Menstrual disturbances

Gender  AFfirming
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Expert articles highlighting important issues in endocrine and reproductive health, insights from our clinical experience and our summaries and interpretations of pertinent studies.

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Understanding your menstrual cycle is a powerful tool in monitoring your endocrine and general health

How aware are you of your menstrual cycle?

Tracking  your menstrual cycle is a useful adjunct to help understand your current health and future fertility.  Downloading a phone app is an easy way to record and monitor changes in your cycle. An  app allows you to keep a permanent record of this information  for the rest of your life. If a doctor then asks about your periods you  have a history of your cycles (literally) right at your fingertips. Recording on an app also allows you to take note of other symptoms  that may be connected  – patterns around headache or migraine or other symptoms that may occur   prior to your period.   

What is a normal menstrual pattern?

Periods ) usually start by the age of 15  and should become regular within two years, settling into a cycle between 25 – 35 days (counting from the first day of one period to the first day of the next period). We would accept cycles in adolescents from 21 – 45 days.   Typically, once cycles are established, the pattern  stays consistent until the perimenopause,or example if you have a a 28 day cycle you are likely to stay this way. l If you are someone who has cycles between 29-33 days then you are likely to stay like this until the perimenopausewhen periods typically move closer together first, then spread out and become less regular.  For more information on the perimenopause see our blog here (insert link)

There are two main phases of the menstrual cycle.  The follicular phase is from the first day of the period to the day you ovulate and the luteal phase is from the day of ovulation until the day your period starts.   It is normal to see a mid cycle change in the type and amount of vaginal discharge (a similar consistency to  egg white)) and this is the most reliable sign  that you are ovulating.  

The duration of the period is the length of time that you bleed for.  There is no “right” amount of time.  Some women bleed for several days and some women for just two or three days.  

 Heavy periods are difficult to quantify so your doctor might ask the following:   How many times do you need to change sanitary products such as pads or tampons. ?   Do you need to use double pads?  Do you need to get up at night to change pads?  Do you flood or leak at night ?  Do you pass blood clots?  If you are answering yes to more than one of these questions then you  have “heavy periods”  also called menorrhagia.  You should discuss this further with your doctor and have your  iron level checked (via a blood test).  

What if I’m on the oral contraceptive pill

Hormonal contraceptives override your natural cycles, making your underlying menstrual cycles difficult to assess.  If periods are regular on a contraceptive pill, you cannot assume they will be regular without a contraceptive pill.  If you are having any unexpected bleeding or lack of bleeding on a contraceptive it is also important to discuss this with your doctor.

How do I know if my periods are irregular?

If periods are consistently sitting outside the normal timing of 25-35 days then you should see your doctor to discuss and consider further testing.    There are different medical terms used to describe period change:

Oligomenorrhea occurs when your menstrual cycles are longer than 35 days but more frequent than three months apart.  This is somewhere between 4 to 9 periods per year.  

Amenorrhea can be primary (having never had a period) or secondary (having started and then stopped periods).  If periods have not started by 15  years old you should consult with your doctor.  If your periods started,  became regular, and then stopped with  no bleeding at all for three months this is consistent with a diagnosis of amenorrhoea.  If periods were irregular with no bleeding at all for six months, then this is defined as amenorrhoea.  

Dysfunctional uterine bleeding is when women have more frequent bleeding than is normal – ie less than three weekly.  

When do I see a doctor?

If you have not had your first period by 15 years of age or are not getting regular monthly periods, then see your GP for a check-up.   You should also see your doctor if you have dysfunctional uterine bleeding or any bleeding outside of your regular periods. 

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