Aptly named ‘the curse’, periods can make your life a misery. We examine the causes of these menstrual problems, and the ways in which they can be relieved.
Menstruation is a natural and normal part of every woman’s life. But it has the potential to become quite a troublesome part of her life, too. The majority of women will experience complications with their periods at some stage in their lives.
Periods begin at the menarche (pronounced ‘men-arkay’), which means ‘first menstruation’. In western countries the average age at menarche is 12 to 13, although it is quite normal to begin menstruation as early as nine years old. The age of menopause – the last menstruation – is usually at about 50.
It is not known exactly what precipitates the body’s ‘decision’ to set up the hormonal sequence that leads to menstruation, although body weight seems to have some role to play – taller, heavier girls tend to reach their menarche first.
The full menstrual cycle takes time to become fully operational, and true ovulation – the release of an egg each month – does not usually happen for the first year or so. Thereafter, however, menstruation is almost always a sign that ovulation has taken place.
The menstrual cycle
A woman’s menstrual cycle lasts on average 28 days. Cycles lasting between 21 days and 35 days are common, however, and many normal, healthy young women have even shorter or longer cycles. The cycle is counted from the first day of the menstrual period.
In the first half of the cycle, the ovaries, under the stimulation of Follicle Stimulating Hormone (FSH) produced by the pituitary gland in the brain, start to ripen between 12 to 20 eggs.
The ovaries also produce the hormone oestrogen, which is the vital female hormone, responsible for the development of female sexual characteristics and governing the processes involved in the menstrual cycle.
Ovulation happens on about day 14 in the average cycle. One of the ovaries releases an egg, which then begins a journey along a Fallopian tube to the uterus.
Periods can be affected by a woman’s general health, both physical and emotional. In other cases, the menstrual process itself seems to be the cause of period problems. This can be the situation with painful periods – a condition experienced at some stage of their lives by as many as 70 per cent of women.
The pain can vary from being moderate and intermittent – involving cramp-like aches that perhaps start the day before the period and then disappear on day one or two of the cycle – to being severely disabling, causing sickness and extreme fatigue.
The causes of this sort of period pain, both moderate and severe, seem to be related to the contractions of the uterus, while it prepares itself to expel its lining or while it actually does so.
The levels of oestrogen in the bloodstream are not high enough to make the muscle fibres of the uterus sufficiently elastic. The result is pain, usually centred in the pelvis, near the site of the uterus and ovaries, but sometimes spreading to the thighs and small of the back.
Younger women in their teens and twenties seem more prone to pain than older women, and it is not uncommon for the pains to cease after a woman has had a child – as if the uterus has ‘learned’ how to contract more easily.
Research into hormone-based drugs to help with painful menstruation backs up the theory that a lack of oestrogen causes the problem. However, drugs of this sort cause sickness and nausea as side-effects in some women, and other ways of giving relief may be advisable. Some doctors prescribe the Pill, because even the low doses of hormone in today’s Pill can be effective. This is because the monthly flow is lighter with the Pill. With heavy periods, the uterus has to contract more to expel the lining, and so causes more pain. Aspirin and other readily-available pain-killers can also help.
Relaxation techniques need to be learned and practised, but they can be very useful – not only to help cope with period pain, but also for stress and tension. The technique known as progressive deep muscle relaxation – sometimes taught in ante-natal classes – can be especially effective. Twenty minutes or so of total relaxation can restore energy and reduce the weakening effects of pain.
Different breathing techniques can also be a great help. You can learn methods of changing your depth of breathing and its rhythm in relaxation and yoga classes, but it is always worthwhile experimenting to find the right individual combination that helps you cope with the intensity and length of the discomfort.
Vigorous exercise – if you feel like it – can help reduce period pain too, and even a brisk walk in the fresh air will make you feel better.
Just as period pain (of the non-PMS type) is associated with younger women, irregular periods are very common in the teenage years, when the cycle is establishing itself. It is not unusual for a young girl to have no more than four periods in the first few years of menstruating.
It is also perfectly normal for a woman to have irregular periods when she approaches the menopause.
Between these two extremes, at the beginning and end of the reproductive years, most women settle down to a reasonably predictable pattern. When this does not happen, it need not signify anything particularly serious.
If a woman does have irregular periods more than just occasionally, however, it is worth discussing the situation with a doctor, who will want to know about the length of menstruation, how heavy the bleeding is and whether there has been any irregularity in the past.
Infrequent, unpredictable periods may not trouble a woman at all until the time she wants to conceive. Conception may take some time simply because a woman who menstruates (and therefore ovulates) only a few times a year has fewer chances of becoming pregnant.
This situation can be cured with hormone treatment.
Excessive blood loss during a period can be very inconvenient and uncomfortable. Periods tend to last longer than average and may be rather painful as well.
In some cases, heavy periods may be temporary and not very significant. However, a heavy flow that continues over some months can be a symptom of hormone disorders, fibroid tumours or, least probably, cancer of the uterus.
Women suffering from endometriosis will also have heavy, painful periods. Endometriosis is a disorder that results when the uterine lining starts to break away or proliferate and form in other parts of the pelvis.
Fibroids – collections of benign (non-cancerous) tissue in the muscle wall of the uterus – can also cause pain and heavy periods if they are large.
Dilation and curettage
Treatment is available for heavy periods, and when their cause is not easily diagnosed, it may be suggested that the woman go into hospital for a diagnostic curettage (known as a ‘D & C’ which stands for dilation and curettage).
This involves the lining of the womb being gently scraped with a metal curette and then being examined in the laboratory, in an attempt to reach a diagnosis, and to decide what steps to take.
A curettage is sometimes performed for other menstrual disorders, such as unexplained bleeding between periods. This can occasionally happen as a side-effect of the Pill or as a result of an underlying disorder.
If a woman whose periods have been regular actually misses one or more, the most likely reason is that she is pregnant. True amenorrhoea – absence of periods – is far more rare than pregnancy in a young sexually active woman. When it does exist, it can be related to severe emotional stress, to illness, or to anorexia nervosa (where body weight is drastically low).
Self-help for premenstrual syndrome (PMS)
If your PMS is not so severe that you need to see a doctor, the self-help tips here will help to alleviate the troublesome symptoms caused by ‘the curse’.
- Don’t go for long periods without food as low blood sugar aggravates the symptoms of PMS.
- Eat a sensible, balanced diet, high in fibre to combat constipation. Wholemeal bread, wheatgerm, bran and green vegetables also contain vitamin B6, which has been found to be helpful in dealing with PMS. Vitamin B6 is also found in milk, cheese and eggs.
- Some women find oil of primrose is very helpful.
Take plenty of exercise.
- Avoid stimulants, such as coffee. Try herbal or fruit teas instead. Some are particularly helpful for relaxation, while others help to combat, naturally, the problems associated with fluid retention.