Period pain (menstrual pain)

Overview: What are menstrual cycle disorders?

If menstruation is associated with very heavy bleeding or pain, this means that everyday life is severely impaired.
Cycle disorders also include very frequent or extremely prolonged bleeding.
This can be very disruptive for those affected and can even lead to anaemia.
Normally, various hormones work in perfect harmony to ensure that an egg matures in a woman’s womb every month.
A child can grow from this if the egg is fertilized by sperm.
However, the fine tuning of the hormones can quickly become unbalanced: stress, illness, malformations or an incorrect diet can lead to bleeding disorders.
Only in the rarest of cases does a female cycle last exactly 28 days without the administration of hormones (the pill).
Between 25 and 31 days from the first day of a menstrual period to the next are completely normal.
Menstruation typically lasts around four to five days.
A woman loses around 80 milliliters of blood in one cycle.
Fluctuations in both the length of the cycle and the intensity of bleeding occur in many women.

In these cases, it is advisable to consult a doctor:

• Your periods are unusually heavy and you need more than five pads or tampons a day (hypermenorrhea).
  The blood loss weakens you.
• Your period lasts a very long time (more than six days, menorrhagia).
• You do not have a period even though you are not pregnant or breastfeeding.
• You are older than 16 and have never had a period.
• The intervals between their periods become permanently longer (oligomenorrhea) or shorter (polymenorrhea).
• Although the menopause is behind you, you still have periods.
• You bleed after sexual intercourse.

If menstruation stops completely (amenorrhea), this can have completely natural causes.
This often occurs in young girls.
Women also have no period during pregnancy and breastfeeding and after the menopause.
However, if menstruation does not start until the end of the 16th year of life, a doctor should look for the reason.
This phenomenon is called primary amenorrhea.
If a woman has already had her period and it stops at some point, experts refer to this as secondary amenorrhea.
Spotting, i.e. light additional bleeding, is relatively common.
They usually occur before or after the actual menstrual period, sometimes between two periods.
There are also women who experience ovulation bleeding shortly after ovulation.

Cycle disorders: Causes and risk factors

An exam, trouble with colleagues, screaming babies – there are many things that cause stress.
Sometimes the female body reacts to this with a change in the menstrual cycle.
Moving house, going on vacation or other lifestyle changes can also alter menstruation.
Hormones have an important influence on menstruation, sometimes too much, sometimes too little.

Extended cycle

If it takes more than 31 days from the start of one period to the next (oligomenorrhea), the follicle matures too slowly or not sufficiently.
This means that this envelope in the ovary cannot rupture in time to release the female egg.
This delays the next period.

Possible reasons for this delayed follicle maturation

• Polycystic ovary syndrome (PCOS): Occurs in five to ten percent of all women and is characterized by cysts in the ovaries as well as acne, obesity and irregular periods.
• Cancer
• Areas of the brain that are responsible for the production of hormones do not function properly.
• Malformations in the reproductive organs
• stress
• Eating disorders
• Competitive sport
• Mental illnesses
• Tumors or inflammations

If the intervals between periods become longer and longer, it can happen that the period stops completely at some point.
On the other hand, oligomenorrhea can also mean that menstrual bleeding starts again after a longer break.

Shortened menstrual cycle (polymenorrhea)

If the menstrual period comes earlier than expected, the follicles mature more quickly.
This is usually the case for young women who are having their first menstruation – their hormones first have to adjust to each other.
Such shortened cycles also occur before the onset of the menopause.
A shortened cycle can also result from the corpus luteum not producing enough progesterone.
The corpus luteum normally develops after ovulation.
It produces the hormone progesterone.
This ensures that the uterus prepares its mucous membrane so that the fertilized egg can implant there properly.
If the egg is not fertilized, the corpus luteum stops producing progesterone after two weeks and the period begins.
If the corpus luteum does not produce enough progesterone, the menstruation starts earlier.
Women with a weak corpus luteum often also have problems getting pregnant.
If the corpus luteum hormone progesterone is synthetically reproduced for medical purposes, it is called progestin.

Excessively heavy periods (hypermenorrhea)

Sometimes the menstrual bleeding is so heavy that those affected hardly dare to leave the house.
One reason for this may be that the uterus is no longer able to contract properly.
Normally, the uterus pushes away the mucous membrane prepared for the egg through this contraction and at the same time closes the blood vessels in the mucous membrane through the movement.
If this contraction does not work properly, the bleeding is not stopped properly. Myomas (benign tumors in the uterus) or polyps in the mucous membrane can also hinder the contraction of the uterus.
Inflammation of the uterine lining (endometritis) or cysts(endometriosis) may also lead to excessive bleeding. Other possible causes of increased menstrual bleeding:

• Hormonal disorders, such as a weakness of the corpus luteum
• Hypertension
• Blood clotting disorders
• Heart diseases
• Kidney diseases
• Malformation of the uterus

Weak menstruation (hypomenorrhea)

If your menstrual bleeding is so light that you need less than two tampons or pads a day, you may have hypomenorrhea.
Possible causes are

• Estrogen deficiency
• Repeated scrapings of the uterus
• Dysfunction of the ovaries
• Body weight too high or too low
• Inflammation of the uterus (endometritis)
• Hormonal contraception with progestogens

Shorter or longer periods

If a period only lasts a few hours or a day and a half, hormonal changes or congenital abnormalities of the uterine lining may be the cause.
If the period lasts longer than seven days, the trigger could be inflammation of the ovaries or uterus, metabolic disorders, benign or malignant tumors or blood clotting disorders.
If spotting occurs before or after your period (light bleeding), this may be caused by a weakness of the corpus luteum or a lack of the hormone oestrogen.
In the middle of a cycle, the falling oestrogen level can also lead to ovulation bleeding.

There is no menstruation (amenorrhea)

When a period occurs in young women varies greatly.
An exchange of experiences with mothers and grandmothers often reveals parallels in the occurrence of the first period.
However, if a woman does not have a period after the age of 16, she should have her reproductive organs checked for normal development.
Extreme physical exertion, for example in competitive sport, or being underweight can prevent the typical onset of menstruation.
If a woman has had regular periods and they stop suddenly or after a few prolonged cycles, doctors refer to this as secondary amenorrhea.
In most cases, the absence of a period is a sign of pregnancy.
However, in rare cases, a hormonal disorder caused by the ovaries or the brain can also be the cause.

Menstruation stops – Possible factors

The following physical and psychological factors can also cause menstruation to stop:

• Malformation of the uterus or vagina
• Polycystic ovary syndrome (PCOS)
• malformed ovaries (such as Ullrich-Turner syndrome)
• Benign or malignant tumors
• Ovarian cancer
• Anorexia
• Competitive sport
• Stress, for example due to extreme strain
• Sheehan’s syndrome (rare pregnancy complication)
• Meningitis (inflammation of the meninges)
• Mental illnesses
• Diseases of the adrenal cortex (e.g. Addison’s disease, adrenogenital syndrome)
• Thyroid diseases
• Diabetes mellitus
• After-effects of the pill, even after stopping

Symptoms: Bleeding disorders accompanied by emotional upset

In addition to a delayed, too heavy or too early period, other symptoms can also occur with a menstrual cycle disorder, such as

• Moodiness and irritability through to depression
• Increased tendency to acne
• Weight gain or weight loss
• Water retention
• Increased body hair (hirsutism)

Cycle disorders: Diagnosis by us

It is a good idea to note down over a longer period of time on which day your period starts, how heavy it is and how long it lasts.
If you take your body temperature (basal body temperature) in the morning before you get up, you will know when you ovulate.
This can provide us with accurate data for its diagnosis.
If your period has stopped, we will first check whether you are pregnant.
If the pregnancy test is negative, we will probably give you oestrogen or progestogen to see whether the lack of bleeding is due to hormonal causes.
We will also ask you about other physical and mental illnesses, hereditary diseases and weight changes.
During the gynecological examination, we will palpate the vagina, uterus and ovaries to detect possible changes.
We often use an ultrasound scan to check for tumors.
More rarely, we also use CT, MRI or a hysteroscopy.
As the female hormones are decisive for the menstrual cycle, we have the concentration of hormones in the blood examined.
This involves the amount of oestrogen, progestogen, androgen and prolactin present.
If you wish to have a child, we usually also check the anti-Müllerian hormone (AMH test).
The anti-Müllerian hormone shows how many eggs a woman produces.

Bleeding disorders: Prevention, early detection, prognosis

If your period comes too early, too late or is particularly light or heavy, the first thing to do is to keep calm and reduce stress factors.
The cycle then often returns to normal on its own.
In general, a healthy lifestyle with plenty of exercise in the fresh air and healthy food helps to balance the body and therefore also the menstrual cycle.
Being underweight and overweight in particular often cause bleeding disorders and should be avoided.
The body mass index (BMI) provides an indication of this.
Avoiding nicotine, getting enough sleep and relaxation techniques also support physical well-being.
In the case of hereditary factors or organic diseases, only medical or surgical treatment can help.
In most cases, these can remedy the cycle disorders.
Those affected often have to take hormones on a long-term basis.
There is usually nothing to prevent them from having children.