Periods do not always cause problems. But if they are consistently very heavy or painful, or if they regularly cause severe mood changes, it can significantly disrupt a person’s life. Irregular or absent periods may also cause difficulty getting pregnant.

Menstrual problems, such as painful, heavy, or irregular periods and premenstrual syndrome (PMS) are common — but effective treatment and management techniques can reduce the symptoms and improve the quality of life.

This article explores some of the most common menstrual problems, including their causes and treatments.

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Some of the most common menstrual problems are:

Also, people with other health conditions may find that symptoms of these get worse before their periods. This is known as premenstrual symptom exacerbation.

Many people with periods experience some degree of menstrual cramping, or dysmenorrhea. Mild-to-moderate cramps that result directly from menstruation are usually not a cause for concern, but they can still be disruptive. Severe cramps can be debilitating.

Over-the-counter (OTC) pain medication and home management techniques can often ease the symptoms, but severe dysmenorrhea may not respond to these approaches.

If the pain is “primary,” it is a direct result of menstruation. “Secondary” dysmenorrhea results from another health condition or cause.

Some factors associated with primary dysmenorrhea include:

  • smoking
  • stress
  • a higher body mass index, also known as BMI
  • attempts to lose weight
  • depression or anxiety
  • heavy periods
  • a family history of painful periods

Some causes of secondary dysmenorrhea include:

Mild or moderate cramps often respond to OTC pain medication, such as ibuprofen (Advil, Motrin).

Learn more about period pain here.

The medical term for this is menorrhagia, and it involves a flow of period blood that lasts longer than 8 days. Or, it involves a flow that requires a new pad or tampon every 1–2 hours or more often.

Occasional heavy periods are usually not a sign of an underlying health issue, but persistent heavy periods can be. Some conditions and circumstances that may cause heavy periods include:

Blood-thinning medications and copper IUDs can also cause heavy periods as a side effect.

Severe bleeding during periods can result in anemia, which develops when the body does not have enough iron.

Learn more about heavy menstrual bleeding, including symptoms and treatment options.

Generally, an irregular period involves a menstrual cycle lasting longer than 35 days. An absent period involves not having a period for 3 months in a row.

Some irregularity from time to time is common, particularly during puberty, after childbirth, while breastfeeding, and during perimenopause. Other factors that may cause irregularity include:

However, some mental and physical health problems also can cause irregular or absent periods, including:

Learn more about irregular and absent periods, including complications and treatment options.

Around 90% of people who menstruate report experiencing PMS. This is a combination of physical and emotional symptoms that occur before a period. Usually, they go away soon after a period starts.

The symptoms of PMS are varied and can include:

  • swollen or sore breasts
  • bloating or gas
  • diarrhea or constipation
  • mood swings
  • headaches
  • back pain
  • tiredness
  • difficulty concentrating or sleeping

The exact cause of PMS is unknown, but it may result from hormone fluctuations. A person’s estrogen and progesterone levels drop significantly after ovulation if they are not pregnant. Decreased estrogen may affect serotonin levels, leading to mood, appetite, and sleep changes.

Factors that are associated with PMS include:

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that affects fewer than 5% of people who menstruate. If mood changes before a period are dramatic, this may stem from PMDD rather than PMS.

Learn more about PMDD here.

If a person has experienced any of the following, they should speak with a doctor:

  • periods that become irregular or absent when they are usually regular
  • three missed periods in a row that have not resulted from pregnancy or breastfeeding
  • periods that happen more often than every 24 days or less often than every 38 days
  • pain that does not respond to OTC pain medication and interferes with daily life
  • bleeding that lasts longer than 8 days
  • bleeding through one or more tampons or pads every 1–2 hours
  • blood clots larger than a quarter
  • heavy bleeding as well as feeling weak, tired, or dizzy
  • depression, anxiety, or panic attacks that seem related to the menstrual cycle

Speak to a doctor promptly if vaginal bleeding or period-like pain occurs throughout the month or after sex. This could be a sign of an underlying condition.

There are a number of treatments for problems with periods. Depending on the issue, treatment may involve:

  • nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin), to reduce pain
  • oral contraceptives, which may regulate hormone levels to reduce heavy bleeding or irregularity
  • a hormonal IUD or implant
  • cyclic progestin
  • tranexamic acid, which is a drug that reduces bleeding

If a doctor finds that another health condition, such as fibroids, cysts, or endometriosis, is likely causing the menstrual problems, they will recommend treatment, which may involve taking medications or having a surgical procedure.

When period irregularity or absence stems from weight loss or an eating disorder, people require mental and physical health support. This may involve talk therapy, support groups, and speaking with a dietitian to understand the body’s nutritional needs.

At home, people can take several steps to ease or prevent symptoms of period problems. These include:

  • stopping smoking
  • using heating pads, hot water bottles, or warm baths to ease pain
  • trying gentle forms of exercise, such as walking, tai chi, or yin yoga
  • managing stress and making time for relaxation
  • using a portable transcutaneous electrical nerve stimulation, or TENS, machine for temporary pain relief
  • avoiding caffeine, alcohol, and refined sugar in the 2 weeks before a period
  • getting enough sleep each night

Having regular periods can mean that the reproductive system is functioning as it should. If menstruation comes with severe pain, heavy bleeding, or mood changes, a healthcare professional should investigate the possible causes and provide treatments.

Even when these symptoms are mild or moderate, there are ways to manage them and reduce their impact.