Mr Paul Curtis MBChB FRCOG
Call: 01483 451669
In the UK the average age for girls to start having periods is 12 years old. However, it is not uncommon to be older than this and some girls will not start theirs until much later at around 16-18 years old. Absent periods after this age fall into one of two categories:
Medical reasons why periods may be absent include; polycystic ovary syndrome, hormonal imbalances, premature ovarian failure and thyroid or genetic conditions. The problem can also be caused by the part of the brain which controls the hormones that are responsible for regulating the monthly cycle.
Although most women will experience some level of discomfort during this stage of their cycle, as many as 20-30% suffer with periods that are so painful they are unable to continue with normal daily activities.
At the end of the monthly cycle the muscles in the lining of the uterus (womb) start to contract which helps to stimulate the lining of the womb to shed and a period begins. These contractions can cause cramping in the lower abdomen and often in the lower back and for some women these cramps can be intensely painful.
The average menstrual cycle lasts for 28 days and although this can vary, most women will have a fairly regular cycle length with a period lasting an average of 5 days. During your cycle the lining of the womb (uterus) thickens itself in preparation for a fertilised egg to be implanted during pregnancy. However, if the egg is not fertilised i.e. pregnancy does not occur, then the thickened lining of the womb will shed itself, causing a bleed or "period".
However, some women will have irregular cycles, some experience exceptionally heavy, long or painful periods and some don't have any periods at all. All of these scenarios can be distressing and are usually accompanied with their own set of symptoms which can heavily impact on your daily life. Unfortunately, a lot of women continue putting up with these menstrual problems because it becomes "normal" for them but it usually doesn't have to be.
The first step in treating any menstrual problems will be to take a detailed medical history to try and determine any underlying factors that may be affecting your cycles and then to possibly perform a scan and/or blood tests.
Treatment may involve either medication or a surgical procedure but will largely depend on the underlying cause of your condition and also whether you are planning to have children in the near future. Possible solutions include:
Medication can be prescribed in the form of hormone tablets; commonly the contraceptive pill and potentially Tranexamic Acid to help reduce blood loss.
Mirena Coil insertion into the uterus prevents the lining of the womb from thickening by slowly releasing hormones. This is also an effective contraception method.
Endometrial Ablation is a surgical procedure performed under general anaesthetic as a day case. Heat is used to destroy the lining of the womb and often after this procedure periods are either significantly lighter or cease all together.
Hysterectomy is only suitable for women who have already had children or do not wish to have children as it involves the removal of the womb, thus stopping periods and the associated problems all together. This is a major operation requiring a few nights in hospital and several weeks recovery. Hormone replacement therapy will usually be required following the operation.
Every woman is different but the NHS defines heavy menstrual bleeding as a blood loss of 60-80 ml or more in each cycle1. Many women will report that they are "flooding" through their sanitary protection onto clothing or bedding and sometimes passing large clots of blood as well. This can make it very difficult for them to continue with their normal daily routine.
In some instances bleeding may be so heavy that it can lead to an iron deficiency (anaemia).
1 Source: NHS Choices Website
It is not uncommon for cycle lengths and the pattern of cycles to stray outside the "28 day average" and to vary from woman to woman. However, you should seek advice if you experience any of the following:
Irregular periods can be caused by lifestyle changes such as sudden weight loss or gain, excessive exercise and stress. They can also be caused by hormonal imbalances, thyroid disorders and polycystic ovary syndrome.
affect countless women and as many as 1 in 5 experience periods so heavy that it affects normal daily activities.