Period Problems

Heavy Periods

Symptoms

• Have to change pads or tampons every hour 
• Have to wake up at night to change pads
• Wear 2 pads at a go 
• Experience flooding or stain your clothes/bedsheets frequently 

Causes

• Uterine fibroids
  These are non-cancerous growths that come from the muscle layer of the uterus. They can result in the uterus being larger than normal. Some fibroids can cause heavier periods than others depending on their location.
• Endometrial polyps
  These are growths are attached to the lining of the uterus (endometrial lining) and result in heavy periods due to the disturbance of the uterine lining.
• Adenomyosis
  This is a condition where the tissue from the womb lining grows into the muscle wall of the uterus, causing the uterus to be enlarged and resulting in heavy periods.
• Polycystic ovarian syndrome (PCOS)
  This is a condition that can cause irregular or infrequent heavy periods.
• Intrauterine contraceptive device (IUD) 
  Copper IUD may cause heavy periods, especially in the first 3-6 months of insertion.
• Pregnancy
• Endometrial hyperplasia/cancer or cervix cancer
  These may also have other symptoms like prolonged bleeding, bleeding in between periods, bleeding after sex, or bleeding after menopause.
• Bleeding disorders 
  Certain bleeding disorders with reduced ability to clot may result in heavy periods.
• Thyroid problems

Possible complications

Anaemia (low blood count) – heavy blood loss can lead to iron deficiency over time and can result in symptoms like weakness, fatigue, dizziness, fainting, pale skin

When to be concerned

See your gynaecologist if you experience more than a few months of heavy periods, or have associated symptoms of anaemia, long periods, bleeding in between periods, bleeding after sex, or bleeding after menopause.

Treatment options

Medical

• Non-hormonal medications: tranexamic acid, non-steroidal anti-inflammatory drugs (NSAIDs) to reduce period flow
• Hormonal medications: this can come in the form of oral tablets (e.g. birth control pills), implants (e.g. Mirena IUD, Implanon), or injections

Surgery (this has to be individualised on your condition)

• Hysteroscopy
• Myomectomy 
• Hysterectomy: this is usually for severe cases

Irregular Periods

Symptoms

The interval between periods should be counted from the first day of one period to the first day of the next. A normal interval can be anywhere from 21 to 35 days.

Causes

Puberty or perimenopause

Being at the extreme ends of reproductive age can cause periods to be erratic due to transition. 

Polycystic ovary syndrome (PCOS)

This is a condition with irregular periods, high male hormones and/or polycystic ovaries on ultrasound scan.

Thyroid or pituitary disorders

Too low (hypothyroid) or high thyroid hormones (hyperthyroid), too high prolactin (hyperprolactinemia), or medicines that can affect these can cause irregular periods. 

Pelvic inflammatory disease (PID)

This is a condition where there is inflammation of a woman’s uterus, fallopian tubes and ovaries, usually caused by sexually transmitted infections (STIs).

Stress, anxiety

These emotions can upset your hormonal balance and result in irregular periods.

Extreme exercise

Exercising frequently and at a high intensity can cause irregular or even no periods.

Drastic weight changes

Being too underweight or overweight – be it from eating disorders, extreme exercise, illness etc – can cause irregular periods.

Birth control or hormone medications

Certain birth control methods can cause irregular periods e.g. intrauterine contraceptive devices (IUD), implanon, injections. Hormone medications such as Visanne (used to treat endometriosis) can also result in irregular periods.

Breastfeeding

Breastfeeding may cause irregular or no periods for up to 6 months, or longer in some cases.

After miscarriage/pregnancy loss 

Some women may experience a few months of irregular periods before resuming their regular cycles.

When to be concerned

See your gynaecologist if you experience more than a few months of irregular periods, or go more than 2 months without having a period (do check to see if you may be pregnant first).

Treatment options

Treatment depends on the cause for your irregular periods. Lifestyle changes may sometimes be sufficient. Treatment options may include hormonal medications such as birth control pills to regulate your periods. Discuss with your gynaecologist about the appropriate options for you.

Light Periods

Symptoms

• Your bleeding lasts for less than 2 days 
• You only have spotting for your period

Causes

Age

Being at the extreme ends of reproductive age (puberty and perimenopause) can cause periods to be erratic and light due to transition. 

Weight and exercise

Having a low body mass index (BMI) with low body fat percentage, over-exercising or eating disorders can result in light or no periods. 

Birth control

Some hormonal birth control methods can cause periods to be light e.g. Mirena IUD, Implanon, birth control pills, skin patch, vaginal ring, injections.

Polycystic ovary syndrome (PCOS)

Hormonal changes in PCOS can result in light, irregular periods or no periods at all.

Stress

This is an external factor that can influence your cycle hormones and cause periods to be irregular and/or light. 

Scarring of the lining of the uterus (Asherman’s syndrome)

Scarring can be caused by previous surgeries including surgical abortions or dilation and curettage. The disturbance to the lining of the uterus results in light periods.

Pregnancy

Implantation bleeding (spotting that occurs when an embryo implants inside the uterus) can be mistaken as a light period.

When to be concerned

See your gynaecologist if you experience more than a few months of light periods, or high/low frequency of periods (either multiple times within a month or no periods for more than 2 to 3 months).

Treatment options

Treatment depends on the cause for your light periods. Lifestyle changes may sometimes be sufficient. Discuss with your gynaecologist the appropriate options for you.