Menstrual Problems, Period Pain & PMS

Your menstrual cycle can affect your mood, your attitude and behaviour, eating habits, your physical appearance and how you cope with life generally.

Conversely, stress, grief, a poor diet, ill health and frequent travel in different time zones can affect your periods. To optimise your quality of life and your fertility (when you are ready) it is important to understand your cycle.
WHAT IS A ‘NORMAL’ PERIOD?

The average menstrual cycle is around 28 days long. Anything between 27 and 32 days is considered ‘normal for you’ if your cycles have consistently been this length since puberty. The ‘normal’ period lasts between 5 – 7 days, starting and finishing quite cleanly, but may include minor spotting at the beginning or end of the bleed. The first day of your bleed is called Day 1. A ‘normal’ bleed would be neither heavy nor light, with loss of 60ml of blood (measured by approximately 4 towel changes a day using standard ultra pads). Blood should be fresh (not stale) with no clotting. There should be no significant pain or mental, emotional or physical symptoms. Some mild breast tenderness, lower abdominal fluid retention and gentle abdominal achiness are normal. Back ache or severe pain is not normal. Your period will occur 14 days after ovulation, which will be mid cycle (Day 14) if you have a 28 day cycle, but later (Day 18) if you have a 32 day cycle.

Most girls start their periods around age 12, though this can vary from age 8 -16. A woman’s periods continue until the menopause, which usually occurs when a woman reaches her late 40s to mid-50s (average age 52).

The reproductive organs inside a woman’s body consist of:

  • two ovaries – where eggs are stored, developed and released
  • the womb (uterus) – where a fertilised egg implants and a pregnancy develops
  • fallopian tubes – the two narrow tubes that connect the ovaries to the womb
  • the cervix – the lower part of the womb that connects to the vagina
  • the vagina –a muscular tube leading from the cervix to outside of the body

During each menstrual cycle, hormone levels (oestrogen) rise, resulting in an egg developing and being released by one of the ovaries (ovulation). Your womb lining thickens in anticipation of a possible pregnancy. The egg moves down the fallopian tube and if it meets a sperm and is fertilised, pregnancy can occur. The egg lives for only about 24 hours. If it isn’t fertilised, the lining of your womb comes away and leaves your body through the vagina mixed with blood. This is a period or ‘the menstrual flow’. Your fertile time is around the time you ovulate, approximately 12 to 14 days before the start of your next period. Abdominal pain or twinges experienced around the time of ovulation may be a sign of ovulation but are not considered normal. You can’t get pregnant if you don’t ovulate. Some hormonal methods of contraception, work by preventing ovulation.

ABOUT MENSTRUAL PROBLEMS
Dysmenorrhoea (painful periods), usually felt as painful muscle cramps in the lower abdomen, which may spread to the back and thighs. The pain may come in intense spasms or be dull but more constant. Period pain may start just before or at the time your bleeding begins, and typically lasts for 48-72 hours. Period pain usually occurs when the muscular wall of the womb contracts and presses against nearby blood vessels. Period pain can also be caused by an underlying medical condition, such as endometriosis or pelvic inflammatory disease. Dysmenorrhoea has been associated with cigarette smoking. Conventional treatment includes medication, application of heat and gentle exercise. The contraceptive pill is often prescribed for painful periods. It is important to note that the contraceptive pill removes your reproductive cycle altogether. Prolonged use of the pill may reduce your fertility in later life.

NOTE ON TAMPONS Try not to use tampons. If you think about it, they work against the natural flow of blood. Many women with painful periods find that tampons make their period pain worse. In addition, tampons draw on all vaginal fluids (not just blood) and may affect the health of your vagina. If you need to use them, limit their use, use natural organic cotton tampons and don’t use them at night.

Menorrhagia (heavy periods) is when a woman loses an excessive amount of blood during consecutive periods. Heavy bleeding does not necessarily mean there is anything seriously wrong, but it can affect women physically, emotionally and socially, and may be disruptive to everyday life.

Seek medical advice if you are concerned about heavy bleeding during or between your periods. If you experience flooding onto your clothes or bedding or need to use towels and tampons together your blood loss may be excessive. Heavy bleeding may be linked to uterine fibroids, use of intrauterine contraceptive devices (IUDs), polycystic ovarian syndrome (PCOS) or anticoagulant medication. Menorrhagia may lead to anaemia and iron deficiency. Medical treatment may include medication, including use of the contraceptive pill and in severe cases surgery.

Amenorrhoea (no periods) means you have stopped having periods or haven’t started them by the time you are 14-16 years old. Amenorrhoea may occur as result of extreme exercise in professional athletes and dancers. Some types of contraceptive medication can cause you to stop having periods temporarily. However, absent periods may be a sign of an underlying medical condition, such as polycystic ovary syndrome (PCOS), so it’s important to consult your GP if your periods stop.

Oligomenorrhoea (irregular periods) Some women find their menstrual cycle isn’t regular. Their periods may be early or late, and may vary in how long they last or how heavy they are. Irregular periods may be due to hormone imbalances, caused by stress, polycystic ovary syndrome (PCOS), extreme weight loss, excessive exercise, thyroid disorders or approaching the menopause.

ABOUT PRE-MENSTRUAL SYNDROME (PMS)

Also known as pre-menstrual tension (PMT). Your body produces different amounts of hormones at different times during your menstrual cycle, causing physical, behavioural and emotional changes. PMS is an umbrella term for a range of symptoms including backache, cramps, headaches, breast tenderness, fatigue, food cravings, poor concentration, sleep problems, tearfulness, depression, mood swings, anxiety and irritability. Most women experience at least one of these symptoms. Studies have shown that schoolgirl exam grades dip before menstruation. There is some evidence that low blood sugar may worsen symptoms. Eating little and often and managing stress with exercise can help. Conventional medical treatment usually involves medication.

Acupuncture for PERIOD PAIN AND PMS

The World Health Organization reports that acupuncture is an effective treatment for primary dysmenorrhoea, and acupuncture has been shown to have a therapeutic effect for the treatment of premenstrual syndrome (WHO, 2003).
Acupuncture can help reduce symptoms of period pain and pre-menstrual syndrome by:

  • Regulating neuroendocrine activity and expression of the hypothalamus-pituitary-ovary axis
  • Relaxing muscle tissues giving relief from uterine contractions which cause period pain
  • Increasing relaxation and reducing tension
  • Stimulating production of endorphins – natural pain relieving substances
  • Changing pain processing in the spinal cord
  • Reducing inflammation

See also:

TREATING MENSTRUAL PROBLEMS, PERIOD PAIN & PMT
“Many women are conditioned to believe that their period is ‘the curse’, something bad. It may be that you have suffered with menstrual problems for many years, so understandably you are fed up with it. Your period is a normal physiological process, a sign of your internal health, vitality and fertility. You may not be interested in conceiving yet, indeed you may be making considerable effort not to fall pregnant at the moment. But it is important to get in tune with your cycles and take steps to keep them healthy. This in turn will help enhance your emotional and physical health now, and your fertility in the future.

I see women in clinic who are now happily in long term relationships and want to start a family. They are having problems conceiving. On discussion of their case history it becomes apparent that they haven’t had a period in several years. At the time they thought it was something of a blessing – ‘no inconvenient periods!’ The reality is that it was probably a sign of ill health which needed to be addressed. Believe it or not, your period is beneficial to your health. It provides an important means of detoxing the body once a month. Women who don’t have periods have a higher risk of endometrial cancer.

So girls and ladies, NOW is the time to take control, sort out your problem periods and feel better! Now is the time to look after your gynae health – so later on, when you want to have a child, you can.”

Judy Bowen-Jones Lic Ac BSc Hons Ac MBAcC
FURTHER INFORMATION

Cannon, E. (2010). The Baby Making Bible. Macmillan

Cannon, E. (2013). Total Fertility. Macmillan

NHS Painful Periods www.nhs.uk/conditions/periods-painful/pages/introduction

Maciocia, G. (2007). Obstetrics & Gynaecology in Chinese Medicine. Elsevier
White, J. (2013). Gynaecology and Fertility. Naturechild

World Health Organization. Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials (2003), 87pp. Full report http://apps.who.int/medicinedocs/pdf/s4926e/s4926e.pdf

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