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
This article explores some of the most common menstrual problems, including their causes and treatments.
Some of the most common menstrual problems are:
- painful periods (dysmenorrhea)
- heavy periods (menorrhagia)
- irregular periods (oligomenorrhea)
- absent periods (amenorrhea)
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
- 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:
- intrauterine devices (IUDs)
- pelvic scarring from sexually transmitted infections
- endometriosis
- uterine fibroids
- ovarian cysts
Mild or moderate cramps often respond to OTC pain medication, such as ibuprofen (Advil, Motrin).
The medical term for this is menorrhagia, and it involves a flow of period blood that lasts longer than
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:
- obesity, as fat cells make a form of estrogen that can affect periods
- uterine polyps and fibroids
- pelvic inflammatory disease
- hypothyroidism
- bleeding disorders, such as von Willebrand disease
- kidney or liver disease
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
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:
- hormonal birth control
- other medications, such as some drugs for anxiety or epilepsy
- endurance training
However, some mental and physical health problems also can cause irregular or absent periods, including:
- emotional stress
- extreme weight gain or loss
- eating disorders, such as anorexia
- hyperthyroidism
- uncontrolled diabetes
- polycystic ovary syndrome
- pelvic inflammatory disease
- high levels of the hormone prolactin, which is called hyperprolactinemia
- primary ovarian insufficiency
Learn more about irregular and absent periods, including complications and treatment options.
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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
- stress
smoking - a personal or family history of depression
- previous postpartum depression
Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that affects
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
- 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.