequately cover the aspects of women’s lives most affected by abnormal uterine bleeding? Opinions of women with abnormal uterine bleeding participating in focus group discussions. Women & health. 2010;50(2):195-211. doi:10.1080/03630241003705037.