Periods…What’s Normal?

Periods…What’s Normal?

There is no “normal”, but there is definitely “abnormal”. Many of us are anxious to discuss our periods, feel “they aren’t that bad”, or “many people have it worse”, or even “they used to be ok before kids, that’s just what happens after babies”. The reality is that many of us are suffering in silence, often unnecessarily. Heavy or painful periods don’t have to be something we put up with, nor do they mean we have to have a hysterectomy. For some women, hysterectomies are life changing, or even life-saving, but for many there are lots of other things which would work, and would significantly improve our quality of life.

In terms of volume, 1-6 tablespoons (10-80ml) of menstrual fluid per cycle is considered “normal”. Flooding through pads, not being able to get through the night without changing pads/tampons, passing clots, are all indicators of heavy periods.

When should I seek help?

If your periods stop you doing what you want to be doing, whether exercising, socialising, sleeping through the night without having to change pads/tampons, if you have to miss work because of your period, if they leave you feeling exhausted, sick, unhappy, if you’re just not sure, please see your GP. No one should leave you feeling misunderstood or that your concerns don’t matter. Our job is to listen, to investigate where necessary, and to try and work with you to find solutions.

I don’t feel comfortable talking about my periods, what can I try myself?

One useful indicator for your menstrual prognosis, is talking to your own mum – often women follow similar menstrual patterns to their mum. So, if your mum had terrible periods, there’s a reasonable chance you may follow that path, but options available for treatment have moved on significantly since your mum’s periods caused her issues.

There’s lots of simple things women can do to try and help

  • Exercise especially yoga and pilates can ease menstrual cramps
  • Relaxation – easy to say when you are a busy mum, but even a few minutes of mindfulness, meditation or just simple breathing exercises can help. Conversely stress is known to make period pains worse.
  • Heat packs – some women find these very soothing, and by the same token warm baths or showers
  • Avoid alcohol and smoking during your period – both are shown to exacerbate period pains
  • Dietary supplements – omega-3 containing fatty acids and magnesium have been found to relieve symptoms, good quality probiotics can help balance gut health and balance oestrogen levels, B6 vitamins have been shown to improve PMS symptoms.
  • Diet – cinnamon, fenugreek and fennel have all been shown to help painful symptoms. One study showed cinnamon was as effective as ibuprofen at reducing period pains. Ginger also has great anti-inflammatory properties.
  • Pain relief – naprogesic or ibuprofen can help significantly with painful periods, as can Panadol, but if this is something you require regularly, might be worth seeing your GP.

Yeah, I’ve tried all of those, but my periods are still impacting my life

Probably time to see your doctor. If you are able to record your periods in a menstrual diary, that can help us immensely – how long your periods lasted, how often you needed to change pads, tampons, menstrual cup, how many days were awful, are all useful for us to know. What do we look for?

  • Anaemia – this can be severe in women with horrid periods, so we may well check a blood count and iron levels, plus your blood pressure and pulse
  • Thyroid – this being out of whack can impact periods massively
  • Clotting disorders – these can worsen bleeding
  • Ultrasound – often we will organise this to look at the uterus and see if there are any indications of what is causing your periods to be so disruptive. Many mums have only ever have pelvic ultrasounds when pregnant, where the focus in on the growing baby and placenta, but we can get lots of information from non-pregnant ultrasounds, and a normal ultrasound a couple of years ago, doesn’t rule out changes now, especially if your periods have changed in that time.

What might you do to help my periods?

There are many causes of painful, or heavy periods.

  • Endometriosis – when the lining of the womb (the endometrium) grows outside the womb, seeding itself on the abdominal wall, bowels, bladder or other surrounding organs. When you have your period, this tissue bleeds causing worsening pain. It affects about 10% of all women, and symptoms range from no symptoms to life-changing, debilitating symptoms
  • Adenomyosis when the lining of the womb grows into the muscular tissue of the womb (the myometrium) causing heavy or painful periods
  • Fibroids – these are benign growths in the uterus, which occur in the majority of women (approximately 75%). In most they are asymptomatic, but for some, they make their periods excessively heavy.
  • Hormonal imbalance, including thyroid disorders, PCOS (polycystic ovarian syndrome)
  • Pelvic inflammatory disease – often caused by chlamydia and other pelvic infections
  • Polyps – benign growths, like skin tags, in the uterus can disrupt periods, and can often be very easy to remove.

Depending on the likely cause, and individual woman’s needs, a plan is made. It may be correcting thyroid imbalance, treating pelvic infection, using medications like the combined oral contraceptive pill (COCP) which generally makes periods less heavy and painful, other contraceptive options such as implanon and mirena intrauterine system. In addition, oral (or even intravenous) iron supplement, or even blood transfusion, can be needed.

Do you not just refer to a gynaecologist?

I probably refer about 20-30% of all my patients with heavy or painful periods on to a gynaecologist. For many, we can manage their symptoms together at general practice level. Who would I refer? The patients whose symptoms are not controlled by all the measures listed above, patients in whom I am considering endometriosis as a cause who may require keyhole (laparoscopic) surgery and patients with complex medical needs, or those who simply ask for a gynaecological specialist opinion.

What might gynaecologists do?

In many women, they will try alternative medical treatments, whether a change of pill, using medications to stop periods, back-to-backing the contraceptive pill (leaving out the sugar pills to try to prevent withdrawal bleeds). If these don’t work, they may consider surgery

  • Hysteroscopy – this is when an endoscope (keyhole device) is inserted into the uterus through the cervix, so that the lining and shape of the uterus can be checked for deformities and irregularities like polyps or fibroids.
  • Mirena or Kyleena – these are hormone releasing intrauterine devices (“coils”) which are inserted either in the rooms, or under anaesthetic which work to reduce the thickness of the lining of the uterus. For many women, the development of the mirena, has reduced the risk of hysterectomy, and has provided excellent treatment for their periods.
  • Endometrial ablation – this is a procedure carried out under general anaesthetic, where the lining of the uterus (the endometrium) is removed surgically (ablated). This is only something that can be done in women who have completed their families, as it is too dangerous to fall pregnant after an endometrial ablation has been performed. But for women who have completed their families, this can be an excellent alternative to hysterectomy. Many patients of mine who have had this procedure, are on their feet and back at work within 48 hours of having the procedure (although we normally tell their partners that they need to avoid cooking or housework for a couple of weeks at least!).
  • Hysterectomy – considered the “last resort”, this procedure has had significant bad press over the years. However for many women, it turns their lives around, giving them a quality of life they haven’t experienced for many years. The old “rest up for 6 weeks” approach to hysterectomies, is long gone. Often this procedure can be performed laparoscopically (keyhole), resulting in an overnight stay in hospital, and again, many of my patients have resumed all their normal activities within a couple of weeks of surgery.

This is by no means an exhaustive list of period problems and their treatments, but as a GP, I’m aware that many women don’t feel comfortable talking about this, or don’t know what options are available. And comments from older generations like “you probably need a hysterectomy”, because that used to be the only option for many women, may now be a barrier to women seeking treatment, for fear of needing major surgery. Please don’t suffer in silence, there are lots of things we, as women, can do to help ourselves, and there are many things doctors can do to help.


This article is general in nature. It is not intended as a substitute for professional advice and you should seek professional verification on matters such as legal, health and wellness, travel or financial opinion prior to relying on such information.
Victoria Kotasthane

Victoria works as a GP in Orange, having emigrated from the UK 7 years ago. She has particular interests in women’s, adolescent and mental health. She is also a mum to 3 children- Rohan (11), Luca (8) and Anoushka (5), and 2 fur babies (Charlie and Izzy!).

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