Let’s Chat: Menstrual Disorders with Dr. Sylvie Gjerde

Let’s talk periods! The good, the bad and the bloody. Around the world people who bleed are very accustomed to “period problems” such as cramps, bloating, and mood swings when it comes to ‘That Time of the Month’. However, some menstruator’s period symptoms are so extreme they disrupt the daily lives of those experiencing them. As periods are a topic not always openly talked about, many don’t know what is normal and abnormal when it comes to the menstrual cycle.

To get a better idea of what we should be aware of when it comes to periods, I spoke to Dr. Sylvie Gjerde about common symptoms menstruators may experience.

KASEY: What is “normal” when it comes to menstrual patterns?

DR. SYLVIE: A menstrual cycle is calculated from the first day of bleeding until the day before the next period starts.

The average length of the menstrual cycle is 26-29 days, but it’s important to note the length of the menstrual cycle differs from woman to woman and changes over time. While a teenager might experience a longer cycle, by the time a woman reaches her 20s-30s it is usually between 21 and 38 days.

The average length of a period (when you are bleeding) is 3-7 days and most women lose less than 80mL during this time.

KASEY: What does the term "menstrual disorder" refer to?

DR. SYLVIE: I suppose it refers to symptoms a woman might notice relating to her period; but I don’t use the term. Basically, if you notice a change in your menstrual cycle or are worried about the symptoms of pain or bleeding then you should see your doctor. A change in your period or menstrual cycle could indicate a number of things – so it’s important to get checked out.

KASEY: What are some of the most common Menstrual Disorders and could you briefly describe the experience of women who have them?

DR. SYLVIE: Heavy menstrual bleeding (formerly called menorrhagia) affects 25% of women of reproductive age and some women who have always had heavy periods may feel their pattern of bleeding is normal.

HMB is defined as excessive menstrual blood loss (more than 80mL) which interferes with the woman's physical, social, or emotional wellbeing.

Lots of conditions can cause heavy bleeding, including fibroids, polyps, endometriosis, adenomyosis and (uncommonly) uterine cancer. The increased blood loss may then cause anaemia and iron deficiency which can make you feel tired.

Amenorrhoea: the absence of periods. This can be caused by a number of conditions and if you don’t get your period for six months you should visit your GP. If you haven’t started menstruating by the age of 16-17 you should speak to your doctor.

Dysmenorrhoea: painful periods. This issue is very common, often underdiagnosed and hence undertreated. Dysmenorrhoea can be a sign of an underlying issue such as ovarian cysts, endometriosis, pelvic inflammatory disease, fibroids or sexually transmitted infection. Dysmenorrhoea can also occur without any underlying cause and this is commonly experienced by younger women.

Oligomenorrhea: Irregular periods. Your menstrual cycle might change relating to life stages like menopause or pregnancy, but it could also be a sign of miscarriage, reduced diet, weight change, a hormone imbalance e.g. Polycystic ovarian syndrome (PCOS) or a side effect of contraception.

Spotting: bleeding between periods, which can be associated with pain and bleeding during intercourse. Spotting needs to be discussed with your GP as it can be a sign of important conditions like sexually transmitted infections, fibroids/polyps, thyroid disorders, PCOS or endometrial cancer in post-menopausal women. Spotting can also be a side-effect of contraception.

PMS: Premenstrual syndrome. Defined as a combination of physical and emotional symptoms in the lead up to the period and which usually resolve when the period starts. Symptoms include mood swings, irritability, lower libido, acne, sore breasts, headaches, bloating and fluid retention. PMS is experienced by up to 30% of women.

PMDD: Premenstrual dysphoric disorder. This is a severe form of PMS affecting a small number of women (8% of those with PMS). It causes significant distress and also has an impact on socioeconomic function. It’s not entirely clear why some women develop PMDD, but smoking and obesity are associated with it.

KASEY: What is your best advice for people who menstruate to get through their periods?

DR. SYLVIE: Be active – endorphins give you a natural boost to your mood and help with period pain. Exercise helps with pretty much everything including period pain and PMS.

Reduce stress levels – stress worsens PMS

For sore breasts – avoid caffeine, wear a supportive cotton bra

You can try a menstrual diary to identify triggers and write down symptoms and bleeding patterns - this is useful if you want to discuss things more with a health professional.

A regular period means you are probably fertile, so think about your fertility – what would you do if you got pregnant? Do you want to fall pregnant in the future? And if you’re sexually active: are you protecting yourself from unwanted pregnancy or sexually transmitted diseases?

Talk to your doctor if you have concerns about your period or your menstrual cycle. You know your body best.

By Kasey Syverson