A woman's menstrual cycle is an important part of the miracle of childbirth. During her reproductive years, the lining of a woman's uterus periodically thickens in preparation for receiving and nurturing a fertilized egg. If a fertilized egg does not implant in the uterus, the lining (endometrium) is shed, along with some blood, and the cycle begins again. This process usually begins at puberty, age 9 to 14, and ends with what we call menopause at about age 51.
Normally women bleed for two to seven days, starting every 28 days, and experience some mild cramping and bloating. Periods occurring too frequently (every 20 days or less) or not often enough (starting at intervals longer than 35 days), as well as irregular periods and bleeding between periods or after menopause can be a cause for concern. However, irregularity is not uncommon in adolescents and women approaching menopause and doesn't always mean there is a major problem.
Some women experience severe pain (called dysmenorrhea) and/or heavy bleeding during their periods. If one or both of these symptoms is interfering with a woman's quality of life or if her periods are irregular, it is time to talk to her doctor. The doctor will perform a pelvic exam and may order some tests, depending on the patient's overall health, health history, age, symptoms, and exam results. Irregularity, pain and abnormal bleeding can have many causes. Each patient is different, and the doctor will individualize the diagnostic evaluation and treatment.
After excluding serious gynecologic issues, the "first-line" treatment for painful periods is taking ibuprofen, Motrin or another NSAID medication. NSAID stands for nonsteroidal anti-inflammatory drugs, and they are available over the counter. A heating pad can also help relax abdominal muscles.
Not every woman can take NSAIDs, as they can irritate the stomach lining. Women who cannot take NSAIDS or women who continue to experience problems should see their doctor again. Keeping a chart that details when bleeding occurs, the degree of pain, and other symptoms may help the doctor with diagnosis and treatment. The doctor may perform more detailed tests, either in his office or in a hospital. Based on the test results and the patient's wishes, the doctor may recommend:
"Hormonal contraceptives (birth control pills, patches, injections and rings) which thin the uterine lining and reduce cramps and bleeding. Some hormonal treatments stop periods completely. Studies have shown that eliminating periods through hormonal therapy is safe.
"IUD (intrauterine device). This is another birth control method that thins the uterine lining and therefore helps reduce cramps and bleeding. An IUD is inserted in the doctor's office.
"Lysteda, a new prescription medication taken only during a woman's period to reduce heavy bleeding.
"Surgical intervention may be the appropriate choice if clear abnormalities, such as fibroids or polyps, are found. The doctor may perform a procedure called a hysteroscopy, which is the insertion of a camera through the cervix to view the interior of the uterus. Another possible procedure is a dilation and curettage (D&C) which physically thins the lining of the uterus. An endometrial ablation permanently destroys the uterine lining. Sometimes surgery is appropriate to exclude serious conditions such as uterine cancer. The surgical removal of the uterus, hysterectomy, may be required. Both endometrial ablation and hysterectomy leave the patient unable to become pregnant.
All treatments have different advantages and side effects, so be sure to discuss them thoroughly with your doctor. The important thing to remember is that treatment usually is available for problem periods. Find a doctor you are comfortable talking with and who will help you find a solution.