Why are my periods so terrible?

Many women suffer with painful, heavy, or irregular periods, and bowel or bladder symptoms before or during their periods.  Some will go years or even decades before seeking help – or may not realize that the pain and bleeding that they’re experiencing are not normal. Recognizing that there may be a problem is the first step to figuring out what may be causing your symptoms, and finding a treatment to control them.

What are possible causes of painful or heavy periods?

There are common conditions such as endometriosis, adenomyosis, or fibroids which can cause pain or abnormal bleeding.  Up to 1 in 10 women may have endometriosis, and up to 80% of African-American women may have fibroids, so these conditions affect a large number of people.  Many women have experienced heavy or painful periods since they were adolescents, and/or their mothers or sisters may also have had similar periods, so they may not have realized that severe pain or heavy bleeding are not normal!  Other causes of heavy or irregular bleeding including uterine polyps, or much more rarely uterine or cervical pre-cancer or cancer.  Though most causes of painful or heavy periods are benign, it’s very important to be seen for an exam, and testing, in order to figure out the cause of your symptoms.

When should I see a Gynecologist for consult?

In general, if you are experiencing period symptoms that are significantly affecting your quality of life, please make an appointment with your gynecologist.  Other reasons to make an appointment as soon as possible:

• You’re experiencing worsening pain with periods
• You have pelvic pain with sex, bowel movements, or exercise
• You’re having heavy period bleeding soaking through pads or tampons frequently or passing large clots
• You’re experiencing bleeding between periods, bleeding with sex, or bleeding after menopause

What tests are done to evaluate painful or heavy periods?

Your gynecologist will do a basic pelvic exam, and testing such as a Pap smear and STD testing as needed.  The imaging study that we use to evaluate pelvic pain and bleeding is a pelvic ultrasound.  Part of this exam is done through with a narrow vaginal probe, but it is generally not painful, and just feels like pressure.  Sometimes an MRI may be ordered as a follow-up test.  If you’re having heavy or irregular bleeding, your doctor may also order bloodwork to check your blood count, iron, hormone levels.  If you are 45 or older, or are having persistent heavy or abnormal bleeding, or your imaging studies show possible thickening of the tissue inside the uterus, your doctor may also recommend a biopsy or a hysteroscopy (camera to look inside the uterus) or D+C (dilation and curettage) to test the tissue from inside the uterus.

What treatments are available for painful or heavy periods?

The treatments that you may be offered will depend on the condition that is causing your symptoms.  But in general, many options may be available, ranging from medications (such as over the counter anti-inflammatory medications such as ibuprofen, hormonal medications i.e. birth control, or non-hormonal medications to stop bleeding), a hormonal intrauterine device (IUD), endometrial ablation (a treatment to cauterize the cavity of the uterus), procedures to remove or destroy fibroids, or a hysterectomy (a surgery to remove the uterus).  Your doctor will discuss what treatments may be right for you, depending on your testing, your plans for future fertility, and your overall health.

I was told that I had to have a hysterectomy for my fibroids or endometriosis.  Is that my only option?

For most patients, unless you are diagnosed with certain types of cancer, a hysterectomy is never the only option.  As above, there are many different types of treatments, though your doctor will need to review your testing to discuss the plusses and minuses and likelihood of success of different options.  We also encourage second opinions if you feel the options recommended are not a good fit for you.

If you’re experiencing painful, heavy or irregular periods, or other bothersome symptoms associated with your periods, schedule an appointment with an Axia Women’s Health specialist today.

Author: Karen Tang, MD, Center for Women’s Surgery

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