Menstrual Problems

Menstrual Problems

Get Back in Sync
with Your Cycle

Cramps. Heavy bleeding. Light bleeding. Being a few days late.

At some point, most women have experienced one or all of these menstrual problems. In fact, in one survey, about 400 working women between the ages of 18 and 72 were asked what health problems doctors had told them they had. Almost one-quarter of the women reported having menstrual problems. "Menstrual problems are very common," says Christine Wells, Ph.D., professor of exercise science and physical education at Arizona State University in Tempe and a researcher on the study.

Many times menstrual problems are nothing to worry about. A change in menstrual flow or cycle length, for instance, happens now and then and is perfectly normal. In fact, perfect regularity is rare, experts say.

Other times, lifestyle changes or new events, whether positive or negative, can trigger a variation in your cycle. Maybe you've started a new exercise program, or maybe you've had an accident or undergone surgery.

But sometimes changes can be a sign that something is not right physically. Uterine fibroids, pelvic inflammatory disease (PID), endometrial polyps, cancer and early menopause all can lead to changes in cycle length or flow.

Monitoring Your Menstrual Health

There are some basic steps you can take to detect menstrual problems early and make managing them easier. Here are some suggestions.

Get checked regularly. Having an annual gynecological exam won't necessarily prevent all menstrual problems, but it can help detect them early and make treatment easier and more successful. "We certainly recommend that everyone have an annual exam," says Natalie Blagowidow, M.D., an obstetrician-gynecologist at Crozer-Chester Medical Center in Upland, Pennsylvania. Women who have a family history of ovarian cancer or who have had benign ovarian tumors in the past should be seen twice a year, she says.

Keep an eye on changes. Know what is normal for you and pay attention to any irregularities. There's probably no need to get too upset over small variations. "If one month it's a little different and then it's back to what is normal for you, that's probably not a reason to worry," says Dr. Blagowidow. "But if you notice a change that is consistent and that's more severe than what you experienced before, you should certainly be examined and evaluated."

Keep a menstrual record. Recording when your period starts and stops and whether you bleed heavily or lightly will help you keep track of whatever changes develop. "I tell everyone to keep a menstrual history," says Annamarie G. Hellebusch, R.N., a certified nurse-practitioner in the obstetrics-gynecology department at the University of Pennsylvania Medical Center in Philadelphia. It's often hard for women to remember over a span of several months exactly when their periods started and stopped, she says.

Consult your doctor. If you notice what you believe is a change, tell your doctor what's going on. Whether you'll need an appointment depends on what the change is, says Margaret M. Polaneczky, M.D., medical director of women's health and assistant professor of obstetrics and gynecology at the New York Hospital- Cornell Medical Center in New York City. If there is unusual discharge or pain or you miss a period, go right away, she says. If, over two or three cycles, your cycle is lengthening or you have spotting or a different flow, your doctor may perform blood tests or other tests to rule out physical or hormonal causes, she says.

Here are some common menstrual problems and what you should do about them.

Heavy Bleeding and Spotting:
Fighting the Flow

There are many things that can cause heavy bleeding in women whose flows are generally light to moderate.

The two most common causes are benign uterine growths known as fibroids and cycles in which a woman doesn't ovulate, says Dr. Polaneczky.

Whether fibroids require surgical removal "depends on the size, growth rate and degree of pain and bleeding," says Dr. Polaneczky. Smaller fibroids may be left alone. For larger ones, some women opt to have a surgical procedure called a myomectomy, in which fibroids are removed. For women who have completed childbearing, a hysterectomy that removes the uterus but preserves the ovaries is also an option.

Endometriosis, a disease in which the uterine lining proliferates beyond normal bounds, can also cause heavy bleeding. So can PID, benign endometrial polyps, thyroid problems and diabetes. Rarely, for older women or those with a long history of irregular periods, heavy bleeding may indicate a precancerous condition.

Sometimes aging can cause heavier bleeding. The uterus continues to grow in small increments until women are about 35 years old, says Dr. Blagowidow. So after 35 they may bleed a little more heavily than they did when they were younger because the uterus is slightly larger and there is more uterine tissue to bleed.

Spotting is normal for some women, says Dr. Blagowidow. Some women spot around the time of ovulation, and they do it every month in a regular pattern, she says. Other women spot for up to a week prior to the start of their menstrual flow. In these cases, the cause is often a hormonal imbalance called luteal phase defect, in which women don't have enough of the hormone progesterone. This is a common cause of spotting in women who are 30 to 45 years old, she says.

When spotting occurs at different times of the cycle, Dr. Blagowidow says, something other than a hormonal imbalance is usually causing it. Possibilities include pregnancy, polyps, fibroids and cancer, she says. For some women, spotting may signal the onset of menopause. And it's been observed in women on the Pill who've contracted a sexually transmitted disease (STD) called chlamydia.

If you're having heavy bleeding or spotting, here is some advice from the experts.

Monitor your flow. If you start bleeding more heavily than usual, keep track of how much. This will help your doctor. You can monitor the increase by writing down how many times you have to change your pads or tampons in one or two hours and what size products you are using, says Dr. Blagowidow.

Keep a record. In addition to noting your flow, make a record of the activities and events surrounding the episode, says Dr. Blagowidow. Did you have sex the day before? Are you suffering from any illnesses? Have you had an unusual amount of exercise? These details will also assist your physician.

Consider the Pill. If you normally have heavy menstrual flow or have endometriosis, the Pill is an option. It usually decreases flow. Consult with your doctor on whether the Pill is right for you.

Get checked for STDs. If you have spotting, ask your doctor to test you for sexually transmitted diseases. Spotting may be an indicator for chlamydia in women who are taking the Pill and have had regular periods while on it.

Cramps: Acing the Ache

Who among us hasn't had cramps? Some of us get them occasionally, others every month. It's estimated that 50 percent of all women get cramps and that 5 to 10 percent have pain that's bad enough to incapacitate them every month for anywhere from one hour to three days.

The culprits behind cramps are substances called prostaglandins. Prostaglandins are produced by cells in the lining of the uterus and are released when the lining begins to slough off during menstruation. That release triggers contractions of the uterus that we feel as cramps.

Cramps tend to start 2 to 24 hours before menstrual bleeding begins and last about 24 to 35 hours. Studies indicate that the severity of cramps declines after ages 25 to 30. And many women report that their cramps lessen in severity after they have had a baby.

While you can have your period even if you haven't ovulated--known as an anovulatory cycle--you usually get cramps only when you ovulate, says Dr. Polaneczky. So if nothing is physically wrong and you have cramps, that's a signal that an egg was released from your ovary at midcycle.

While cramps can be normal, they can also result from something more serious, such as endometriosis, PID or fibroids.

If your cramps are not caused by a disease or fibroids, you can take steps to make them milder. Here's how.

Watch your diet. "I often counsel women to cut back on caffeine and heavy meals," says Hellebusch. Though it's not clear why this may help lessen cramps, it has worked for many women, she says. Avoid heavy meals and spicy foods that may cause gastrointestinal upset, and increase your intake of fluids, especially water, seven to ten days before your period starts, she advises.

Reach for the medicine cabinet. Several over-the-counter medications are effective for relieving cramps. Acetaminophen works, but at the top of the list are the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxyen sodium (Aleve), which block prostaglandin activity and thereby help eliminate cramps. If you're regular and can anticipate when you will start bleeding, you can take an NSAID the day before, says Hellebusch. That way it will already be in your system, she says. If you can't forecast the date of your period's arrival, it's not essential to start the medication ahead of time. You can start it with the onset of bleeding or pain, says Dr. Polaneczky.

Switch medications. Research indicates that 80 to 85 percent of women respond to antiprostaglandin medications. But if you try one and it doesn't work, don't give up. Try another. Also, if you use one medication for months and then it stops working as well, switch; you may have developed a resistance to the first type. Finally, if the over-the-counter antiprostaglandin medications don't provide enough relief for you, talk to your doctor, who may prescribe higher doses or other NSAIDs. Prescription forms are also available.

Try birth control action. For women with severe cramping, oral contraceptives are an option. The Pill decreases the amount of menstrual tissue--the source of the chemicals that cause cramping. So less tissue, less prostaglandins, less pain.

Move it. Regular exercise may help keep cramps to a minimum, experts say. "Women who regularly exercise will tell you that when they do exercise, their cramps are less severe," says Dr. Polaneczky.

Although it's not clear exactly how exercise helps, experts point to brain chemicals called endorphins, which are released when you work out. These chemicals are thought to mediate the perception of pain, and it's possible that they interfere with the pain mechanism responsible for menstrual cramps.

Coping with the Unexpected

In women over 30, changes in the cycle appear to be the biggest concern among patients, doctors say. "The most common thing is that the timing of bleeding is different," says Dr. Blagowidow. "The cycle is a week earlier or a week later. Their concern is 'This is not the way I usually am. I'm usually regular,' " she says.

Many things can cause the timing of your period to change. The many sources of stress--travel, a job change, moving--and the beginning of menopause can cause cycle changes.

Women who have sporadic sexual activity or who are celibate tend to have cycles that are unusually long or short. And women who spend more time with men--sexually or otherwise--tend to have more regular cycles.

Some women always have irregular cycles, and some have cycles that are much longer than the usual 28 days. A small study of ten women at the University of California at San Diego shed some light--literally--on the problem of longer cycles. Researchers there observed that the length of women's cycles was shortened when they were exposed to a light source while sleeping.

For two months, women were exposed to light while they slept. The light source was a table lamp or a light mask (a Hollywood-style sleep mask with a built-in light source) timed to come on about a half-hour after the women went to sleep. The women were exposed to white light for the first month and to red light for the second month. Before the study, the average length of the women's cycles was about 40 days. After the study, the cycles of the women exposed to white light shortened to an average of about 33 days. Women exposed to red light had average cycles of about 37 days.

While they can't guarantee that light exposure will work for all women, researchers say it's worth a try. Simply turn on your bedside lamp before you go to sleep or set it on a timer so it turns on after you've fallen asleep.

While doctors say there's little you can do to control irregular cycles or cycle changes, there are some things you can do to make living with them a little easier.

Pay attention to the signs. Your body often gives signals that your period is on the way. You may feel breast tenderness, bloating and cramping, experts say. Listen to your body.

Plan ahead. Have tampons or pads handy for those times when your period arrives unexpectedly. Stash them everywhere--in your car, in your briefcase, in your office, in your pocketbook. "Just be prepared," says Dr. Blagowidow. If you don't want to be bothered with a pocketbook, try a hip pack. They're big enough to hold tampons or the thinner pads. Wear blazers with big outside pockets or inside breast pockets and stash a tampon or pad there for emergencies during the workday.

Change panty liners often. Wearing panty liners is one way to be prepared for unexpected bleeding. Just be sure to change them often. Their plastic bottom traps moisture, which can trigger yeast infections, says Hellebusch.

Find out your family history. If you find yourself in early menopause, check out your Mom's history. You may be following the same pattern she did. "Women who go through premature menopause may be more likely to have family members that did, too," says Dr. Polaneczky.

Accept change. If you've seen your doctor and any physical cause for your problem--such as pregnancy, fibroids, endometriosis or PID--has been ruled out, understand that your cycle may change as you age. "Women think their body will stay the same forever and ever. It takes a lot of reassurance that nothing's wrong," says Dr. Polaneczky. "It's normal for periods to change in women over 30," she says.

Breast Tenderness: Soothing the Pain

Breast tenderness preceding menstrual periods is a frequent complaint, and in most cases it is normal.

"Breast tenderness is very common," says Kathleen Mayzel, M.D., director of the Faulkner Breast Centre and assistant clinical professor of surgery at Tufts University School of Medicine in Boston. "Most is hormonally related. As estrogen levels go up right before your period, the breasts get more tender. Then as they go down after your period, the breasts get less tender. And there's no need to do anything about it."

But if you're really uncomfortable, there are a few things that you can try.

Cut out caffeine. "One thing that is effective is to stop caffeine intake," says Dr. Blagowidow. Cut it out as much as you can, she says. Sources of caffeine to keep an eye out for are coffee, sodas, tea and chocolate. If you feel that quitting caffeine altogether is impossible, at least try to cut back the week before your period is due, says Hellebusch.

Take vitamin E. The use of vitamin E for breast tenderness is controversial, but some women find it works, says Hellebusch. Women start taking 400 international units a day ten days before their period starts and continue until they stop menstruating for the month, she says.

See your doctor. If none of these measures helps, talk to your doctor. She may want to check you out for cysts--tiny fluid-filled sacs--and costochondritis, an inflammation of the ribs that can cause pain in the breast.

Doctors don't know what causes either of these conditions, says Dr. Mayzel, although cysts may have something to do with fluctuating hormone levels. Postmenopausal women do not get these cysts, she says.

Fortunately, either of these types of breast tenderness can be relieved. "Cysts can be aspirated--drained--in a physician's office with a needle and syringe," says Dr. Mayzel, "and costochondritis can be relieved with anti-inflammatory medication from your doctor."