Menstrual Cycle Problems

See complete list of charts.

From missed periods to painful periods, menstrual cycle problems are

common, but usually not serious. Follow this chart for information
regarding changes in your cycle.

SYMPTOMS DIAGNOSIS SELF-CARE

1. Have your
periods
Go to Question 5.*
become
painful?

2. Have you This may be normalMENSTRUAL Use over-the-

been more CRAMPS, or you may counter
emotional, havePREMENSTRUAL SYNDROME medicine such
fatigued or (PMS). as ibuprofen or
irritable, or naproxen for
do you have bloating and
more pain. Avoid
bloating or caffeine and
weight gain alcohol. Make
than usual, changes to the
or do you way you eat
have trouble and exercise.
concentratin Eat smaller,
g or sleeping more frequent
just prior to meals that are
your periods? high in complex
carbohydrates
such as
fruits,vegetable
s and whole
grains, and take
a daily
multivitamin
and calcium.
See your doctor
 if symptoms get
worse.

3. Do you
have a
sexually URGENT
transmitted You may have a serious infection See your doctor
disease, or around your ovaries, fallopian right away. Any
do you have tubes, and uterus called PELVIC infection in the
a fever or INFLAMMATORY DISEASE (PID). abdomen can
foul-smelling be serious.
vaginal
discharge?

4. Do you
have pain at
other times
You may haveENDOMETRIOSIS, a
such as See your
problem with the lining of the
during sex, doctor.
uterus, orOVARIAN CYSTS.
ovulation or
bowel
movements?
*5. Are your
periods
heavier or
are you Go to Question 9.**
bleeding
longer than
usual?

The IUD may have caused this

6. Do you use See your
change in the pattern of your
an IUD? doctor.
bleeding.

7. Do you Your symptoms may be See your

have a from FIBROIDS,noncancerous doctor.
constant tumors of the uterus.
feeling that
you need to
urinate, or do
you have
pelvic
pressure,
constipation
or pain in
your back or
legs?

8. Do you
have muscle
aches,
swelling or
stiffness in
You may have a problem with
your joints, See your
your THYROID GLAND such
tightness or doctor.
asHASHIMOTO'S DISEASE.
swelling in
your throat,
and/or
weakness in
your legs?
**9. Are your
periods
irregular,
Go to Question 14.***
infrequent or
have they
stopped?

If you could be
pregnant, do an
at-home
pregnancy test.
10. Do you
If it's positive,
have breast
see your doctor
tenderness, You may have anOVARIAN CYST,
for
abdominal or you may bePREGNANT.
confirmation. If
fullness or
you don't think
nausea?
you're pregnant
and symptoms
continue, see
your doctor.
 Wait to see if
you have a
period at the
end of your
next pack of
Some women will miss a period
11. Are you pills. See your
while onBIRTH CONTROL PILLS.
on birth doctor if you
There is a small chance you could
control pills? have signs of
be PREGNANT.
pregnancy or
you don't have
a period after
the second
month.

Periods that stop after years of

regularity may be caused by
12. Are you normal or prematureMENOPAUSE.
See your
35 years old Irregular periods may be due
doctor.
or older? to FIBROIDS, HORMONE
PROBLEMS, or other medical
conditions.

13. Have you

You may have a HORMONE
felt sluggish,
PROBLEM, such as a THYROID
or have you
GLAND problem. Periods may See your
gained or lost
stop or become irregular if your doctor.
weight
weight falls dramatically, as can
without
occur withANOREXIA NERVOSA.
trying?

***14. Are
See your doctor
you bleeding
right away.
at times
Your bleeding could be Early detection
other than
from FIBROIDS,ENDOMETRIOSIS, of endometrial
your period,
or from a serious condition such cancer is
or again after
asENDOMETRIAL CANCER. important for
having gone
successful
through
treatment.
menopause?
 For more
information,
please talk to
your doctor.
If you think
the problem
is serious,
call your
doctor right
away.

Puberty and Periods

Menstruation (a period) is a major stage of puberty in girls; it's one of

the many physical signs that a girl is turning into a woman. And like a
lot of the other changes associated with puberty, menstruation can be
confusing. Some girls can't wait to start their periods, whereas others
may feel afraid or anxious. Many girls (and guys!) don't have a
complete understanding of a woman's reproductive system or what
actually happens during the menstrual cycle, making the process seem
even more mysterious.

When girls begin to go through puberty (usually starting between the

ages of 8 and 13), their bodies and minds change in many ways. The
hormones in their bodies stimulate new physical development, such as
growth and breast development. About 2 to 2½ years after a girl's
breasts begin to develop, she usually gets her first menstrual period.

About 6 months or so before getting her first period, a girl might notice
an increased amount of clear vaginal discharge. This discharge is
common. There's no need for a girl to worry about discharge unless it
has a strong odor or causes itchiness.

The start of periods is known as menarche. Menarche doesn't happen

until all the parts of a girl's reproductive system have matured and are
working together.
The Female Reproductive System
Baby girls are born with ovaries, fallopian tubes, and a uterus. The two
ovaries are oval-shaped and sit on either side of the uterus (womb) in
the lowest part of the abdomen called the pelvis. They contain
thousands of eggs, or ova. The two fallopian tubes are long and thin.
Each fallopian tube stretches from an ovary to the uterus, a pear-
shaped organ that sits in the middle of the pelvis. The muscles in a
female's uterus are powerful and are able to expand to allow the
uterus to accommodate a growing fetus and then help push the baby
out during labor.

As a girl matures and enters puberty, the pituitary gland releases

hormones that stimulate the ovaries to produce other hormones called
estrogen and progesterone. These hormones have many effects on a
girl's body, including physical maturation, growth, and emotions.

About once a month, a tiny egg leaves one of the ovaries — a process
called ovulation — and travels down one of the fallopian tubes toward
the uterus. In the days before ovulation, the hormone estrogen
stimulates the uterus to build up its lining with extra blood and tissue,
making the walls of the uterus thick and cushioned. This happens to
prepare the uterus for pregnancy: If the egg is fertilized by a sperm
cell, it travels to the uterus and attaches to the cushiony wall of the
uterus, where it slowly develops into a baby.

If the egg isn't fertilized, though — which is the case during most of a
woman's monthly cycles — it doesn't attach to the wall of the uterus.
When this happens, the uterus sheds the extra tissue lining. The blood,
tissue, and unfertilized egg leave the uterus, going through the vagina
on the way out of the body. This is a menstrual period. This cycle
happens almost every month for several more decades (except, of
course, when a female is pregnant) until a woman reaches menopause
and no longer releases eggs from her ovaries.

How Often Does a Girl Get Her Period?

Just as some girls begin puberty earlier or later than others, the same
applies to periods. Some girls may start menstruating as early as age
10, but others may not get their first period until they are 15 years old.
The amount of time between a girl's periods is called her menstrual
cycle (the cycle is counted from the start of one period to the start of
the next). Some girls will find that their menstrual cycle lasts 28 days,
whereas others might have a 24-day cycle, a 30-day cycle, or even
longer. Following menarche, menstrual cycles last 21-45 days. After a
couple of years, cycles shorten to an adult length of 21-34 days.

Irregular periods are common in girls who are just beginning to

menstruate. It may take the body a while to sort out all the changes
going on, so a girl may have a 28-day cycle for 2 months, then miss a
month, for example. Usually, after a year or two, the menstrual cycle
will become more regular. Some women continue to have irregular
periods into adulthood, though.

As a girl gets older and her periods settle down — or she gets more
used to her own unique cycle — she will probably find that she can
predict when her period will come. In the meantime, it's a good idea to
keep track of your menstrual cycle with a calendar.

How Long and How Much?

The amount of time that a girl has her period also can vary. Some girls
have periods that last just 2 or 3 days. Other girls may have periods
that last 7 days or longer. The menstrual flow — meaning how much
blood comes out of the vagina — can vary widely from girl to girl, too.

Some girls may be concerned that they're losing too much blood. It can
be a shock to see all that blood, but it's unlikely that a girl will lose too
much, unless she has a medical condition like von Willebrand disease.
Though it may look like a lot, the average amount of blood is only
about 2 tablespoons (30 milliliters) for an entire period. Most teens will
change pads 3 to 6 times a day, with more frequent changes when
their period is heaviest, usually at the start of the period.

Especially when menstrual periods are new, you may be worried about
your blood flow or whether your period is normal in other ways. Talk to
a doctor or nurse if:
 • your period lasts longer than a week
• you have to change your pad very often (soaking more than one
pad every 1-2 hours)
• you go longer than 3 months between periods
• you have bleeding in between periods
• you have an unusual amount of pain before or during your period
• your periods were regular then became irregular

Cramps

Some girls may notice physical or emotional changes around the time
of their periods. Menstrual cramps are pretty common — in fact, more
than half of all women who menstruate say they have cramps during
the first few days of their periods. Doctors think that cramps are
caused by prostaglandin, a chemical that causes the muscles of the
uterus to contract.

Depending on the girl, menstrual cramps can be dull and achy or sharp
and intense, and they can sometimes be felt in the back as well as the
abdomen. These cramps often become less uncomfortable and
sometimes even disappear completely as a girl gets older.

Many girls and women find that over-the-counter pain medications (like
acetaminophen or ibuprofen) can relieve cramps, as can taking a warm
bath or applying a warm heating pad to the lower abdomen. Exercising
regularly throughout the monthly cycle may help lessen cramps, too. If
these things don't help, ask your doctor for advice.

PMS and Pimples

Some girls and women find that they feel sad or easily irritated during
the few days or week before their periods. Others may get angry more
quickly than normal or cry more than usual. Some girls crave certain
foods. These types of emotional changes may be the result
of premenstrual syndrome (PMS).

PMS is related to changes in the body's hormones. As hormone levels

rise and fall during a woman's menstrual cycle, they can affect the way
she feels, both emotionally and physically. Some girls, in addition to
feeling more intense emotions than they usually do, notice physical
changes along with their periods — some feel bloated or puffy because
of water retention, others notice swollen and sore breasts, and some
get headaches.

PMS usually goes away soon after a period begins, but it can come
back month after month. Eating right, getting enough sleep, and
exercising may help relieve some of the symptoms of PMS. Talk to your
doctor if you are concerned about your premenstrual symptoms.

It's also not uncommon for girls to have an acne flare-up during certain
times of their cycle; again, this is due to hormones. Fortunately, the
pimples associated with periods tend to become less of a problem as
girls get older.

Pads, Tampons, and Liners

Once you begin menstruating, you'll need to use something to absorb

the blood. Most girls use a pad or a tampon. But some use menstrual
cups, which a girl inserts into her vagina to catch and hold the blood
(instead of absorbing it, like a tampon).

There are so many products out there that it may take some
experimenting before you find the one that works best for you. Some
girls use only pads (particularly when they first start menstruating),
some use only tampons, and some switch around — tampons during
the day and pads at night, for example.

Girls who worry about leakage from a tampon often use a pantiliner,
too, and some girls use liners alone on very light days of their periods.

Periods shouldn't get in the way of exercising, having fun, and enjoying
life. Girls who are very active, particularly those who enjoy swimming,
often find that tampons are the best option during sports.

If you have questions about pads, tampons, or coping with periods, ask
a parent, health teacher, school nurse, or older sister.
What is menstruation?
Menstruation (men-STRAY-shuhn) is a woman's monthly bleeding.
When you menstruate, your body sheds the lining of the uterus
(womb). Menstrual blood flows from the uterus through the small
opening in the cervix and passes out of the body through
the vagina (see how the menstrual cycle works below). Most menstrual
periods last from 3 to 5 days.

What is the menstrual cycle?

When periods (menstruations) come regularly, this is called the
menstrual cycle. Having regular menstrual cycles is a sign that
important parts of your body are working normally. The menstrual
cycle provides important body chemicals, called hormones, to keep
you healthy. It also prepares your body for pregnancy each month. A
cycle is counted from the first day of 1 period to the first day of the
next period. The average menstrual cycle is 28 days long. Cycles can
range anywhere from 21 to 35 days in adults and from 21 to 45 days in
young teens.

The rise and fall of levels of hormones during the month control the
menstrual cycle.

What happens during the menstrual cycle?

In the first half of the cycle, levels of estrogen (the “female hormone”)
start to rise. Estrogen plays an important role in keeping you healthy,
especially by helping you to build strong bones and to help keep them
strong as you get older. Estrogen also makes the lining of the uterus
(womb) grow and thicken. This lining of the womb is a place that will
nourish the embryo if a pregnancy occurs. At the same time the lining
of the womb is growing, an egg, or ovum, in one of the ovaries starts
to mature. At about day 14 of an average 28-day cycle, the egg leaves
the ovary. This is called ovulation.

After the egg has left the ovary, it travels through the fallopian tube to
the uterus. Hormone levels rise and help prepare the uterine lining for
pregnancy. A woman is most likely to get pregnant during the 3 days
before or on the day of ovulation. Keep in mind, women with cycles
that are shorter or longer than average may ovulate before or after
day 14.
A woman becomes pregnant if the egg is fertilized by a man’s sperm
cell and attaches to the uterine wall. If the egg is not fertilized, it will
break apart. Then, hormone levels drop, and the thickened lining of the
uterus is shed during the menstrual period.

See how the menstrual cycle works below.

Having trouble viewing the tool above? Take a look at

our menstruation diagram.

What is a typical menstrual period like?

During your period, you shed the thickened uterine lining and extra
blood through the vagina. Your period may not be the same every
month. It may also be different than other women's periods. Periods
can be light, moderate, or heavy in terms of how much blood comes
out of the vagina. This is called menstrual flow. The length of the
period also varies. Most periods last from 3 to 5 days. But, anywhere
from 2 to 7 days is normal.

For the first few years after menstruation begins, longer cycles are
common. A woman's cycle tends to shorten and become more regular
with age. Most of the time, periods will be in the range of 21 to 35 days
apart.

What kinds of problems do women have with their periods?

Women can have a range of problems with their periods, including
pain, heavy bleeding, and skipped periods.

• Amenorrhea (ay-men-uh-REE-uh) — the lack of a menstrual

period. This term is used to describe the absence of a period in:
o Young women who haven't started menstruating by age 15
o Women and girls who haven't had a period for 90 days,
even if they haven't been menstruating for long

Causes can include:

o Pregnancy
 o Breastfeeding
o Extreme weight loss
o Eating disorders
o Excessive exercising
o Stress
o Serious medical conditions in need of treatment

As above, when your menstrual cycles come regularly, this means that
important parts of your body are working normally. In some cases, not
having menstrual periods can mean that your ovaries have stopped
producing normal amounts of estrogen. Missing these hormones can
have important effects on your overall health. Hormonal problems,
such as those caused by polycystic ovarian syndrome (PCOS) or
serious problems with the reproductive organs, may be involved. It’s
important to talk to a doctor if you have this problem.

• Dysmenorrhea (dis-men-uh-REE-uh) — painful periods, including

severe cramps. Menstrual cramps in teens are caused by too
much of a chemical called prostaglandin (pros-tuh-GLAN-duhn).
Most teens with dysmenorrhea do not have a serious disease,
even though the cramps can be severe. In older women, the pain
is sometimes caused by a disease or condition such as uterine
fibroids or endometriosis.

For some women, using a heating pad or taking a warm bath

helps ease their cramps. Some over-the-counter pain medicines
can also help with these symptoms. They include:
o Ibuprofen (eye-byu-PROH-fuhn) (for instance, Advil, Motrin,
Midol Cramp)
o Ketoprofen (key-toh-PROH-fuhn) (for instance, Orudis KT)
o Naproxen (nuh-PROK-suhn) (for instance, Aleve)

If these medicines don’t relieve your pain or the pain interferes with
work or school, you should see a doctor. Treatment depends on what’s
causing the problem and how severe it is.

• Abnormal uterine bleeding — vaginal bleeding that’s different

from normal menstrual periods. It includes:
o Bleeding between periods
o Bleeding after sex
o Spotting anytime in the menstrual cycle
o Bleeding heavier or for more days than normal
 o Bleeding after menopause

Abnormal bleeding can have many causes. Your doctor may start by
checking for problems that are most common in your age group. Some
of them are not serious and are easy to treat. Others can be more
serious. Treatment for abnormal bleeding depends on the cause.

In both teens and women nearing menopause, hormonal changes can

cause long periods along with irregular cycles. Even if the cause is
hormonal changes, you may be able to get treatment. You should keep
in mind that these changes can occur with other serious health
problems, such as uterine fibroids, polyps, or even cancer. See your
doctor if you have any abnormal bleeding.

When does a girl usually get her first period?

In the United States, the average age for a girl to get her first period is
12. This does not mean that all girls start at the same age. A girl can
start her period anytime between the ages of 8 and 15. Most of the
time, the first period starts about 2 years after breasts first start to
develop. If a girl has not had her first period by age 15, or if it has been
more than 2 to 3 years since breast growth started, she should see a
doctor.

How long does a woman have periods?

Women usually have periods until menopause. Menopause occurs
between the ages of 45 and 55, usually around age 50. Menopause
means that a woman is no longer ovulating (producing eggs) or having
periods and can no longer get pregnant. Like menstruation,
menopause can vary from woman to woman and these changes may
occur over several years.

The time when your body begins its move into menopause is called the
menopausal transition. This can last anywhere from 2 to 8 years. Some
women have early menopause because of surgery or other treatment,
illness, or other reasons. If you don’t have a period for 90 days, you
should see your doctor. He or she will check for pregnancy, early
menopause, or other health problems that can cause periods to stop or
become irregular.
When should I see a doctor about my period?
See your doctor about your period if:

• You have not started menstruating by the age of 15.

• You have not started menstruating within 3 years after breast
growth began, or if breasts haven't started to grow by age 13.
• Your period suddenly stops for more than 90 days.
• Your periods become very irregular after having had regular,
monthly cycles.
• Your period occurs more often than every 21 days or less often
than every 35 days.
• You are bleeding for more than 7 days.
• You are bleeding more heavily than usual or using more than 1
pad or tampon every 1 to 2 hours.
• You bleed between periods.
• You have severe pain during your period.
• You suddenly get a fever and feel sick after using tampons.

How often should I change my pad and/or tampon?

You should change a pad before it becomes soaked with blood. Each
woman decides for herself what works best. You should change a
tampon at least every 4 to 8 hours. Make sure to use the lowest
absorbency tampon needed for your flow. For example, use junior or
regular tampons on the lightest day of your period. Using a super
absorbency tampon on your lightest days increases your risk for toxic
shock syndrome (TSS). TSS is a rare but sometimes deadly disease.
TSS is caused by bacteria that can produce toxins. If your body can’t
fight the toxins, your immune (body defense) system reacts and
causes the symptoms of TSS (see below).

Young women may be more likely to get TSS. Using any kind of
tampon puts you at greater risk for TSS than using pads. The Food and
Drug Administration (FDA) recommends the following tips to help avoid
tampon problems:

• Follow package directions for insertion.

• Choose the lowest absorbency for your flow.
• Change your tampon at least every 4 to 8 hours.
• Consider switching between pads and tampons.
 • Know the warning signs of TSS (see below).
• Don't use tampons between periods.

If you have any of these symptoms of TSS while using tampons, take
the tampon out, and contact your doctor right away:

• Sudden high fever (over 102 degrees)

• Muscle aches
• Diarrhea
• Vomiting
• Dizziness and/or fainting
• Sunburn-like rash
• Sore throat
• Bloodshot eyes

Irregular Periods

Periods can sometimes be a real pain. They can make you feel sick. They can give you a
headache. They can make your stomach ache. Yes, periods can be a real pain, and things can
be even worse if they decide to become irregular. Irregular periods are one of the most common
menstrual complaints around. Usually, irregular periods are nothing to worry about, but on
occasion, they can signal health complications.

Regular Periods
Before we can define an irregular period, we must first determine what a regular period is. People
often say that a regular period occurs every 28 days, but actually, every woman's menstrual
cycle is different. Depending on your body and your hormones, you may get your period every 20
days or your may get your period every 35 days. A good way to determine if your periods are
regular is to keep a chart and count the number of days between each period. If they occur with
roughly the same number of days between each cycle, then your periods are regular. A regular
period typically lasts 5 days, but it is completely normal to menstruate for anywhere between 3
and 7 days.

Irregular Periods
Irregular periods aren't unusual they affect about 30% of women in their reproductive years. An
irregular period is any type of bleeding that is abnormal when compared to your usual menstrual
cycle. This can include a late period, an early period or bleeding between periods. It can also
appear as particularly heavy bleeding (menorrhagia) or scanty bleeding. Many women also
experience irregular periods in the form of a missed period, continuous periods, or periods that
occur twice in one cycle.
Causes of Irregular Periods
Irregular menstrual periods are usually the result of hormonal signals that have been thrown out
of sync. In order to produce a period, your body makes hormones, like estrogen and
progesterone. These hormones are kept in the hypothalamus, pituitary gland, and ovaries inside
your body. In order to trigger ovulation and menstruation, these parts of the body need to send
signals to one another. Sometimes, these signals get crossed or skipped, causing irregular
periods.

But what causes these hormone signals to get out of whack? Well, there are actually a number of
things that can easily cause your hormone levels to change.

• Pregnancy: If you are pregnant, your body will begin producing different levels of
hormones. This will cause numerous pregnancy symptoms, including an end to your period.
• Stress: Stress is a common cause of irregular periods. If you are fatigued, worried, or
anxious this can cause your hormones to become unbalanced.
• Diet: A poor diet or extreme weight loss or gain can also affect your hormones. Women
with anorexia orbulimia often have no period or irregular periods.
• Exercise: Intense exercise can wreak havoc on your body, often causing irregular
periods.
• Menarche: the cycles after a girl's first period may be irregular for some time. It can take
up to 3 years to get regular periods.
• Menopause: Menopause causes changes in your hormone levels, and is often signaled
by irregular periods.
• Hormonal Birth Control: Birth control pills and irregular periods sometimes go hand in
hand. It can take a while for your body to adjust to the new levels of hormones delivered by
hormonal birth control.

Complications
For most women, an irregular period is nothing to be worried about; the majority of women will
eventually develop a regular cycle with regular periods. Sometimes though, underlying
complications can be the cause of these period problems. If you are noticing particularly
irregular periods, or have gone a year or more with missed periods, see your health care
professional. If you experience extreme cramping, heavy period bleeding, dizziness, nausea, or
fainting you should also visit with your health care provider.

Polycystic Ovary Syndrome

Polycystic ovary syndrome, or PCOS, is a fairly common complication, affecting about 10% of all
women. PCOS causes cysts to form on the ovaries, interfering with regular ovulation. Symptoms
of this syndrome include: excessive hair growth, weight gain, acne, dandruff, high blood pressure,
and infertility. If you display any of the symptoms, you may want to make an appointment to get
checked for PCOS. Left untreated, it can lead to other more serious complications,
including endometriosis, heart disease, and ovarian cancer.

Inflammatory Bowel Disease

Inflammatory bowel disease causes inflammation of the lower intestines (also known as the
bowel). It is linked with irregular periods, and may also be accompanied by symptoms of weight
loss, abdominal pain, and diarrhea. Inflammatory bowel disease can become severe, and
sometimes requires hospitalization or surgery. If you have any of these symptoms, ask your
doctor to check you for inflammatory bowel disease.

Treating Irregular Periods

Depending on the cause of your irregular periods, there may or may not be much you can do
about them. If you have only been experiencing irregular periods for a short time (less than 7
months), it is likely that your periods will become regular again on their own. However, if there is
an underlying medical condition that is causing your irregular periods, then receiving treatment for
the condition should help to get your periods back on track. If you find that irregular periods are
becoming annoying, there are some things that you can try to help regulate your hormones.

• Reduce your stress levels. Take time to meditate, relax, or just hang out. This may help
put your cycle back on track.
• Get help for your eating disorder. If you are anorexic, bulimic, or if you suffer from other
types of disordered eating, you must seek help. Not only will these eating disorders interrupt
your menstrual cycle, but they can also severely affect your liver, bowel, throat, and heart
functions.
• Don't over exercise. While it is important to exercise regularly and keep fit, exercising too
much can be problematic. If you are an endurance athlete, try to cut back on your training a
little bit, until your irregular periods return to normal.

Medical Treatments
There are a few medical treatments which may be helpful in regulating your period:

• Hormonal Contraceptives: Hormonal contraceptives are often used to help regulate

menstrual cycles. These contraceptives combine estrogen and progesterone and maintain your
body's hormones at specific and balanced levels. They are available by prescription and come
in oral, patch, ring, and injectable forms.

• Hormone Supplements: If you have a specific hormone problem, such as

overproduction of testosterone, hormonal supplements may be able to help regulate your
periods.