Periods: what’s normal and what’s not
Period questions and answers

Periods: what’s normal and what’s not

For most women, having a period (menstruating) is nothing more than a minor monthly discomfort, but for some women it can cause serious, and sometimes debilitating, physical and emotional issues.

Menstruation is when the lining of the uterus breaks down and sheds cells, resulting in vaginal bleeding that occurs approximately once a month.

Period-related problems are a common reason for time off work, school or for visits to the GP, and may have a significant impact on a woman’s quality of life. Periods can cause issues at any age, but more commonly affect teenagers and those approaching menopause.

Is my period normal?

The menstrual cycle is a normal part of every woman’s life. How long it lasts, how heavy it is and duration between periods varies for each woman.

Menstrual fluid is mostly made of blood, but also contains mucus, water and tissue. It can be bright red, dark red or dark brown in colour, and may  contain small clots (dark pieces of blood) in it. Clots that are greater than a 50 cent piece in size should be  investigated further by a doctor. While it may seem like a lot, on average women lose about 20 to 80 mls of blood during each period (20 ml being equal to four teaspoons and 80 ml equalling 1/3 of a cup).

Periods can start in girls as young as nine or as late as 17 (the average age of menarche – the first period – in Western countries is 12 or 13) and continue until menopause (the last period) is reached between the ages of 45 and 55.

Initially, periods may be irregular, as it can take a year or two for the cycle to regulate. Once regular, periods tend to begin around the same time each month (on average every 26-29 days) but they can be as often as three weeks apart or as far as eight weeks apart.

Common menstrual issues

“There are a range of issues that women may experience relating to their menstrual cycle,” says Jean Hailes gynaecologist Dr Elizabeth Farrell. “It’s important if you have pain, or feel something isn’t quite right, to have it checked out by your doctor.”

Painful periods – dysmenorrhoea

While some women experience minimal or mild discomfort during menstruation, other women suffer from severe, debilitating pain. Some women may have always experienced painful periods, whereas others may develop pain with time. Period pain is more common in teenagers and women in their 20s, but can also occur in older women.

Period pain happens when the muscles in the uterus contract or tighten. Pain may include cramping and heaviness in the pelvic area, as well as pain in the lower back, stomach or even legs. Some women also experience nausea, vomiting, paleness or diarrhoea.

Women who experience painful periods may have higher levels of prostaglandins – a natural body chemical that causes contractions of the uterus, bowel and blood vessels. Pain may be due to endometriosis (when cells lining the uterus travel to other areas of the pelvis), fibroids (benign tumours made of muscle and tissue that grow inside the uterus), or pelvic infections.

If a woman is experiencing period pain that is affecting her quality of life, it is important to see a health practitioner for further investigation, as there are medications and treatment which can make a difference.

Symptom relief for painful periods

Symptoms may be relieved by:

• Applying heat on the belly or lower back
• Exercising to release the body’s endorphins (natural feel-good hormones)
• Relaxation techniques such as rest, warm baths or meditation
• Taking a herbal remedy or mild over the counter analgesic or pain killer to help with muscle contractions
• Oral contraceptives or antiprostaglandins, such as ibuprofen or naproxen for severe pain

Premenstrual syndrome (PMS)

PMS refers to a collection of symptoms that some women experience before each period. Symptoms include physical responses like bloating, headaches, tiredness and food cravings, and psychological responses like irritability, anger, depression and low self esteem. Women who suffer from PMS may find physical activity, dietary changes, yoga, relaxation techniques and herbal remedies helpful in relieving symptoms; however women with severe symptoms may require specific medications. See your health practitioner for further information.

Self-help techniques for PMS

• Eat a range of healthy foods and drink plenty of water
• Increase your level of activity e.g. swimming, walking or dancing
• Get plenty of sleep
• Try relaxation techniques such as yoga, massage, having a warm bath or meditation
• Eat foods high in Vitamin B6, B1, C, calcium and iron
• Avoid smoking and reduce alcohol intake

If these do not help, it is important to see your health practitioner.

Irregular periods – oligomenorrhoea

Periods may be irregular in the first few years after they begin, in the lead up to menopause or following childbirth, miscarriage or termination of a pregnancy. Some women however, never establish a regular cycle. Irregular periods may be due to:

• Stress
• Starting or changing contraception
• Pregnancy, miscarriage or an ectopic pregnancy (where the baby grows in the Fallopian tube or
  somewhere else outside the uterus)
• Polycystic ovary syndrome – a common hormone disorder
• Change in diet or sudden weight loss or gain 

Absence of periods – amenorrhoea

Amenorrhoea (other than in pregnancy) may occur because of a hormonal disturbance caused by factors including weight gain or loss, over-exercising, anxiety or stress, travel, dietary changes and conditions such as polycystic ovary syndrome. Amenorrhoea may be temporary, with periods returning after some months. Women experiencing amenorrhoea for longer than six months should consult a health practitioner.

Heavy bleeding – menorrhagia

A heavy period (more than 80 ml) can significantly interfere with everyday life. While it is difficult to accurately measure the amount of menstrual fluid, having to change your pad or tampon hourly, or needing to change during the night, is a good guide that your period is heavy.

A number of factors (including fibroids, polyps, endometriosis and rarely, uterine cancer) can cause heavy bleeding. Heavy bleeding may then lead to anaemia (low red blood count), with symptoms of fatigue, paleness, lack of energy and shortness of breath.

When no cause is found (dysfunctional uterine bleeding) hormonal medications to reduce bleeding are usually prescribed. These include the oral contraceptive pill and progestin hormone therapies including tablets or a progestin hormone-releasing intra uterine device (IUD).

Spotting – bleeding between periods

Bleeding between periods may be caused by diet, stress, being underweight, doing too much exercise, sexually transmissible infections, endometriosis, fibroids, polycystic ovary syndrome, thyroid disorders or gynaecological cancer. It can also be a side effect of some contraceptives or medications.

Any bleeding between periods should be investigated by a doctor, particularly for postmenopausal women who are at higher risk of endometrial cancer. “When you visit your doctor it helps if you can describe your pattern of bleeding,” says Dr Farrell. “The doctor will also need to know if bleeding occurs after sex or if there is any accompanying pelvic or lower abdominal pain.” 

Getting checked – when to see your health practitioner

It is important to see your doctor if you experience any of these period issues. Keeping a menstrual diary, including when you get your period, the length, heaviness and anything else you notice will help your doctor work out how best to help you. 

Resources

The Foundation has a number of fact sheets including understanding your menstrual cycle, endometriosis, polycystic ovary syndrome and heavy uterine bleeding. These are available to download at www.jeanhailes.org.au or by calling tollfree on 1800 151 441.

Useful websites include:

http://www.endometriosis.org.au/

http://www.managingpcos.org.au/

Sexual Health and Family Planning Australia

http://www.shfpa.org.au/ 

Period questions and answers

Gynaecologist Dr Elizabeth Farrell answers your questions about periods 

Why do you get changes in bowel habits before and during your period?

The body makes substances called prostaglandins, especially just before and in the first few days of the period. These prostaglandins cause muscle contractions in internal organs, and in combination with the hormonal pattern in the premenstrual week, can cause changes in bowel habits. Some women notice a difficulty in opening bowels prior to the period like constipation, and then when the period starts the bowel motion loosens and may be more like diarrhoea.

Why does the colour of blood change over the days of the period?

The blood colour changes because usually the flow is heaviest in the first few days and then slows until finished. The colour may change from dark or bright red initially, to dark brown later in the cycle.

Is it normal to have a certain odour down there when I have my period?

Most women have some odour related to the bleeding, but little is known about why it is sometimes stronger. If the odour is offensive then it’s best to see your doctor.

If on the pill, are there any risks in skipping multiple periods?

There are no known risks, but you need to make sure you don’t miss any pills. Some women may
experience spotting after prolonged use.

If I still have my period in my late 40s, does that mean I’m still ovulating?

Yes, you may still be ovulating, either regularly or irregularly, until your periods stop.

My daughter has had two periods, with a few months in between. When is she likely to get her next period?

It depends on her age. If she has just begun her periods it may take up to two years for the cycle to regulate itself. If the cycle remains irregular see your doctor for advice.

Why do I get sensitive, upset and angrier in the week prior to when my period is due?

About 90 per cent of women experience some premenstrual symptoms, but only in about 10 per cent will there be symptoms that interfere with quality of life. Exactly why this happens is not known but there seems to be some increased body sensitivity at this time which alters the chemicals in the brain and leads to many of these symptoms. 

For more questions and answers about periods go to www.healthforwomen.org.au/content/view/134/175/

© 2008 The Jean Hailes Foundation for Women's Health

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Content Updated November 25, 2008