Menstrual cycles can cause a range of uncomfortable symptoms in the days leading up to your period. However, more serious menstrual issues can also arise. Abnormalities such as heavy or light bleeding, or even the absence of a period, may indicate underlying health concerns affecting your cycle. It’s important to note that a “normal” menstrual cycle varies from woman to woman. What’s normal for you may not be for someone else. Pay attention to your body and consult your doctor if you notice significant changes in your menstrual cycle.

To access information on a variety of menstrual issues see the below list:

Endometriosis

Endometriosis occurs when tissue grows outside of the womb. These cells can respond to hormonal changes during the menstrual cycle, leading to inflammation, pain, and the formation of scar tissue. Endometriosis affects around 10% of women and individuals assigned female at birth, from puberty to menopause

Causes of endometriosis

Symptoms happen when patches of endometriosis break down and bleed during your period but cannot leave your body. It can affect anyone who has periods.  

Symptoms

• severe period pain, that stops a woman from doing normal activities 

• heavy periods, where pads or tampons need to be changed every 1 to 2 hours, or  may bleeding through to clothes. 

• pain when urinating or defecating 

• pain in the lower tummy and back (pelvic area) 

• pain during or after sex 

• extreme tiredness (fatigue) 

Treating endometriosis

Always see the GP in the first instance who will refer to a gynaecologist for further tests if required. Medicines are often the first treatment for endometriosis. They include: 

• painkillers, such as paracetamol and ibuprofen 

• hormones, such as the combined contraceptive pill – these can help ease pain 

• Surgery for endometriosis – this is only in cases where treatments have not worked or there is lots of endometriosis or it is affecting a woman’s ability to conceive. 

Heavy Bleeding (Menorrhagia)

Some women experience menstrual bleeding that is heavier than usual or lasts longer than a few days. This condition (also called menorrhagia) is a common concern, though most women don’t experience enough blood loss to be classified as heavy menstrual bleeding. When menstrual bleeding is heavy, the increased flow and cramping can interfere with daily activities. There are various treatments available to help manage the condition.

Causes of heavy periods

They can sometimes be heavy at different times, like when you first start your periods, after pregnancy or during the menopause. Sometimes heavy periods can be caused by: 

• conditions affecting your womb or ovaries, such as fibroids or endometriosis conditions that can make you bleed more easily, such as Von Willebrand disease  

• some medicines and treatments, including some anticoagulant medications and chemotherapy medicines 

• Rarely, heavy periods can be a sign of womb cancer. 

Treatment

Heavy periods do not always need to be treated. But there are treatments that can help if they’re affecting your daily life. Treatments from a GP include: 

• some types of contraception, such as an intrauterine system (the coil) intrauterine system or the combined contraceptive pill  

• medicine to help reduce the bleeding, such as tranexamic acid 

• prescription-only anti-inflammatory painkillers, such as mefenamic acid or naproxen 

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age, often beginning during adolescence, though symptoms may vary over time. PCOS can lead to hormonal imbalances, irregular periods, and ovarian cysts. Symptoms can be managed through lifestyle changes, medications, and fertility treatments. Women with a family history of the condition or type 2 diabetes are at an increased risk.

Causes of PCOS

The exact cause of PCOS remains unclear, but it often runs in families and is linked to hormonal imbalances, including elevated insulin levels. Many women with PCOS are resistant to the action of insulin in their body and produce higher levels of insulin to overcome this. Being overweight or obese also increases the amount of insulin your body produces. 

Symptoms of PCOS

Signs and symptoms of PCOS typically become noticeable during the late teens or early 20s and may include: 

• Irregular periods or no periods at all 

• Difficulty conceiving due to irregular ovulation or lack of ovulation 

• Excessive hair growth (hirsutism), commonly on the face, chest, back, or buttocks 

• Weight gain 

• Thinning hair or hair loss on the scalp 

• Oily skin or acne 

PCOS is also linked to a higher risk of developing long-term health conditions, such as type 2 diabetes and high cholesterol. 

Treatment

While there is no cure for PCOS, its symptoms can be managed. If you suspect you have the condition, consult a GP for advice and diagnosis. For those who are overweight, losing weight and following a healthy, balanced diet can help improve symptoms. Medications are available to address specific issues, such as excessive hair growth, irregular periods, and fertility challenges. 

Fibroids

Fibroids are non-cancerous growths that develop in or around the womb (uterus). The growths are made up of muscle and fibrous tissue and vary in size. Fibroids are common, with around 2 in 3 women developing at least 1 fibroid at some point in their life. They most often occur in women aged 30 to 50. Fibroids are thought to develop more frequently in women of African-Caribbean origin. It’s also thought they occur more often in overweight or obese women. Women who have never had children have a lower risk of developing fibroids. 

Causes of fibroids

The exact cause of fibroids is unknown, but they have been linked to the hormone oestrogen (the female reproductive hormone produced by the ovaries (the female reproductive organs). 

Symptoms

Women who do have symptoms (around 1 in 3) may experience: 

• heavy periods or painful periods 

• tummy (abdominal) pain 

• lower back pain 

• a frequent need to urinate 

• constipation 

• pain or discomfort during sex 

Treating fibroids

Fibroids do not need to be treated if they are not causing symptoms. After the menopause, they’ll often shrink without treatment. If a woman has symptoms caused by fibroids, medicine to help relieve the symptoms will usually be recommended first.There are also medications available to help shrink fibroids. If these prove ineffective, surgery or other, less invasive procedures may be recommended.  

If your GP suspects fibroids, they’ll usually carry out a pelvic examination to look for any obvious signs and then refer to a hospital for an ultrasound scan to confirm the diagnosis.