Period problems

It’s the lucky few – just 20 per cent of women – who pass through the years between puberty and menopause without some trouble with their periods.

Unfortunately normal periods do cause normal women a certain amount of discomfort and pain (although that doesn’t mean they have to grin and bear it). It’s when there’s a radical change of some kind in the menstrual cycle that medical help may be advisable.

Painful periods

It’s estimated that one in every two women suffers from some discomfort during menstruation. The pain may begin a few hours before the bleeding starts and lasts for a maximum of 12 hours; it’s uncomfortable but bearable and can be dealt with by simple measures- taking aspirin or lying down with a hot-water botdc.

But lor some women, the pain can be agonizing, accompanying almost every period. Although this condition, known as dysmenorrhoea, does tend to get easier with the passage of time – often once a woman has had a baby- this knowledge doesn’t make the intervening years any easier to bear.

The root of the pain lies in the muscles of the uterus, which go into cramps under the influence of prostaglandins -hormones produced in the muscle tissues. It seems that the higher the levels of prostaglandin, the more forcibly the walls of the uterus contract.

Most women evolve their own techniques for dealing with the miserable days of pain, and certainly there’s no shortage of suggested remedies. Some women find that exercise helps. Acupuncture, meditation, even a change of diet to include less meat and more vegetables have their enthusiastic exponents, while for some women having sex seems to be an effective pain-reliever. Simple aspirin is one of the most effective pain killers to use, as long as it’s taken in good time. It works because it’s an anti-prostaglandin but, like all drugs, the body needs time to absorb it, so it’s important to take one or two before the pain sets in, repeating the dose every four hours, as directed. l » ‘. [f none of these remedies help, do consult your doctor, who may be able to offer a number of alternatives. There are drugs called and both of which are antiprostaglandins, but slightly stronger than aspirin. These are still relatively new so, as yet, there’s no long-term research into their effects.

The contraceptive Pill has also proved to be very helpful with period pains. It may succeed in banishing the problem altogether, even after women stop taking it, but this isn’t always a viable alternative, particularly for young girls.

For older women, a simple D and C operation can be the solution. Why this operation, (which involves stretching the neck of the womb slighdy and gendy scraping away its lining) should work isn’t at all clear. It’s possible that by stretching the cervix the uterus has to contract less forcibly to expel the lining in the future.

Disorders that cause ‘period’ pain

If a woman starts experiencing pain when she menstruates, having never had any discomfort before, there’s usually a very specific cause and she should always see her doctor about it so that tests (including a smear) and an internal examination can be made. It’s reassuring to know that pain is rarely a sign of cancer, but some of the conditions which do give rise to pain can cause infertility if they are neglected.

Frequendy, as well as becoming painful, the periods are also heavier than usual. One rather curious condition which produces these symptoms is small spots of the womb’s lining (the endometrium) appear quite inappropriately elsewhere in the abdomen. Every month, the hormones which stimulate the womb also stimulate these spots of tissue, making them swell and bleed and causing pain which can be agonizing in intensity, and often lasts much longer than the normal period pain.

Hormone preparations can do a great deal to quieten these spots, and a six-month course of the Pill or progesterone hormone is often the answer. But if these fail to work, surgery may be necessary.

Chronic infection of’ the womb or Fallopian tubes also provokes pain and heavier bleeding because it increases the flow of blood to the organs, making the tissues hot, red and swollen – with increased throbbing and cramps in the lower abdomen. As a rule, there’s a discharge too, and the pain isn’t necessarily associated with menstruation – it may be more or less constant, but is often worse during intercourse.

Infection needs immediate treatment with antibiotics and since it’s not always easy to diagnose, let alone eradicate, treatment may go on for several months. If the infection is allowed to go on unchecked, there’s a danger that it will cause infertility or reach a stage where the only cure is surgery.

Pelvic congestion

Muscular cramps in the abdomen are very common, but, if they are accompanied by backache and a feeling of pressure in the pelvis, the problem could be This is often associated with heavy and too-frequent periods. What happens is that the womb becomes too congested with blood, as a result of a hormone imbalance. Emotional stress or unhappiness, particularly marital or sexual problems, are often at the back of this, but if it doesn’t settle of its own accord, the doctor may prescribe hormone therapy in the form of progesterone tablets.

Loss of periods

In itself, going without periods can’t do any harm – all it means is that the womb is not building up its lining each month. This happens quite naturally after having a baby, or following a miscarriage or an abortion, because the hormones controlling menstruation are temporarily disrupted. But a number of other factors can disrupt the chain of hormone-producing glands (the hypothalamus, the pituitary and the ovaries) and their ‘target organ’, the womb.

Certain chronic diseases can produce loss of periods: tuberculosis (though this is now rare), anaemia, thyroid disease and other disorders which affect the hormone system. Some tranquillizers, anti-depressive drugs and those used to control blood pressure can provoke the same results. If you are in any doubt about any drugs you are taking, check with your doctor. For the most part, though, loss of periods has a simple cause. Being pregnant is the commonest – but sometimes overlooked – reason for loss of periods. It is also very common not to have periods for several months after coming off the contraceptive Pill -but they invariably return in time.

Sometimes, though, girls go through their teens without starting their periods. Often, menstruation is simply delayed, but occasionally there’s a physical abnormality or a glandular disorder responsible which will need investigating. But there’s no need to consult a doctor, usually, unless the girl has not menstruated by the time she is 16.

Emotional factors

Being seriously overor undcr-weight (nearly all girls suffering from anorexia lose their periods) often leads to this kind of disruption, and stress or emotional disturbance is an extremely common cause. This is because the hypothalamus also contains the centres tnat control appetite and metabolism and is influenced by the ‘higher centres’ in the brain connected with our emotions. A change of job, a death in the family, moving house or a broken marriage can all cause periods __f to stop for a while. Often the disruption is very short -lived. Indeed unless more than four months pass by without a period, it’s not even considered to be a problem. Although a doctor will conduct various tests at this stage to check for any serious disorder, provided none is found, he may well be reluctant to start any treatment to induce the cycle to start again until at least six months have gone by. Ha specific disease is causing loss of periods, treatment to clear it up will usually restore the monthly cycle.

Disorders affecting the hormone balance

Although the timing of the periods is principally controlled by the hormones produced in the pituitary gland and the ovaries, other hormonal changes in the body can, indirectly, affect the hormone balance, and cause loss of periods. An underactive thyroid gland results in the slowing down of many of the body’s systems – and the periods may stop as a result. As soon as the condition is diagnosed and treated with thyroid hormone, the periods will return. Problems with the adrenal glands may have a similar effect.

Sometimes the problem lies within the pituitary gland itself. Over-production of a hormone called may cause a constant milky discharge from the nipples and also a loss of periods. Occasionally, the excessive production of prolactin comes from a small benign growth in the pituitary, and this can be removed surgically.

The hormones produced by the ovaries may be upset by the presence of cysts. If these cysts lead to the over-production of certain hormones, they may have to be removed.

A woman with this condition tends to be heavily built and to have high blood pressure, and will often have more body nair than usual.

Heavy periods

Finding that their periods suddenly become very heavy can be of much concern to women. It is important to see a doctor if this happens, but often it’s the result of something as simple as a temporary hormonal imbalance due to an emotional upheaval, or a reaction to an IUD internal contraceptive.

Anything which enlarges the surface area of the womb will increase the flow of blood each month; after each pregnane}’, the womb is slightly larger than before, leading to heavier periods than previously experienced.

Fibroids in the womb or endometriosis will have the same effect, and a prolonged imbalance of the two ovarian hormones progesterone and oestrogen can eventually make the womb swell. Certain blood disorders, when clotting is defective or the blood capillaries are excessively fragile, may cause heavy periods, and disruption to any of the glands – an underactive thyroid or disease of the hypothalamus-can have the same result. Occasionally heavy periods are accompanied by bleeding between periods as well. If this occurs more than once, it is important to see a doctor without delay as it can be an early __p sign of cancer of the womb or cervix. The most effective drug treatment is hormonal – the high dose combined contraceptive Pill or alternatively a synthetic progestogen. The Pill prevents the lining of the uterus getting too thick and eventually makes it flat. Progestogen also stops the lining thickening.

Of course, any fundamental disorder will need medical attention. Only if the condition fails to respond to other treatment will an operation be considered; initially this may bejust a D and C. As yet the only treatment for fibroids is to remove them. In older women who have had children, a doctor may recommend a hysterectomy, but this is never something to take lightly. It is usually only recommended if the symptoms are seriously disabling.

Women who suffer from naturally heaw periods right from the start can benefit from hormone treatment; other than that there’s little that can be done, except to rest during the period and eat plenty of iron-rich food to avoid the risk of anaemia.