Worst Menstrual Problems: How to Treat Them

Menstrual cramps, heavy bleeding and mood swings can drag you down. But when do they become a health concern? We asked experts about the worst menstrual problems and how to get relief... Every month, like clockwork, you’re irritable, exhausted and curled up in your bed with cramps. But sometimes your period arrives with unfamiliar symptoms. Stress and normal hormonal changes can trigger extreme pain or irregular bleeding. But these symptoms can also have a more serious cause. “If you always have regular periods and suddenly become irregular, there may be a medical problem,” says Mary Gallenberg, M.D., a gynecologist at the Mayo Clinic in Rochester, Minn. Some are easily treated with diet changes or over-the-counter remedies, but others may require a doctor’s care or even surgery. Here, experts explain how to identify and treat the five most common menstrual problems. 1. Heavy periods (menorrhagia) How it feels: If your period lasts more than seven days, produces large blood clots, soaks through a pad or tampon every hour or has you up at night to change protection, you may have menorrhagia. “It’s the most common gynecological compliant,” says Robin Miller, M.D., an internist and Lifescript women’s health expert. Besides being frustrating and embarrassing, it can increase your risk of anemia, which causes fatigue, shortness of breath, chest pain and fainting. Why it happens: The most likely cause is a menstrual cycle without ovulation, Miller says. That prevents the body from making enough of the hormone progesterone; without it, estrogen builds up the uterine lining more, which results in heavier periods. Other pelvic problems that can also cause excessive bleeding: Endometriosis – When the uterine lining grows outside, on the ovaries or bladder, leading to cysts and infertility Polyps or fibroids – Possibly painful, noncancerous growths that develop in the uterus Pelvic inflammatory disease (PID) – An infection of the reproductive organs (uterus, fallopian tubes, ovaries, cervix) that could cause infertility Adenomyosis – A painful condition that occurs when endometrial tissue grows into the uterine wall Other potential reasons for heavy bleeding include a hormonal imbalance, underactive or overactive thyroid, liver and kidney failure, or a blood disorder. Medical treatments: First, see your doctor to identify an underlying condition. Treating that will usually stop the excessive bleeding. If the blood loss has made you anemic, your doctor may also prescribe iron supplements. Medications such as birth control pills, oral progesterone, the hormonal IUD (Mirena) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) can lessen menstrual flow. If they don’t reduce the bleeding, your doctor may recommend surgery. In a dilatation and curettage (D&C), tissue from the uterine lining is scraped out to reduce menstrual flow. If bleeding remains heavy, the procedure may need to be repeated. Endometrial ablation and endometrial resection destroy or remove the uterine lining, which dramatically reduces menstrual flow. These procedures are becoming a more common alternative to a hysterectomy (removal of the uterus), Gallenberg says. These can reduce your ability to get pregnant. Natural remedies: Getting enough rest and avoiding aspirin, which stops blood from clotting, can ease symptoms. Acupuncture will also lessen heavy bleeding for some women, Miller says. 2. Painful periods (dysmenorrhea) How it feels: A heating pad is no match for these severe cramps. The lower-abdomen pain begins before or during your period, sometimes along with nausea and vomiting. One form (primary dysmenorrhea) often starts with the first menstrual cycle, while the other (secondary dysmenorrhea) usually occurs in women 30-45 years old. Why it happens: No one knows what causes primary dysmenorrhea. But it’s linked to increased levels of prostaglandin, a hormone produced in the uterus that produces stronger uterine contractions, according to the American Academy of Family Physicians. Secondary dysmenorrhea is triggered by the same pelvic problems as menorrhagia: endometriosis, fibroids and PID. Other risk factors include smoking and starting periods an early age, Miller says. Medical treatments: As with menorrhagia, see your doctor to treat any underlying conditions. NSAIDs such as ibuprofen (Advil) and naproxen (Aleve) can ease cramps. They’re especially effective when used with birth control pills that regulate and lighten periods, Miller says. If all other treatments fail, your doctor may suggest a hysterectomy, says Millie Behera, M.D., a reproductive specialist at Duke University Medical School in Durham, N.C. Natural remedies: Heat – from a shower, bath or heating pad – and alternative therapies may ease cramping for both types of dysmenorrhea, Miller says. These treatments can help, but consult your doctor before trying them: Supplements such as thiamine, vitamin E, vitamin B6, calcium, magnesium or omega-3 The Chinese herbal remedy toki-shakuyaku-san Acupuncture, acupressure and transcutaneous electrical nerve stimulation (TENS) Yoga, meditation and massage Also, avoiding sugar, caffeine, red meat and junk food may also reduce painful cramps, says Sara Thyr, N.D., a naturopathic physician in Petaluma, Calif. 3. Spotting or bleeding between periods (intermenstrual bleeding) How it feels: When you’re not menstruating, you notice light bleeding (spotting) or heavier flow and cramping. For teens and women on birth control, between-period spotting is common and usually not something to worry about, Gallenberg says. But if you’re nearing menopause, alert your doctor. It could be a sign of endometrial cancer, which is more common in older women. Why it happens: Besides endometrial cancer, spotting can result from stress, hormonal imbalances, underactive thyroid, poor ovulation, fibroids or polyps, and cervical infections. Medical treatments: Schedule an annual gynecological exam so your doctor can catch any issues early, Gallenberg says. Your doctor may recommend a blood test to check thyroid and ovarian function and a colposcopy (a test that uses a microscope to examine the vagina and cervix) or endometrial or cervical biopsy to rule out cancer. Your doctor may also suggest a progesterone-only treatment, such as an intrauterine device (IUD) that releases the hormone, says Pamela D. Berens, M.D., professor of obstetrics and gynecology at University of Texas Medical School in Houston. 4. Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) How it feels: Most women face PMS at some point in their lives. Its symptoms – bloating, breast tenderness, muscle pain, irritability, food cravings and fatigue – usually start a few days before menstruation. Severe PMS, known as PMDD, causes more extreme moods, such as anxiety, depression or anger. About 3%-8% of women with PMS experience PMDD, according to the U.S. Department of Health and Human Services. Why it happens: Hormone surges around menstruation and chemical changes in the brain are believed to trigger symptoms, according to the Mayo Clinic. Stress worsens them. Medical treatments: NSAIDs ease PMS symptoms such as breast discomfort, Berens says. Birth control pills stabilize hormones to relieve discomfort or stop your cycle completely, Behera says. To ease mood symptoms, your doctor may prescribe an antidepressant, either taken daily or for the two weeks before a menstrual cycle. Natural remedies: Don’t give in to your body’s PMS cravings, especially for sweet and salty foods, says Mary Jane Minkin, M.D., clinical professor of obstetrics and gynecology at Yale University School of Medicine in New Haven, Conn. “If you do, you’ll usually feel worse.” Here’s why: Sweets can make your blood sugar levels change quickly, causing mood swings. And salty foods can make you retain water, adding to your PMS bloating. Certain supplements may ease symptoms, according to the Mayo Clinic. Try calcium (1,200 mg), magnesium (400 mg), vitamin B6 (50-100 mg) and vitamin E (400 international units). Reduce stress and improve your mood by sleeping better, exercising or getting a massage. 5. Missed periods (amenorrhea) How it feels: You usually get your period like clockwork, but suddenly, it stops. Sometimes just once or for several months in a row. It’s not unusual to skip a period as a teen or during perimenopause (the years before and one year after menopause starts). At other times, see your ob-gyn, especially if you miss three in a row, Berens says. Why it happens: Pregnancy, breastfeeding, menopause, birth control pills or hormone shots (like Depo-Provera injected birth control) can all cause missed periods. Other reasons include: Polycystic ovarian syndrome (PCOS): a hormonal problem that stops the body from developing or releasing eggs Premature ovarian failure: when ovaries stop producing estrogen or releasing eggs in women under 40 Asherman's syndrome: scarring of the cervix or uterus from an infection or surgery Stress, which interferes with the body’s hormone levels Low body weight, such as from anorexia and other eating disorders Medical treatments: Treating the underlying cause will regulate menstrual cycles. Natural remedies: If stress or weight loss are the problems, make lifestyle changes, according to Berens. For example, once underweight women return to a healthy weight, they usually start getting their period again.