|  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.
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