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Irregular Periods and Painful Cramps: all that you need to know

18 April

For most women, menstrual cycles occur about every 28 days, and periods last four to seven days.

Abnormal menstruation includes problems such as heavy bleeding, known as menorrhagia, irregular menstrual bleeding, and pain during periods, known as dysmenorrhea.


Some common reasons for irregular, heavy, and painful periods include:

  • Adenomyosis: Endometrial tissue, which normally lines the inside of the uterus, grows into the muscle wall of the uterus
  • Bleeding disorders: Certain inherited bleeding disorders can cause abnormal bleeding
  • Cancer: Cervical cancer and uterine cancer can cause heavy menstrual bleeding
  • Endometriosis: Endometrial-like tissue grows on the outside of the uterus or on the ovaries, fallopian tubes, or other nearby organs
  • Medications: Certain anticoagulants, anti-inflammatory medications, or hormonal medications can lead to heavy menstrual bleeding
  • Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder that can cause small cysts, or fluid-filled sacs, to develop in the ovaries, causing irregular periods
  • Pregnancy complications: A miscarriage or ectopic pregnancy can cause heavy bleeding
  • Premature ovarian failure: A condition when a woman’s ovaries stop working before age 40, leading to irregular periods and possible infertility
  • Uterine fibroids: Benign tumours made up of muscle tissue can grow in the walls of the uterus, the lining inside the uterus (endometrial cavity), or on the outside of the uterus
  • Uterine polyps: Overgrowth of endometrial tissue can form growths called polyps inside the uterus
  • Hormonal imbalances: Can be due to PCOS or is often related to the perimenopausal period when normal cycles in monthly hormones become out of balance


Signs and symptoms of heavy menstrual bleeding include:

  • Bleeding for more than seven days
  • Bleeding that soaks through one or more tampons or pads every hour for several hours in a row
  • Need to use multiple pads to control menstrual flow
  • Need to change pads or tampons during the night
  • Menstrual flow with blood clots larger than a quarter
  • Flooding of clothing and bedsheets with menstrual bleeding
  • Symptoms of anemia, such as fatigue and shortness of breath

Symptoms of menstrual pain include:

  • Diarrhea
  • Headaches
  • Lower back pain
  • Nausea
  • Pain that starts a few days before the period, worsens during the period and lasts two to three days after the period ends
  • Throbbing or cramping pain in the lower abdomen that can be intense
  • Lower back pain during menses

Patients should see their doctors if:

  • periods stop for more than 60 days
  • periods become erratic
  • periods are less than 21 days or more than 35 days apart
  • bleed between periods
  • bleed after sex
  • vaginal bleeding after menopause


To diagnose heavy bleeding and painful periods, doctors usually recommend one or more tests, such as:

  • Blood tests- gives information regarding iron deficiency, thyroid disorders, or blood-clotting abnormalities
  • Ultrasound: use of sound waves to produce images of the pelvic organs. It is helpful to look for any abnormalities
  • Pap smear: Sample of cells from the cervix that are examined under a microscope for infection or changes that can lead to cancer or already are cancerous
  • Endometrial biopsy: A test that samples a small amount of endometrial tissue for examination under a microscope
  • MRI scans: Equipment that uses a large magnet and radio waves to produce detailed images of pelvic organs


Painful Periods

If the painful periods are not relieved with over-the-counter medications or start to interfere with daily activities, physicians recommend the following

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). If over-the-counter NSAIDs such as ibuprofen don’t relieve symptoms, prescription NSAIDs might be prescribed.
  • Hormonal birth control- Birth control prescriptions contain hormones that can help regulate hormone levels throughout the month and reduce the severity of menstrual cramps.
    • These hormones also can be delivered by pills, an injection, a patch, an implant placed under the skin of the arm, or a flexible ring that is inserted into the vagina.
    • Another option is an intrauterine device that contains a hormone called progesterone. These methods can be very effective in managing symptoms, even if patients are not sexually active.
  • Surgical removal of the abnormal tissue can help reduce the symptoms. Many uterine-sparing, fertility-sparing and definitive surgical options exist to help with these symptoms.

Heavy Bleeding

treatment for heavy bleeding is based on the amount of bleeding.

  • hormone therapy and other non-hormonal medical therapies- If there is a reason estrogen should not be prescribed, an oral progestin might be recommended. Over-the-counter treatments such as ibuprofen can help decrease the amount of bleeding and pain, as well.

Dr. Sirisha Reddy Koppula

Consultant Gynecologist
MBBS, DNB (Obstetrics & Gynecology)
CARE Hospitals – Musheerabad






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