What are periods?

A period, also known as menstruation, is bleeding from the vagina that happens about once a month, as a normal part of the menstrual cycle. This happens once you have gone through puberty, which typically begins around the age of 12 but can start as young as 9 years of age.

During this cycle, hormones make the lining of the uterus become thicker, getting ready in case of pregnancy. Hormones also cause an egg to be released from an ovary, which is known as ovulation.

If a woman doesn’t become pregnant, then her period starts about 2 weeks after ovulation. The lining of the uterus sheds and flows out through the vagina in the form of blood. Periods can be light or heavy, and the blood can range from bright red to dark brown. There might also be small blood clots.

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Dr Nisha Khot:

I’ve got a little prop here. It’s a uterus, that’s what’s in the centre. On both sides are two tubes and just under them are two ovaries. Women and girls get periods every month because this ovary here or this one produces an egg every month. And in response to the egg, the lining of the womb prepares for a possible pregnancy.

Each month, as the egg is maturing within the ovary, the lining of the womb is preparing for a pregnancy and growing thicker and thicker like a soft cushion. When the egg is released, it gets into the tube and travels to the uterus. However, not all months result in pregnancy. When there isn’t a pregnancy, this lining that has formed inside the womb then sheds through the vagina out as bleeding. And that is what constitutes a period.

For most girls, period start somewhere between 8 and 16 years of age. That is called the "menarche" or the first period. Women will continue to have periods throughout that time when there are eggs in their ovaries until they reach the point of menopause, which is when their periods stop, usually somewhere between 46 to 55 years of age.

What should women remember about having periods?

Periods are a normal part of your body preparing itself for pregnancy each month.

Not having a period every month is not dangerous. Sometimes periods will be irregular, especially when a woman starts having them or if she is going through some stress. Delaying your period by using contraception is not dangerous either.

Do you need to use female hygiene products like intimate body washes or douches?

No, the vagina is a self-cleaning organ. You do not need to do anything else other than to wash with warm water.

How often should you change your menstrual pad or tampon?

You need to change your menstrual pad when it starts to feel wet, and your tampon at least every 8 hours.

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Dr Nisha Khot:

What’s happening is that when your uterus is trying to remove clots, it’s contracting. So it’s almost like something like labour. The uterus is made up of a muscle. And when that muscle contracts, you can get pain. And that’s what the cramping is all about. And so if you have heavy periods, especially if you’re losing clots, the muscle in your uterus is contracting and clamping down to push them out. And that might cause cramps.

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Dr Nisha Khot:

First of all, if they think their periods are heavier than normal the first port of call would be to contact their GP, their own doctor, and have a discussion with their GP about what their periods are like, are they regular or are they irregular? The doctor will have some options for investigation and treatment.

Some of it depends on how old you are when you have heavy periods. For young girls starting out with their periods, it’s quite common for them to have irregular, heavy periods with a lot of cramping. And this is happening because their ovaries haven’t quite gotten into the pattern of producing an egg every month. And so when the egg is not produced, then that gives that irregularity of the cycle and heavy periods. For most of these young girls there’s no pathology. There’s nothing wrong with them. This is just a normal way of their body settling.

Similar things can happen later on when you get close to menopause. Again, your ovaries are not producing eggs every month and so similarly, you can have irregular periods. Not all the women who have heavy periods need to have special investigations or tests or anything like that.

For most women, if you’re feeling lethargic, if you’re feeling tired, then it’s worth doing a blood count just to check if your iron levels are low and if you need them to be replaced. You might need an ultrasound scan to check to see if everything is well with the womb and with the ovaries. But not all women will need an ultrasound scan.

Some of the simplest things that we can do to manage heavy periods is to use some drugs which are called non-steroidal anti-inflammatory agents. Now it’s a long name- don’t be put off by the long name! It’s essentially just tablets that can reduce the amount of blood loss by about a third. They don’t have any hormones in them, if you’re worried about taking hormones. So they work really well. They’re taken only during periods. They can sometimes cause a tummy upset but by and large, they’re very safe to take. So that’s often the first line of treatment for heavy periods, especially in young girls when they’re just starting out to have their periods.

What is PMS?

Premenstrual syndrome (PMS) is a combination of symptoms that occur around your period, generally before you start to bleed. You can experience bloating, diarrhoea, mood swings, headaches, breast tenderness, or other common symptoms.

If you are suffering from PMS, try to find out if there are any triggers for you. 
Some women avoid chocolate or coffee for a few days before their period starts. Keep up regular exercise, especially outside in the sunshine, to improve your mood and stay active.

When should I worry about my periods?

If you keep experiencing heavy, frequent, or long-lasting period, you can talk to your GP. They may recommend a contraceptive or medication to regulate your cycle. They may also recommend an anti-inflammatory tablet (e.g. Naprogesic) to reduce pain if suitable. You can also see your GP if you have not had a period for 6 months or more or if your period comes very infrequently.

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Dr Nisha Khot:

Counselling can help, there’s no doubt about it. Having a supportive family and a supportive partner who realises that you are on your period and hence you are irritable. It’s a huge help. Maintain friends, maintain connection with family, have a discussion with those around you about how your periods affect you.

There are certainly drugs available for mood swings but I know that for most women they don’t want to take more medication to help with it. Trying to manage it without medication is probably a better option for most women. And doing all of these things might help.