Period problems – understanding the causes and what helps

Irregular, painful, or heavy periods? Period problems can disrupt your life, but there are things you can do to help ease your symptoms.

What are the symptoms?

What causes period problems? 

Self-care tips

When to see a doctor and getting diagnosed

How are period problems treated?

Where to find support

Menstrual issues like irregular, painful, or heavy periods can affect daily life. Find out more about possible causes, from lifestyle factors like stress to conditions such as PCOS, and what can help you manage your periods from self-care tips to medical treatments.

Period problems, which are also called menstrual disorders, include irregular, heavy, painful, or absent periods. These issues can be disruptive but you don’t have to put up with them as support is available.

While it’s normal to experience some discomfort during your period, if your periods are stopping you from doing your usual activities, speak to a healthcare professional to find out what might be going on. 


## What are the symptoms?
Your symptoms will often depend on the type of period problem you have. They can include: 

- __[heavy periods (menorrhagia)](https://www.livehealthily.com/self-care/heavy-periods)__ – this can involve having to change your pad or tampon every 1-2 hours, to empty your menstrual cup more than usual, or to use 2 period products at once like a pad and a tampon or menstrual cup 
- __[painful periods (dysmenorrhea)](https://www.livehealthily.com/health-library/symptoms/painful-periods)__ – you experience painful and frequent cramps during your period. The pain is usually felt in your lower belly and pelvic area, but can also spread to your lower back and thighs. It can also feel like heavy pressure or tugging in your pelvic area 
- __[irregular periods (oligomenorrhea)](https://www.livehealthily.com/health-library/symptoms/periods-irregular)__ – while the average menstrual cycle is 28 days, it’s normal for your cycle to be between 21 and 35 days long, with bleeding lasting between 2 and 7 days. If you have irregular periods, your cycles may vary; they may be longer than 35 days or shorter than 21 days, the amount you bleed may change or for how long 
- __[absent or missed periods (amenorrhea)](https://www.livehealthily.com/health-library/symptoms/periods-absent)__ – this is when you skip a period, when periods stop for more than 3 months, or you’re over the age of 16 and you’ve not yet started your periods 
- __[premenstrual syndrome (PMS)](https://www.livehealthily.com/health-library/conditions/premenstrual-syndrome)__ – up to 2 weeks before your period starts, you may experience symptoms such as mood swings, feeling sad or irritable, headaches, tiredness, bloating, and tender breasts. Some people experience these emotional and physical symptoms severely, known as premenstrual dysphoric disorder (PMDD)
- __menstrual migraines__ – some people also experience [migraines](https://www.livehealthily.com/health-library/conditions/migraine) around the time of their period, which feel like very bad headaches and usually happen 2 days before or in the first 3 days of your period starting. 


Get help with this

## What causes period problems? 
There are many reasons, from lifestyle reasons to medical conditions.

This includes: 
- __hormonal imbalances__ – heavy periods can be caused by an imbalance of the hormones estrogen and progesterone 
- __problems with ovulation (anovulation)__ – if ovulation does not happen then the body stops producing the hormone progesterone, which can cause heavy bleeding 
- __uterine fibroids and polyps__ – [fibroids](https://www.livehealthily.com/health-library/conditions/fibroids) are usually non-cancerous tumours that grow on the inside of the uterus (womb) and can cause painful, heavy, and irregular periods, as well as abnormal bleeding when you’re not on your period. Polyps are small growths on the walls of your womb that can result in long or heavy periods 
- __[endometriosis](https://www.livehealthily.com/health-library/conditions/endometriosis)__ – a condition where the lining of your uterus (womb) grows in other places such as your fallopian tubes and ovaries. This can lead to painful, heavy, or irregular periods 
- __[polycystic ovarian syndrome (PCOS)](https://www.livehealthily.com/health-library/conditions/polycystic-ovarian-syndrome)__ – a condition where the ovaries start making androgens (male hormones) such as testosterone. This can cause irregular or missed periods 
- __medications__ – birth control pills, IUDs, and blood thinners can cause heavy bleeding while medication for anxiety and epilepsy can make periods irregular 
- __lifestyle factors__ – such as stress, extreme exercise, or sudden weight changes can all cause changes to your monthly cycle, such as making periods irregular or absent 
- __thyroid conditions__ – having an overactive thyroid ([hyperthyroidism](https://www.livehealthily.com/health-library/conditions/thyroid-over-active)) could lead to fewer or lighter periods while an underactive thyroid ([hypothyroidism](https://www.livehealthily.com/health-library/conditions/thyroid-under-active)) could cause heavy bleeding 
- __bleeding disorders__ – genetic conditions that reduce blood clotting (such as [Von Willebrand disease](https://www.livehealthily.com/health-library/conditions/von-willebrand-disease)) can lead to heavy bleeding during your period. 

### Who is affected?
Anyone who has a period can experience period problems, but some factors can make you more likely to experience them:  

- if you start your period before the age of 11, you’re more at risk of heavy, prolonged, and painful periods 
- [perimenopause](https://www.livehealthily.com/health-library/conditions/perimenopause) may cause you to skip periods, or have episodes of heavy bleeding 
- being overweight or underweight can increase your chances of painful or absent periods
- if you’ve been pregnant multiple times you’re more likely to have heavy bleeding. If you’ve never given birth you’re more likely to get painful periods 
- smoking can increase your chances of having heavy periods 
- if you're an athlete or exercise a lot you may be more likely to get absent or irregular periods.


## Self-care tips
There are some things you can do yourself to help ease the symptoms and make you more comfortable during your period. This includes: 

- __taking pain relief__ – if you get painful periods, try over-the-counter painkillers like acetaminophen (paracetamol) or ibuprofen (check this is suitable for you; aspirin must not be taken by children under 16). Speak to your pharmacist about the right pain relief for you 
- __heat therapy__ – using a heat pad or warm compress or taking a warm bath can help ease cramping if you have painful periods  
- __gentle exercise__ – activities like yoga, light stretching, and walking for 45-60 minutes, 3 times a week, can help ease pain and also help with stress 
- __dietary changes__ – try to eat a balanced diet and stay hydrated throughout your cycle. Some people find making some adjustments before their period starts can make an impact, such as consuming iron-rich foods (like leafy greens and red meat) to help prevent heavy bleeding-related anemia, and avoiding caffeine, alcohol, and foods high in sodium, to reduce bloating  
- __stay fresh__ – change your period products every 4-6 hours and shower regularly. If you have heavy periods, you may want to wear 2 types of period products at the same time to prevent leaks. If you’re out and about you might want to consider putting together a period pack including fresh underwear, period products, and a change of clothes 
- __keep a period diary,__ or track your cycle using an app so you have a detailed record of what happens during your period to show your doctor.


## When to see a doctor and getting diagnosed
You should speak to your doctor if you’re worried about your periods or notice any changes in your cycle, especially if: 

- __self-care methods aren’t helping__ to ease symptoms, and you have pain that stops you doing your normal activities (like going to work or school) 
- __periods are extremely heavy__ (soaking through pads/tampons within an hour) or are passing blood clots larger than 2.5 cm (the size of quarter or 10p coin) 
- __menstrual cycles are irregular__ – your period last longer than 7 days, you also have symptoms such as weight gain, tiredness, facial hair growth, and dry/oily skin
- __you have abnormal bleeding__ such as bleeding between periods, bleeding that lasts for longer than is normal for you or is heavier than usual, bleeding after menopause, or you bleed after sex
- __symptoms of iron-deficiency anemia appear__ – such as fatigue, dizziness, shortness of breath, or pale skin, which may be due to heavy blood loss. 

In order to diagnose what might be causing your symptoms, your doctor will ask you about your symptoms and may carry out a physical exam. 

You may also have blood tests, imaging tests like an ultrasound, or in some cases, a procedure such as a biopsy. 


## How are period problems treated?
Medical treatment will often depend on the type of period problem you have but can include:

- __hormonal contraception__ – such as birth control pills, shot, ring or intrauterine devices (IUDs) along with other hormonal treatments for fibroids and endometriosis can regulate cycles and reduce heavy bleeding
- __pain relievers__ – if over-the-counter pain medication isn’t working your doctor may prescribe you nonsteroidal anti-inflammatory drugs (NSAIDs) like naproxen, flurbiprofen, or mefenamic acid
- __treatment to help reduce bleeding__, such as tranexamic acid 
- __iron supplements__ – may be recommended if you experience heavy bleeding to prevent or treat anemia 
- __surgical options__ – in severe cases, procedures like fibroid removal (myomectomy), endometrial ablation (removing the womb lining). A hysterectomy may be recommended as a last result if other treatment options don’t work. 


## Where to find support
Period problems can be distressing and can have an impact on your quality of life. Thankfully there’s support out there: 

- [Wellbeing of Women – Periods Information Hub](https://www.wellbeingofwomen.org.uk/what-we-do/campaigns/just-a-period/periods-information-hub/) – a UK-based organisation that offers guidance and information on period problems 
- [Menstrual Health Coalition (UK)](https://www.menstrualhealthcoalition.com/) – an advocacy group that raises awareness for menstrual health 
- [Office on Women's Health (US)](https://womenshealth.gov/) – a government body that provides information and support on women’s health and operates a helpline.


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References

Rosa Bowden

Jo Wheatley

Dr Tamer T Malak

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Irregular, painful, or heavy periods? Period problems can disrupt your life, but there are things you can do to help ease your symptoms. 