trouble with periods
by Jenny Bryan
Nine out of ten women have period problems at some time in their life. Recent studies have shown that 75% of menstruating women have painful periods and at least 30% complain of heavy periods. But knowing you're not alone is small consolation when period problems are disrupting your working or social life.
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Sara knew she had to do something about her painful periods when she almost passed out at an important meeting.
'I was so embarrassed when the chairman stopped the meeting and asked me what was wrong because I looked so dreadful. His female assistant led me out of the room to the "ladies", but I was convinced all the men in the room were nodding their heads and saying "women's troubles".'
Penny was equally mortified during a job interview when she was having one of a series of heavy periods.
'They must have wondered why I'd bothered turning up, I was so bad. I couldn't concentrate on selling myself for the job when all the time I was wondering what was happening at my other end. I just wanted it to be over so that I could get to the toilet.'
painful periods
treatments
Fortunately, Sara's painful periods (also called dysmenorrhoea) responded well to non-steroidal anti-inflammatory drugs (NSAIDs) – the medicines most commonly recommended by doctors for this condition.
Ibuprofen is the best known of this group and can be bought direct from the chemist. NSAIDs help restore the natural balance of prostaglandins – a group of chemicals found all over the body, which are involved in pain, inflammation and fever.
Many women find that ibuprofen works best when started the day before a period is due or, if that's difficult to predict, at the very first sign that it has arrived. No one wants to take drugs unnecessarily, but waiting to see how painful a period is going to be can make it harder to control the pain once it has taken hold. A regular dose, taken according to the manufacturer's instructions, during the first and sometimes the second day certainly did the trick for Sara.
'I couldn't believe what a difference it made. Instead of battling on making the best of it, I take the ibuprofen at the first twinge and then just get on with the day as if nothing were happening.'
In general, periods tend to be more painful at the start of a woman's menstrual career and become less of a problem after she has had children. However, some women don't respond to NSAIDs and need further treatment. Taking a combined oral contraceptive pill is one option but, if the pain persists, it may be necessary to get it properly investigated by a specialist.
can the pill be used for period problems?
It is perfectly OK to take the pill continuously for a few months. It's one way to reduce the number of bleeds you have between packs of treatment, particularly if these 'withdrawal' bleeds are heavy or painful (bleeding is usually fairly light and not painful when you take the pill).
Taking the pill continuously is also a way of making sure you don't have a period when you are on holiday, doing exams, etc. This technique is sometimes called tri-cycling – taking three packets of 21 pills consecutively, followed by a seven day break. One of the problems with this is that it increases the overall hormone dose over the course of a year. Another potential problem is that you may bleed between your normal withdrawal bleeds, when you are taking the pill. This is called breakthrough bleeding. The longer you take the pill continously, the more likely you are to have a breakthrough bleed.
There is no evidence to suggest that this method causes or promotes future infertility.
endometriosis
About two million women in the UK suffer from endometriosis – a condition which can make periods very painful and heavy.
Endometrial tissue, which normally lines the womb, spreads to other parts of the body and establishes itself as 'stray' patches. Usually, it stays in the pelvic region, around the outside of the womb and fallopian tubes, the ovaries, bladder or bowel, but it occasionally strays further afield. Each month, the tissue swells and bleeds, just as it would if it were still inside the womb, and this can be very painful. Gradually the tissues become scarred and may stick to surrounding structures, sometimes forming large cysts.
diagnosis and treatment
Endometriosis is usually diagnosed in an exploratory laparoscopic operation during which a small telescope is inserted through an incision in the abdomen so that the consultant can look for tell-tale signs of the disease.
Treatment aims to relieve symptoms and shrink the abnormal patches of endometrial tissue by stopping ovulation and menstruation, usually for about six months. This can be done with a variety of hormonal treatments, all of which have side effects ranging from weight gain and headaches to increased body hair and voice deepening.
Since endometriosis is often linked to infertility, the aim of treatment for many women is to enable them to have a child, and they have to juggle treatment for their endometriosis with the need to ovulate normally in order to get pregnant.
Sometimes surgery is used to remove the endometrial growths and, in more severe cases, where women do not want more children, hysterectomy and removal of the ovaries can cure the condition.
heavy periods
The solution to Penny's heavy periods (also called menorrhagia) was much harder to find than that for Sara's painful ones. Like many women who experience heavy periods, Penny was nearing the menopause. Gradually, her cycle had changed until she seemed to be bleeding two or three weeks in every four. Not only was it a continuing source of stress and embarrassment, the heavy loss of blood was making her anaemic.
'I felt so tired all the time and, when I took iron supplements for the anaemia, I started getting constipated. So it was just one thing after another.'
Even defining heavy periods can be difficult; what is heavy to one woman is normal to another. But, on average, women lose about 30-40ml (2-3 tablespoons) of blood during a period. Those who lose 80ml (5 tablespoons) or more are usually said to have heavy periods. As it's obviously very difficult to know how much blood you are losing, most doctors take heavy periods to mean blood loss that seriously affects a woman's lifestyle.
diagnosis and treatment
Although Penny's heavy periods started when she was in her early 50s, the problem affects women of all ages. Some respond to prescribed medicines from their GP, such as an NSAID called mefenamic acid or a clotting agent called tranexamic acid. The combined contraceptive pill or hormone replacement therapy (HRT), particularly for women nearing the menopause, are other options.
But, if these measures don't help, the next step is a referral to a specialist. As with painful periods, there may be an underlying cause for heavy periods, which needs to be sorted out. Endometriosis is one possibility, benign growths in the womb, such as polyps and fibroids, are another. Rarely, the cause could be cancer – another good reason to get the problem checked out.
The diagnosis is usually made during an internal examination, using a miniature telescope to look directly up through the vagina into the womb. Samples can be taken and examined in the laboratory.
Polyps and fibroids can be removed surgically but they may grow back. Some women with heavy periods benefit from having a small T-shaped progestogen-releasing device called Mirena put into their womb. This is a specialised form of intrauterine coil that gradually releases levonorgestrel, a synthetic form of progesterone widely used in contraceptive pills. Studies have shown that the device can significantly reduce blood loss in women with menorrhagia. It also acts as a highly effective form of contraception.
surgery
Unfortunately, some cases defy every drug that doctors can prescribe and the only remaining option is surgery.
Either the womb can be removed completely (hysterectomy) or just the lining (endometrial ablation). The latter procedure can be done with a hot wire or a laser beam and can be very successful. Some women never have another period, others only an occasional, small bleed. However, in unskilled hands, there is a risk of damage to surrounding tissues. So it is very important to talk through the pros and cons of the technique with your surgeon before making a decision and ensure that he or she is experienced in the procedure.
By the time Penny's heavy periods had been fully investigated and she had tried a variety of different drugs, she decided on hysterectomy. Recovery took longer than with endometrial ablation, but there was no chance of her having another period.
'I was so fed up with the whole thing that I decided on hysterectomy as I knew other women who had had them without any problems. It was several months before I was able to twist and turn, bend and lift normally. But it was great to know that I would never be embarrassed by periods again.'
help and info
Channel 4 is not responsible for the content of third party sites.
See our complementary medicine section for details of therapies that may be helpful for those with premenstrual syndrome (PMS).
organisations
Endometriosis SHE Trust
Tel: 08707 743665
Website: www.shetrust.org.uk/est.html
Offer help, holistic information and support to women with endometriosis and everyone else interested, to enable them to make informed choices about conventional, nutritional and complementary therapies.
Hysterectomy Association
60 Redwood House
Charlton Down DT2 9UH
Helpline: 0871 78 111 41
E-mail: info@hysterectomy-association.org.uk
Website: www.hysterectomy-association.org.uk
Provides impartial information to women contemplating a hysterectomy to enable them to make appropriate decisions for their long term health. Website has information about the diseases that can lead to hysterectomy, alternative techniques that may be available for treatment and information about the menopause and hormone replacement therapy.
National Association for Premenstrual Syndrome (NAPS)
41 Old Road
East Peckham
Kent TN12 5AP
Helpline: 0870 777 2178
E-mail: contact@pms.org.uk
Website: www.pms.org.uk
A medical charity providing information, advice and support to women affected by PMS, their partners and families. Also provides diagnosis and treatment guidance to health professionals.
The National Endometriosis Society
50 Westminster Palace Gardens
Artillery Row
London SW1P 1RR
Tel: 020 7222 2781
E-mail: nes@endo.org.uk
Website: www.endo.org.uk
Information and support for women with endometriosis.
Womens' Health Concern
PO Box 2126
Marlow SL7 2RY
Tel: 01628 488065
Helpline: 0845 123 2319 (Tue-Thurs 9.30am-2.30pm)
E-mail: counselling@womens-health-concern.org
Website: www.womens-health-concern.org
Charitable organisation working to support women dealing with menopause and other gynaecological conditions.
Women's Health
52 Featherstone Street
London EC1Y 8RT
Helpline: 0845 125 5254 (Mon-Fri 9.30am-1.30pm)
Textphone: 020 7490 5489
E-mail: info@womenshealthlondon.org.uk
Website: www.womenshealthlondon.org.uk
Confidential and non-judgemental health information and support on gynaecological health issues such as abnormal smears, HRT, fertility awareness, fibroids, lesbian health, hysterectomy, painful periods, menopause, vaginal infections, thrush, pelvic inflammatory disease, PMS, unplanned pregnancy and abortion care.
websites
BeingGirl.co.uk
www.beinggirl.co.uk
This site is produced by the makers of Tampax Tampons and features advice and information about puberty, periods, relationships and sex. Includes answers to FAQs, information about using pads and tampons, and advice on how to relieve period problems.
Likeitis.org – Periods
www.likeitis.org.uk/periods.html
This website for young people includes FAQs about periods, a brief look at what happens during your cycle and information about sanitary protection.
The Menstrual Cycle
www.netdoctor.co.uk/health_advice/facts/menstruation_cycle.htm
Informative article from NetDoctor discussing menstruation and problems such as painful and irregular periods.
The Natural Health Website for Women
www.marilynglenville.com
Produced by Dr Marilyn Glenville, this website contains useful information and advice on health issues affecting women including PMS and menstrual problems, weight loss, smears, hysterectomies, infertility, the menopause, osteoporosis and many other conditions.
Periods and Some Period Problems
www.patient.co.uk/showdoc.asp?doc=23068953
This leaflet explains the menstrual cycle and menstruation, and briefly outlines some common problems.
The Red Spot
http://onewoman.com/redspot
This personal site aims to be a gathering place for the knowledge and experience that women gain about their periods over time. It is not meant to replace a doctor's advice.
Periods: the facts
www.thesite.org/ ...
Information from The Site on what's normal and what's not.
Women's Health UK
www.womens-health.co.uk
Information for women and their partners regarding pregnancy choices, complications and investigations, as well as details on common gynaecological conditions including endometriosis.
reading
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Coping with Endometriosis by Jo Mears (Sheldon Press, 1997) |
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The Period Book: Everything you don't want to ask (but need to know) by Karen Gravelle and Jennifer Gravelle (Piatkus Books, 1997) |
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Women, Hormones and the Menstrual Cycle: Herbal and medical solutions from adolescence to menopause by Ruth Trickey (Allen & Unwin, 1998) |
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Women's Bodies, Women's Wisdom: The complete guide to women's health and wellbeing by Christiane Northrup (Piatkus Books, 1998) |
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(January 2003, resources updated January 2005)
