Period Dramas: When do you need to see a doctor?

From painful cramps to heavy bleeding, it seems most women have a complaint or two about their periods. The sight of blood on your pad or tampon can be disturbing, especially if it’s accompanied by clots and/or a foul odour.

What’s “normal, healthy” period?

Dr Fong Kah Leng, Consultant Obstetrician & Gynaecologist, Gynae Consultancy Pte Ltd at Mount Elizabeth Medical Centre says, “The menstrual cycle starts on the first day of your period and finishes on the first of the next. The period might occur every 21 to 35 days and last 2 to 7 days. Flow during the first few days might be heavy and at times associated with pain.”

 

According to Dr Fong, some of the most common period problems women suffer from include missed periods, irregular periods, painful periods, and a heavy flow.

 

What’s normal and what’s not?

First, let’s talk about the colour. Towards the end of your period, you may notice that your menstrual blood becomes dark brown or almost black. This is a normal colour change – a sign of older blood being expelled from the body.

 

Next, we look at the flow. A heavier flow in the early days of your period may not be a cause for concern. However, if you are experiencing prolonged heavy flow or “flooding” (you soaked through 1 pad or tampon every hour or two, or use more 16 pads/tampons per cycle), a trip to the doctor may be necessary. You’ll be examined for anaemia, infection, an early miscarriage, and for any hormonal issues.

 

If your heavy flow is accompanied by painful cramps, this can be a sign of endometriosis, a condition when endometrial tissue, which lines the uterus, begins to form in areas like the ovaries, or between the vagina and the rectum. Endometriosis can lead to inflammation within the abdominal cavity, which can result in the formation of scar tissue, bowel problems, and infertility.

 

Many women are embarrassed by the odour of their period blood and may wonder if it is a sign of an infection or something worse. A foul odour happens when period blood is trapped in a sanitary pad for several hours; the smell is that of dying red blood cells contaminated by bacteria. However, if the odour is accompanied with itching or burning sensations, go to a doctor to get checked for yeast infection, cervix infection, or trichomonas infection.

 

How do I know if my period is affecting my fertility?

According to Dr Fong, painful periods could be a sign of Polycystic Ovarian Syndrome (PCOS). PCOS is a hormonal condition and affects up to 15 percent of women in the reproductive age group. “During menstruation, women’s bodies shed the lining of the uterus. So, women who ovulate infrequently do not allow their womb lining to be shed regularly. Unshed lining that stays in the womb for too long may lead to pre-cancer changes, or eventually even cancer. The risks of such occurrences increase with age, obesity, diabetes mellitus and family history of similar types of cancer. Heavy periods or pain might be associated with growth in the womb or ovaries, for example, fibroids and endometriotic cyst, which can impair fertility.”

 

Lifestyle factors

Our periods are affected by our lifestyle too. Fluctuations in body weight, stress and a diet low in iron-rich foods may all contribute to irregularities in our menstrual cycles. “Have a healthy, regular, and balanced diet and lifestyle,” says Dr Fong. “Gaining or losing a significant amount of weight within a short time can knock down the reproductive system – shutting down the ovaries.”

Finally, Dr Fong advises that if you spot the following symptoms, consult a gynaecologist as soon as possible:

• periods suddenly stop for more than 90 days and you are not pregnant
• periods become erratic after having been regular
• bleeding for more than seven days
• bleed more heavily than usual or soak through more than one pad or tampon every hour or two
• periods are less than 21 days or more than 35 days apart
• bleeding between periods or after intercourse
• develop severe pain during period