Adverse mood changes and fluid retention are very common in the several days before the menstrual bleeding starts. These problems are worrying and may be difficult to treat, but are the result in some women of perfectly normal hormonal variations during the menstrual cycle.
Some women find at the onset of menstruation that there is severe cramping abdominal pain, on occasion accompanied by faintness or nausea. This is caused by muscular contractions in the wall of the uterus. Other women may have more dull prolonged pain lasting for several days. These pains very rarely indicate that anything is wrong, and are usually normal.
The menstrual cycle is different for different women and may even be different at different times in a woman’s life. Periods may be regular, irregular, light, heavy, painful, painfree, long or short and still be absolutely normal. Variation in the menstrual cycle is medically less significant than bleeding, pain or discharge between periods. Only when problems are extremely severe or recur for several months is medical attention required. Emergency treatment is seldom needed.
For fluid retention prior to a period, try reducing salt intake for a week before the period is due. This helps to avoid excess build- up of salt in the body which accompanies fluid retention. Use the minimum of salt in cooking and do not add salt to food at the table.
For menstrual cramps, use soluble aspirin. This does seem to work rather better than paracetamol but some may prefer the latter. Take the tablets regularly so long as pain lasts. There are
various proprietary products available over- the- counter for painful periods, but the main ingredient of most of them is either aspirin or paracetamol. Some patients swear by these compounds and they are fine if you want to pay extra for the name or fancy packaging. But we don’t believe that they are any better than soluble aspirin.
What the Doctor Will Do
Take a history of the complaint and often simply give advice. Vaginal examination is not usually very helpful, but may be performed. The doctor may prescribe diuretics for fluid retention or powerful pain- killers for menstrual pain. Sometimes muscle relaxant drugs are used for menstrual cramps. If the pain or fluid retention are persistent, hormone treatment may be used and the contraceptive pill can be helpful. The pill stops ovulation and also stops the usual variation in body hormone levels which bring about the changes of menstruation and its various difficulties. The normal period is substituted by a relatively painfree artificial bleed, at a regular 28 day interval. However, many doctors are wary of using the pill simply for menstrual problems as it can occasionally have other side effects of its own. Adverse mood changes occurring in the week or so before a period may be treated with the pill, but other hormone treatment which does not stop ovulation can also be used.
If there is heavy bleeding, or where there is any abnormality on pelvic examination, the GP may refer to a gynaecologist for further investigation or treatment.
A D & C may be required for diagnostic purposes. Surgery is rarely required for menstrual problems alone.