Periods and Some Period Problems

Why do periods occur?

Females have small organs called ovaries in the lower part of their abdomen. The ovaries lie either side of the uterus (womb). The ovaries start to produce female hormones in girls around puberty which cause changes to the lining of the uterus (womb). Every month during your period the lining of the womb is shed together with some blood.

Normal periods (menstruation)

Starting to have periods is part of growing up for girls. Periods usually start to occur around the same time as other changes happen to the body such as starting to develop breasts or grow pubic hair. The average age to start periods is 13, but it is normal to start anytime between the ages of 11 and 15. A small number of girls may start before or after this. Periods continue until the menopause which is usually between the ages of 45 and 55.

What happens during a period?

For several days each month there is blood loss from the vagina. The amount of blood loss varies from period to period, and from woman to woman. Some women have a dark scanty loss, some have a heavier loss which is a brighter red. Sometimes clots are passed, especially if the loss is heavy. Sometimes there are small flaky fragments in with the menstrual blood. A normal amount of blood loss each period is between 20 and 60 ml. (This is about 4 to 12 teaspoonfuls.) Bleeding can last up to eight days, but five days is average. The bleeding is usually heaviest on the first two days. Some pain in the lower abdomen ('period pain') is common and normal.

Do I have to avoid anything when I have a period?

No. Carry on as normal. If you find the periods painful then try to keep busy as this often helps. You can go swimming, have a bath, etc. Periods are not 'dirty'; they are a normal part of a woman's life.

Sanitary towels or tampons?

It is probably best to use sanitary towels when periods first start. These are placed in your underwear to soak up the blood. Tampons, which are towels that you insert into the vagina to absorb the blood, can be more convenient and can be tried later when you are more used to periods. They need to be changed regularly.

Other effects of the female hormones

The female hormones (oestrogen and progesterone) have other effects which you may notice apart from causing periods. For example, the texture of the mucus in the vagina changes at different times of the cycle. The vagina tends to be drier, and the mucus more thick, in the first half of the cycle. Shortly after ovulation, when progesterone levels rise, the vaginal mucus becomes thinner, more watery, and slippery. It becomes thicker again towards the next period as the progesterone level falls.

Progesterone may also cause 'water retention' in various parts of the body. Your breasts may become slightly bigger or tender, and your abdomen may swell a little before a period. You may feel irritable before a period which is possibly hormone related. To have such symptoms before a period is normal. Sometimes the symptoms prior to periods can be more severe. This is then called 'pre-menstrual syndrome' or 'pre-menstrual tension'.

Some symptoms relating to periods

In general, if you have a change from your usual pattern that lasts several periods, it may be 'abnormal'. It is best to see a doctor if this occurs.

Heavy periods (menorrhagia)

This is common. It is difficult to measure blood loss accurately. Periods are considered heavy if they cause such things as: flooding, the need for double sanitary protection, soaking of bedclothes, passing clots, or if your normal lifestyle is restricted because of heavy bleeding. See your doctor if your periods change and become heavier than previously. There are various causes of heavy periods. However, in most women, the cause is unclear and there is no abnormality of the uterus or hormones. Treatment can reduce heavy periods, and is dealt with in more detail in another leaflet called 'Heavy Periods'.

Painful periods (dysmenorrhoea)

When periods first start they are usually painless. However, later on most girls notice an ache in their lower abdomen, back and tops of the legs, especially in the first few days of a period. The first two days are usually the worst. Some women have more pain than others. Painkillers or anti-inflammatory painkillers such as ibuprofen usually ease the pain if it is troublesome. Another leaflet called 'Painful Periods' gives details.

It is common to have some period pain. The cause of the pain in most women is not fully understood. Sometimes conditions such as endometriosis can make period pains become worse. See a doctor if:

• the pain becomes gradually worse each period.
• pain begins a day or more before the onset of bleeding.
• pain is severe over the whole time of the period.

Bleeding at abnormal times

If you have vaginal bleeding at times apart from your expected periods, you should see a doctor. This includes if bleeding occurs after you have sex, or after the menopause. There are various causes of bleeding between periods. One common cause is called 'breakthrough bleeding' which are small bleeds that occur in the first few months after starting the contraceptive pill. This usually settles over a few months.

Periods which stop (amenorrhoea)

Pregnancy is the most common reason for periods to stop. However, it is not uncommon to miss the odd period for no apparent reason. But, it is unusual to miss several periods unless you are pregnant. Apart from pregnancy, other causes of periods stopping include stress, losing weight, exercising too much (long distance runners etc), and hormone problems. As a rule, it is best to see a doctor if your periods stop for several months without explanation.

Also, see a doctor if your periods have not started at all by the age of 16.

Irregular periods

The interval between periods can vary in some women. Irregular periods may indicate that you do not ovulate every month, and the balance of the female hormones may be upset. See a doctor if your periods become irregular in your younger years. However, irregular periods are common in the few years leading up to the menopause.

Further help and information

Women's Health Concern

Whitehall House, 41 Whitehall, London SW1A 2BY
Helpline: 0845 123 2319 Web: www.womens-health-concern.org
Provides advice to women on a wide variety of women's health issues including periods.