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Cramps, migraines and heavy bleeding are widely accepted as standard side effects of the menstrual cycle, but doctors warn that women shouldn’t settle for pain and discomfort.
Associate Professor Dr Gino Pecoraro, a gynaecologist from Brisbane, revealed the reasons behind common period complaints and the warning signs you should always discuss with a doctor.
Missed periods are most commonly caused by stress, but bleeding between periods or directly after sex is ‘never normal’ and should be investigated to rule out serious health issues like cancer.
Premenstrual headaches and breast tenderness are caused by natural hormonal imbalances, but intense cramping that disrupts your daily life can be a sign of endometriosis and should be examined.
‘Having a period is a normal part of life, but people’s ignorance around the menstrual cycle is actually quite concerning,’ Dr Pecoraro told Daily Mail Australia.
‘We need young women, and indeed men, to be more health literate.’
HEAVY FLOW
A sudden increase in the volume of your period could be a sign of underlying issues like hypothyroidism, uterine fibroids, polycystic ovarian syndrome (PCOS) or polyps, which are abnormal growths of tissue in the cervix.
Between 20ml and 30ml is the average flow of a healthy period, which should be easily contained with pads or tampons, but not both.
‘If you need to line your bed with towels, or you’re ‘flooding’ through sanitary products overnight, that’s significant bleeding and you should consult with your GP,’ Dr Pecoraro said.
‘In young women, an unusually heavy period is often the first sign of a bleeding disorder, which are now believed to be more common than we originally thought.’
Prolonged heavy periods can lead to iron deficiency, which effects hair, teeth and nail strength and causes fatigue.
IRREGULAR AND MISSED PERIODS
Irregular periods are perfectly normal for many women, but sudden changes in frequency are always worth investigating.
‘A stereotypical, healthy cycle is 28 days long, so you ovulate on day 14 and have a period on day 21 that lasts between four and seven days,’ Dr Pecoraro said.
‘But not everyone has a 28 day cycle – lots of women have 21 day cycles, and some have anywhere up to 35.
‘Your cycle is individual to your body clock. It’s changes in the timeline of your period that you need to watch for.’
And while a range of health issues can cause missed periods – the most obvious being pregnancy – stress is often the biggest culprit.
‘Once pregnancy has been ruled out, the most common cause of missed periods is stress. In young women, this is often liked to exams, sporting fixtures and applying for new jobs,’ he said.
BLEEDING BETWEEN PERIODS
Bleeding between periods or directly after sex is ‘never normal’, and could be a sign of serious health issues.
‘Bleeding between periods is one of the hallmark symptoms of endometriosis, and the same goes for bleeding after intercourse,’ Dr Pecoraro said.
He urged women to consult with a doctor, even if your last cervical screen came back clear.
‘Even if you’ve had a normal cervical screen, you need to have unexplained bleeding checked by a gynaecologist – it could be the only sign of precancerous cells.
‘Remember, it’s only a screening. If you’ve got irregular bleeding, you need further testing.’
SEVERE CRAMPING
Cramping is one of the most talked about period complaints, but Dr Pecoraro insists anything more than mild aching should be investigated.
‘Having a period is a normal part of life, but if you’re having pain that’s interfering with your daily life – causing you to miss days at work or school – that shouldn’t be accepted,’ he said.
Dr Pecoraro wants to see a change in the level of pain and discomfort women are willing to accept during their period, and hopes more will take control of their health because periods are ‘not something women should dread’.
‘We need to change the general attitude. There’s a national awareness campaign running about endometriosis, but unfortunately it’s still about seven years from the time symptoms start until the condition is diagnosed, and that’s not good enough.
‘If you’re having pain, don’t accept it. Don’t accept a doctor telling you “that’s just the way it is” – ask for a referral to a gynaecologist,’ he said.
Cervical infection, polyps, fibroids and endometriosis are all possible causes of severe cramping.
HEADACHES AND MIGRAINES
Headaches just before the start of a period are known as ‘menstrual migraines’, which are caused by rapidly fluctuating hormones, mainly oestrogen.
‘Sudden increases and withdrawals of oestrogen increase the reactivity of blood vessels in the brain, triggering spasms which cause headaches,’ Dr Pecoraro said.
While many women experience menstrual migraines each month, women who suffer from headaches while taking the combined contraceptive pill should consult with a doctor to confirm the medication is suitable for their needs.
‘There are certain types of contraceptive pill that people prone to migraines can’t take, because they increase the risk of stroke,’ he said.
‘It absolutely does not mean you can’t have contraception, you may just need something without oestrogen.’
INTENSE PREMENSTRUAL SYNDROME
Premenstrual syndrome (PMS) is a combination of symptoms that many women experience one to two weeks before their period.
Bloating, diarrhoea, mood swings and breast tenderness are common side effects, with most of these caused by normal hormonal changes associated with the menstrual cycle.
But while PMS is part and parcel of monthly periods, it shouldn’t get in the way of your daily routine.
‘If PMS symptoms are impacting your life, that’s not acceptable or normal,’ Dr Pecoraro said.
Severe complaints should be discussed with a doctor, but there’s a wide variety of natural remedies for milder issues.
Tender breasts can be alleviated by taking supplements of evening primrose oil, while mood swings can be eased with 1200mg calcium tablets.
BLOOD COLOUR
The colour of menstrual blood varies throughout the cycle, transitioning from a brighter red to a dark shade of brown.
And while a change in shade can be alarming, it’s usually nothing to worry about.
Brown blood is older blood that’s been in the uterus for longer, while red blood is fresher and hasn’t had a chance to oxidise, a chemical reaction which causes the change in colour.
Clotting is also a normal part of a period, but consistently large clots should be investigated to rule out underlying issues like hypothyroidism, fibroids and anaemia.
Dr Gino Pecoraro is President of the National Association of Specialist Obstetricians and Gynaecologists (NASOG).