A woman tracks her menstrual cycle on a calendar.
Menstruation typically lasts about five days. Longer durations or heavier-than-typical flows may merit a visit to your doctor. (For Spectrum Health Beat)

It’s that time of the month.

Say that to any girl or woman past the age of puberty and she knows exactly what you mean. Yes, that time of month.

Unpack the pads and tampons and prepare for the cramps and the misery of another menstrual cycle.

Right?

“Our society has a tendency to normalize a painful period,” said Jessica Lalley, MD, a Spectrum Health Medical Group physician of obstetrics and gynecology. “Our culture treats menstruation as pain, but if you’re curling up into a fetal position and vomiting from painful cramps, if you’re not sleeping or missing work, that’s not normal.”

Having periods is a normal part of being a woman. There are, however, abnormalities that can indeed cause pain or heavy bleeding, beyond what can be considered normal.

What’s normal and what’s not

Menstruation is a discharge of blood and tissue from the uterine lining through the vagina, lasting about five days and reoccurring every 28 days.

Most girls experience their first period around age 12 and continue to have monthly cycles through menopause—with the exception of pregnancy, when menstruation stops.

“Endometriosis can cause pain during menstruation and sometimes throughout the cycle,” Dr. Lalley said. “It can sometimes lead to changes in bleeding patterns. Endometriosis can take a long time to diagnose because it’s difficult to spot. Or fibroids, benign tumors growing in the uterus, can also cause pain and heavy flow.”

These are conditions, Dr. Lalley said, that can be treated with hormones, pain relievers or surgery.

“Most of the problems we see are in women in their late 30s to late 40s or even early 50s, women who are perimenopausal to post-menopausal,” Dr. Lalley said. “Changes in menstrual cycles including pain and heavy bleeding can occur in all ages of women. The causes and treatments are different depending on age and reproductive desires.”

Considering the options

When patients come to see her, Dr. Lalley first does a work-up to make sure nothing serious is causing the pain or heavy flow.

“We may do a pelvic ultrasound or take tissue—an endometrial biopsy—from the uterus in an outpatient procedure to rule out cancer,” she said. “If we find fibroids, we may do additional imaging. If there are no fibroids and the biopsy is normal, but there is dysfunctional bleeding, that can happen as we age.”

In that case, Dr. Lalley said, women have several options to consider:

  •  The IUD—The T-shaped intrauterine device, about the size of a quarter, is placed directly in the uterus and is a birth control method that prevents sperm from reaching eggs and fertilizing them. The IUD releases a hormone, called progestin, which is the same hormone contained in some birth control pills. Some IUDs do not contain any hormones, but contain copper instead, which can prevent pregnancy. Although it is a form of contraception, it is also used to help with heavy and painful periods by thinning the endometrium, leading to less pain and less flow. Most women using the IUD will stop having a period.
  •  Hormones—Birth-control pills release small doses of progestin and estrogen to prevent pregnancy. They inhibit the body’s natural cyclical release of hormones and so can lessen flow.
  •  Ablation—This surgical procedure involves either heat, extreme cold, or radio frequencies that destroy the lining of the uterus, thus reducing menstrual flow.
  •  Hysterectomy—This surgical procedure removes the uterus, sometimes also the cervix, fallopian tubes, and ovaries, eliminating periods.

A gynecologist’s perspective

“The IUD is probably the most popular method my patients choose, because it requires a minor procedure without any need for anesthesia and is temporary—current IUDs last about six years,” Dr. Lalley said.

“Hormones taken orally in the form of birth control pills are the least popular due to side effects,” she added. “Ablation can be a good option for the right candidate—it’s a ‘one and done’ procedure, no meds are involved. Hysterectomy, like ablation, is for women who no longer want or can have children. Large fibroids, pain and endometriosis are the most common reasons for this option.”

Dr. Lalley cautions that any spotting or bleeding after menopause is a cause for concern, and a woman should always see her doctor if this occurs.

“Periods are normal, but suffering isn’t,” she adds. “Menstruation shouldn’t interfere with quality of life.”