Menstrual Pain: When Your Period Signals a Problem (cont.)

Some helpful things to note:

  • How many days is it from the first day of one period to another?
  • How long do your periods last?
  • How heavy/light is the bleeding? What are the heaviest days in your cycle?
  • Do you have spotting in between periods? If so, when? After sex?
  • Do you have pain? Describe it. Where is it coming from? When does it occur?
  • What are your other symptoms? Do you experience headaches, backaches, gastrointestinal problems, fatigue, or fainting spells? Do you have any unusual discharge?
  • Are you taking any medications?

When consulting a doctor for a menstrual problem, it's important to report your medical history (if it's not already known), and family history of disease. Make sure to tell the physician what else is going on in your life. Sometimes emotional distress, diet, or exercise can affect the menstrual cycle.

Keeping track of your periods not only assists physicians, it can also help you determine what's normal and abnormal for your body. It could give you a clue if you're pregnant, when it's best to be more vigilant about contraception, when you're ovulating, or if you could be experiencing perimenopause.

"Nobody knows one's body more than the patient herself," says Mark, stressing the importance of being an educated consumer. "If it's a concern to you and you take the time to visit your physician, then that really needs to be looked at."

The relationship between patient and doctor should be a partnership, adds Mark. If your doctor isn't meeting your needs, it may be time to find one who will pay attention.

For menstruation-related issues, a doctor may do a physical exam including a pelvic exam, and a pregnancy test. Your pulse and other vital signs will be checked. You may be asked to provide a sample of your urine or blood. A physician may also order a vaginal ultrasound; this will help get a closer look at the uterus and ovaries.

The type of exam you will have depends on your symptoms, age, clues from your history and physical exam, and what your doctor thinks is appropriate for your situation.

Common Menstrual Problems

If you haven't had a period by age 16, you'll need to be evaluated by a doctor. Many things could be to blame including eating disorders, hormonal problems, excess stress or exercise, and undernutrition in a young teen. Other possible culprits could be a genetic disorder, ovarian tumors, ovary failure, poorly formed reproductive organs, or problems in the nervous system or pituitary gland which secrete hormones that trigger puberty.

On the other hand, if you've had a normal menstrual cycle, and you skipped a month, see a doctor. You may be pregnant.

"The first rule-out for no cycles in any woman during all of her years of menses always has to be pregnancy," says Nancy Church, MD, FACOG, an ob-gyn in private practice in Chicago.

After the possibility of pregnancy as the cause of a missed period is eliminated, the doctor may ask a few more questions to better determine the reason for an irregular or missed period. Possible causes include:

  • Breastfeeding
  • Medication use, including birth control pills
  • Menopause
  • Stress
  • Poor nutrition, including eating disorders
  • Depression
  • Extreme weight loss
  • Overexercising
  • Ongoing illness
  • Sudden weight gain or obesity
  • Hormonal problems including thyroid disorders and polycystic ovary syndrome (PCOS)

Also keep in mind that it's not uncommon to skip one or two periods a year. If you miss one cycle, chances are your next one may be heavier. That's because the lack of a period may have led to a buildup of the uterine lining from the last month.

Missing more than two periods in a row is unhealthy. It can put you at risk for uterine cancer because of the excessive exposure to estrogen. On the other hand, missing a period from a lack of estrogen can increase the risk of osteoporosis.

Irregular periods may mean you are not ovulating properly. This can be of great concern to women trying to get pregnant.

Bleeding Between Periods

Spotting in between periods can be a sign of a problem, particularly if it happens for a prolonged duration. Vaginal spotting in girls who are less than 10 years old, during pregnancy, or after menopause should be evaluated.

Light bleeding between periods may mean the progesterone level in your body is not high enough. In people who use birth control pills, this can happen if they do not take pills at a regular time each day. Or it may mean that the dosage of birth control pills may need to be adjusted.

"Bleeding the week before your cycle means your progesterone is not high enough or your pill is not strong enough," says Church, who notes that it's best to consult a doctor about the matter.

Minor bleeding is also a common side effect of the contraceptive Depo-Provera. Other possible causes of abnormal vaginal bleeding include:

  • Pregnancy problems
  • Ovulation
  • Perimenopause
  • Intraurine device (IUD) use
  • Breastfeeding
  • Overexercising
  • Hormone irregularities due to an overactive thyroid, or diabetes

Heavy Bleeding, Prolonged Bleeding, and Clots

Each woman's assessment of her period varies. What is heavy or prolonged bleeding for one woman is normal for another. It's a good idea for women with prolonged bleeding, heavy bleeding, or excess clots to get checked for anemia.

Women with excess bleeding are prone to developing iron deficiency anemia.

If periods become heavier or thicker over time, there may be nothing to fret about as long as annual pelvic exams and biannual blood tests are performed. Talk to your doctor about ways to help prevent anemia or control excess or heavy bleeding.

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