Periods: they can signal that you’re healthy, fertile and ‘not pregnant’, but period positives aside, it’s fairly rare to relish the arrival of the monthly bleed, mainly because many of us experience uncomfortable twinges, bloating and often a dip in mood in the few days before and during our period. For some women, however, periods provoke the kind of extreme symptoms that make going to work, having a social life or even leaving the house in the week of their period virtually impossible. If you’re one of them or know someone who is, here are some of the more severe manifestations of menstruation, how to know what’s “normal” and what you can do to improve your quality of life for that dreaded week.
Medically termed 'menorrhagia', flooding refers to extreme blood loss during periods. If your flow is too heavy for the largest absorbency tampon, and you’re having to change sanitary protection very frequently, you could be experiencing flooding. In more severe cases, blood can leak through to bedding and generally make going about your daily business extremely challenging. Consultant gynaecologist at London Gynaecology Mr Narendra Pisal underlines what might constitute flooding, and possible causes:
“Periods vary considerably in different women, however, many women with extremely heavy periods still believe their periods to be normal as they have nothing else to them compare with. The amount of blood lost during the average period is 30ml-40ml, with the majority of women losing under 80ml (less than half a cup).”
“Despite this, a lot of women do experience more bleeding than this. If you are passing lots of blood clots or having to constantly use double protection (tampons and pads), changing protection more frequently than every four hours or if your periods are making you anaemic, it’s likely you’re suffering with menorrhagia. It can often also mean that your period leaks through sanitary protection and clothing.”
Why am I getting it, and what can I do?
“Heavy periods can be an indicator of underlying problems such as fibroids, endometriosis or thyroid dysfunction, and it is always a good idea to get things checked out with your GP or gynaecologist.”
“If the bleeding is extremely heavy or making you tired, exhausted and weak, you should see a doctor. He or she is likely to arrange an ultrasound scan and will schedule blood tests to check your haemoglobin, thyroid function tests and iron levels, to determine whether you could be anaemic .”
If you are anaemic, your doctor will likely recommend iron supplements. Other causes of very heavy periods can include PCOS , an infection in your genital tract (pelvic inflammatory disease), a condition called adenomyosis, where the lining of the uterus is in the wall of the uterus and can cause of bruising during periods, polyps, blood clotting disorders and extremely rarely, gynecological cancers such as womb cancer. Refer to the NHS website and always book an appointment with your GP if you’re worried. Flooding can also be triggered by the coil - heavier periods are common within the first six months of having it inserted.
Crippling period pain
There’s the odd cramp, and then there’s the searing, bent-double kind of pain that leaves you reeling, and very often, bedridden. Mr Pisal admits that the triggers of such agony aren’t always clear cut, but can include:
Lots of clotting: uterus contracts to pass blood clots can be very painful.
Endometriosis: when the inner lining of the uterus is inside the abdomen, causing painful periods, and very often pain during sex.
Fibroids: common, benign (non-cancerous) lumps of the uterine muscle, which can cause painful and heavy periods.
Adenomyosis: (see above)
Why am I getting it, and what can I do?
It is important to seek medical attention for a proper diagnosis and appropriate treatment for any of these conditions, but Mr Pisal acknowledges that there are still a lot of unknowns where severe period pain is concerned- hormonal imbalance is often cited where there is no other physical explanation. Very painful periods are known as ‘dysmenorrhoea’, taking in much of the extreme symptoms mentioned in this article, but often primarily related to contractions of your uterus during menstruation. During these contractions, menstrual blood is released along with lipids called prostaglandin, which cause the womb muscles to further contract, which leads to MORE PAIN, often in addition to blood clotting. How considerate, and we still don’t know why some women might experience stronger contractions, and a greater release of prostaglandin, than others. While medical research needs to up its game where women’s health is concerned across the board, Mr Pisal highlights that there’s always something that can be done to alleviate your pain- never suffer in silence:
“Simple painkillers can help, but don’t underestimate the power of a hot water bottle.”
This may seem like the most cliché of remedies, but the NHS reports that heat has been shown to reduce pain- warm baths, heat pads and even warming massage in circular movements around the abdomen can help to take the edge off.
Painkiller wise, note that ibuprofen and aspirin have been proven to be more effective in reducing period pain than paracetamol, and if neither of those is nailing it your GP can prescribe codeine or naproxen. The prescription medication tranexamic acid can also be helpful for reducing the amount of bleeding, while Mr Pisal reports that mefenamic acid can be very effective for reducing painful spasms.
Taking the contraceptive pill or having a contraceptive implant or injection can sometimes help to make periods lighter and less painful, and stopping smoking has been shown to have an effect- smoking is associated with a greater risk of more severe period pain. Mr Pisal comments that long-term solutions can range from using a Mirena contraceptive device to endometrial ablation to keyhole hysterectomy, but of course these are options to be considered according to your specific circumstances with a gynaecologist. If none of the above is working for you, it’s best to see a gynaecologist for a thorough assessment and pelvic ultrasound scan.
The hormonal roller coaster is real, and clearly adding pain and other unpleasantness into the mix isn’t going to benefit your mood any, but GP Dr Sohère Roked emphasises that high oestrogen levels, or oestrogen dominance which is particularly common in young women in their 20s and 30s, can make mood fluctuations, fatigue and that foggy-headed feeling worse.
Why am I getting them, and what can I do?
While there are no 'normal' oestrogen levels, and oestrogen oscillates throughout our monthly cycle, it’s worth seeking a hormone test if you’re suffering with extreme mood swings, particularly seeing as high oestrogen levels are also associated with heavy periods, fibroids and endometriosis . Abdominal fat cells also produce oestrogen, so maintaining a healthy weight could help, while laying off alcohol could also help to keep oestrogen levels in check- drinking too much, too often can cause oestrogen levels to spike according to Cancer Research UK. Plummeting oestrogen levels post-ovulation are also associated with low mood, so it seems there’s no winning, and once again, more research is desperately needed.
Mr Pisal recommends that patients experiencing mood swings keep a diary of symptoms- this will help you to recognise exactly when and how your mood changes throughout the month, and will be useful for any future GP or doctor’s appointments. Vitamin B supplements can sometimes help, and Dr Roked reports that some of her patients have seen improved mood thanks to evening primrose oil or agnus castus taken towards the end of the cycle, but always consult your doctor before taking any supplements. Gentle exercise such as yoga and swimming can also help to release tension and improve mood if you feel up to it.
Bleeding ALL THE TIME
This one can be a red flag according to Dr Pisal:
“Bleeding between periods or after sex is not normal and you should definitely see a doctor if you’re experiencing this. Sometimes there can be a bit of spotting mid-cycle, indicating ovulation, but if the bleeding is unpredictable or heavier, please seek medical attention- the causes can range from a simple polyp to fibroids to, much more rarely, cancer.”
Why am I getting it and what can I do?
As above, this one particularly merits prompt medical investigation, but don’t panic, as the triggers are likely not serious and your doctor will be able to advise on managing symptoms, or refer you to a relevant specialist. This is another case when a journal can come in handy too for tracking bleeds.
Dizziness, headaches and vomiting
From the sudden onset of a fierce migraine to being sick on the bus, acute PMS can be both distressing and significantly affect wellbeing, your career and your personal life, in both the short and long term. Monthly episodes of violent illness are hard to handle, so get help.
Why am I getting it and what can I do?
Dr Pisal thinks that the catalyst for such severe symptoms could be twofold:
“Symptoms such as intense headaches and vomiting can be caused either by hormonal changes associated with the menstrual cycle, or excessive pain, or a combination of the two. Sometimes going on the contraceptive pill can really help in these cases, as can taking some supportive medication- please discuss this with your doctor as you shouldn’t have to endure this.”
Damn straight, and as Dr Pisal emphasises that most women will suffer from at least one of these frankly horrible symptoms during their lifetime, if not every month, and that period pain and other menstrual side-effects can last for at least 72 hours at a time, it seems pretty shoddy that we’re often none to wiser as to some of the causes and best treatments for menstrual disorders. Let’s demand better studies and wider research while educating girls about a whole gamut of period experiences- smashing stigma regarding talking about periods ( more than a quarter of girls still don’t know what to do when their period starts ) will help empower women of the future to speak up when they encounter problems, not hide away under a duvet until it passes.