How to cope with menstrual problems
Menstrual Hygiene Day is an annual awareness day on 28 May that addresses menstrual health and hygiene issues. Let’s face it, periods are no picnic. Women around the world suffer from menstrual problems every month. But although these problems can have a profound impact on quality of life, many women feel uncomfortable about openly discussing them. And that’s a shame. Because many menstrual problems are super common and there are usually simple ways to treat them. We want to be open and honest about periods and provide a positive space for this topic to be discussed. These answers to key questions will help you to cope with your period problems!
Why do women get periods?
A women’s fertility cycle is a sophisticated process that is regulated by two hormones: oestrogen and progesterone. These hormones tell the ovaries to produce follicles, in which a maturing egg (oocyte) is nourished. They also play a role in thickening the lining of the uterus, so that it can nourish the fertilised egg.
In this sense, the uterus is like a nest in which the fertilised egg grows into a baby. When pregnancy doesn’t occur, oestrogen and progesterone ensure the ‘nest’ is cleaned up. The thick lining in the uterus is shed, which involves the tearing of small blood vessels. The prepared uterine lining along with some blood is shed via the vagina. This is your period. Then the cycle starts anew. The length of the menstrual cycle varies from woman to woman, but the average is to have periods every 28 days.
What problems can women have with their periods?
No one really looks forward to these monthly clean-ups. This is because most women in the fertile age bracket have menstrual problems, such as:
- Premenstrual syndrome (PMS) (mood swings, breast tenderness, fluid retention, pre-period headaches or migraines).
- Menstrual pain (abdominal pain or cramps, lower back pain radiating down the legs).
- Heavy periods (periods where an excessive amount of blood is lost, often with large blood clots).
- Breakthrough bleeding (spotting).
- Irregular periods or no periods.
10% of women suffer pain so bad that they are unable to carry out their usual daily activities or participate in leisure activities. And that’s a shame, since most menstrual problems can be treated effectively.
Are there natural ways to alleviate menstrual problems?
The next time you have your period, try to go natural before you rush to your medicine cabinet. Here are some natural home remedies for period pain relief:
- Rest. Snuggle up on the sofa or in bed with a good book or the remote control within easy reach.
- Heat. Place a hot water bottle against the abdomen or back, drink hot tea or have a bath. Heat relaxes the muscles and relieves cramps.
- Muscle-relaxing exercises. Gentle stretching or exercises to relieve tension in your lower back can help.
- Lower back massage.
- A healthy lifestyle and diet can also help to relieve period pain. Eat healthily and exercise regularly. Try to lose weight if you too heavy. Women who are overweight often have abnormal or irregular menstrual cycles.
If natural home remedies do not relieve the pain, then turn to your medicine cabinet for help.
What medicines help relieve menstrual problems?
There are various medicines that help alleviate menstrual problems and other female health issues.
Painkillers for menstrual pain
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ibuprofen or naproxen provide effective relief for menstrual pain. If you cannot or don’t want to take these painkillers, then paracetamol is a good alternative.
Contraceptive pill for menstrual pain
Women who use contraceptive pills do not have menstrual bleeding but withdrawal bleeding. A withdrawal bleed is very much like a period, but it is lighter, less painful and very regular. If you have painful, heavy or irregular periods, this can be a solution. However, this means you won’t be able to get pregnant. So if you would like to have children, this option is not for you.
Progestogen for menstrual and fertility problems
Progestogen is a type of medication which produces effects similar to those of the natural female sex hormone progesterone in the body. It is also effective for menstrual problems. Norethisterone (the active ingredient in Primolut) and progesterone (the active ingredient in Utrogestan) are a type of progestogen. Doctors may prescribe progesterone therapy for women with heavy periods, irregular periods or fertility problems, or for delayed first period in girls. Note: this medicine should not be used if you are or could be pregnant, or if you are trying to conceive.
Antidepressant for premenstrual problems
Sometimes doctors prescribe an antidepressant to treat women with PMS. Antidepressants that contain the active ingredient sertraline are effective in treating symptoms such as mood swings, breast tenderness and oedema (fluid retention).
How can I delay my period?
There is never a good time to have your period. But sometimes periods are especially inconvenient. For example, if you are going on holiday or have an important presentation coming up. Luckily, there are ways to delay your period.
Delaying your period with the contraceptive pill, contraceptive skin patch or vaginal ring
One of the advantages of the contraceptive pill, the contraceptive skin patch and the vaginal ring is that they can be used to delay your period. This is done through continuous use. This way, you can determine when you want to have your period. The contraceptive skin patch and the vaginal ring can be used continuously for a maximum of six weeks. Most contraceptive pills can be taken back to back (i.e. without a seven-day break) for even longer. Always be sure to read the instructions on the package leaflet or ask your pharmacist or doctor for advice.
You can only delay your period with the contraceptive pill if you are taking a monophasic contraceptive pill (e.g. Microgynon 30, Diane 35 or Yasmin) or a multiphasic contraceptive pill (e.g. Qlaira). Mini pills (e.g. Cerazette) cannot be used to delay your period. However, mini pills usually cause menstrual bleeding to become irregular, and sometimes women may even stop getting their period altogether.
Delaying your period without the contraceptive pill, contraceptive skin patch or vaginal ring
If you are not using hormonal birth control but want to skip your period for one month, you can also use hormones to schedule your period. Tablets containing norethisterone (Primolut) can also be used to postpone your period.
Why am I bleeding between periods?
Some women bleed in the middle of a menstrual cycle. Breakthrough bleeding, or spotting, is a common menstrual problem and can be caused by a variety of factors.
Breakthrough bleeding related to the use of the contraceptive pill
If you are using a contraceptive pill and have skipped multiple pill-free weeks to delay your period, this can cause spotting. In this case, you should go back to having a pill-free week in between packs to see if the spotting stops.
It’s also possible that the pill you are taking is too low dose for you. Some contraceptive pills with less hormones have a reduced chance of side effects. However, the disadvantage of these low-dose pills can include spotting. If this is the case, it may be time to switch to another birth control pill.
Breakthrough bleeding related to medicine use
Certain medications may have vaginal bleeding problems as a side effect. For example, frequent use of aspirin or anti-inflammatory drugs can lead to increased bleeding. Speak to your doctor if you experience spotting to see if your medication regime can be altered.
Breakthrough bleeding due to chlamydia or gonorrhoea
Breakthrough bleeding can also be a sign of an STD, such as chlamydia or gonorrhoea. These STDs are usually also accompanied by other vaginal problems, such as increased vaginal discharge, pain during urination and, in the case of chlamydia, irregular periods. You can get tested for STDs at your GP or local Municipal Health Service. If you feel uncomfortable asking for an STD screening, there are also home test kits available. If you test positive for chlamydia or gonorrhoea, it is important that you are treated with antibiotics (e.g. ciprofloxacin) in order to prevent complications.
Other causes of breakthrough bleeding
Breakthrough bleeding can be due to inflammation of the cervix or other conditions affecting the uterus, such as a polyp or fibroid, or in rare cases, cancer.
Note: if breakthrough bleeding is a persistent issue, you should contact a doctor to find out the exact cause of spotting and have it treated.
I’ve stopped having periods. What should I do?
If you used to get regular periods but have missed a period or have stopped altogether, this can have various reasons.
- Pregnancy. If you are sexually active, the first thing you need to do is take a pregnancy test to exclude the chance of pregnancy. You should always take a pregnancy test, even if you’re on birth control!
- Weight loss, severe dieting and exercise.
- Menopause. If you’re approaching menopause, your periods will become irregular. You may even start missing periods for months on end. Most women’s periods stop around the age of 50, although some women reach this phase in their 30s or 40s.
- Medicine use. Some medicines, including antidepressants, can affect women’s menstrual cycle, resulting in missed periods.
- Contraception. Some contraceptive pills, such as the mini pill, can cause previously regular menstrual cycles to become irregular or to stop completely. Women who use hormonal IUDs may also experience lighter menstrual bleeding and fewer periods.
- Health issues such as thyroid disorder or a condition affecting the ovaries.
Sometimes no explanation can be found. If a hormonal imbalance is responsible for a missed or late period, your period will usually return at some point. Have your periods stopped, and you don’t know why? Make an appointment with your doctor to determine the cause.
More information on menstrual problems and treatments
If your question is not answered here, you can always ask a doctor for advice. You can also find various in-depth articles on Dokteronline.com about topics related menstrual health, vaginal health, STDs, pregnancy and fertility. Found a treatment that fits your needs? The website has an option to book an online consultation directly. This way, you stay in charge.
Happy Menstrual Hygiene Day!
Dokteronline.com is a platform for connecting patients with doctors and pharmacies, enabling targeted treatment and care. Dokteronline.com believes in responsible self-management of treatable health conditions.
Freya. (n.d.). Je menstruatiecyclus (Your menstrual cycle). Consulted on 13 May 2020 on https://www.freya.nl/kinderwens/zwangerworden/je-menstruatiecyclus/
KNMP (Royal Dutch Pharmaceutical Society). (2014, 9 December). Menstruatieklachten (Menstrual problems) – Apotheek.nl. Consulted on 13 May 2020 on https://www.apotheek.nl/klachten-ziektes/menstruatieklachten#!
KNMP. (2015, 26 May). Norethisteron (Norethisterone) – Apotheek.nl. Consulted on 13 May 2020 on https://www.apotheek.nl/medicijnen/norethisteron#!
KNMP. (2020a, 12 March). Progesteron (Progesterone) – Apotheek.nl. Consulted on 13 May 2020 on https://www.apotheek.nl/medicijnen/progesteron#!
KNMP. (2020b, 19 March). Sertraline – Apotheek.nl. Consulted on 13 May 2020 on https://www.apotheek.nl/medicijnen/sertraline#!
Nederlands Huisartsen Genootschap (Dutch College of General Practitioners). (2014, 17 July). Ik heb tussentijds bloedverlies (I’m experiencing breakthrough bleeding) | Thuisarts. Consulted on 13 May 2020 on https://www.thuisarts.nl/vaginaal-bloedverlies/ik-heb-tussentijds-bloedverlies#
Nederlands Huisartsen Genootschap. (2018, 1 March). Ik word al een paar maanden niet ongesteld (I haven’t had a period in months) | Thuisarts. Consulted on 13 May 2020 on https://www.thuisarts.nl/vaginaal-bloedverlies/ik-word-al-paar-maanden-niet-ongesteld
Nederlands Huisartsen Genootschap. (2019, 3 May). Ik heb veel pijn als ik ongesteld ben (I have severe menstrual pain) | Thuisarts. Consulted on 13 May 2020 on https://www.thuisarts.nl/vaginaal-bloedverlies/ik-heb-menstruatiepijn#medicijnen-bij-pijn-bij-de-ongesteldheid
Nederlands Huisartsen Genootschap. (2020, 6 May). Ik wil mijn ongesteldheid uitstellen (I want to delay my period) | Thuisarts. Consulted on 13 May 2020 on https://www.thuisarts.nl/menstruatie-uitstellen/ik-wil-mijn-menstruatie-uitstellen
SoaAids. (n.d.). Bloedverlies (Blood loss). Consulted on 13 May 2020 on https://www.soaaids.nl/nl/heb-ik-soa/bloedverlies