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period management by specialist GPs in Newcastle including PMS, heavy periods and painful periods.

Period Care & Management

At Brightwell Health our experienced team of GP specialists and gyneacologists are here to help. We treat and manage menstrual concerns of all kinds, including premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD) and period pain.

Premenstrual syndrome (PMS)

PMS refers to the physical and emotional symptoms some women experience one to two weeks before their period. While typically manageable, it affects about two-thirds of menstruating women, often including breast pain and other discomforts that tend to ease with the onset of menstruation. Symptoms may intensify during adolescence and menopause due to hormonal fluctuations, and in some cases, they escalate into a more severe condition known as premenstrual dysphoric disorder (PMDD), affecting a smaller percentage of women. 

Symptoms of PMS

PMS manifests differently for each individual and can vary from cycle to cycle. These symptoms encompass physical discomforts such as breast tenderness, bloating, and acne, along with emotional challenges like irritability and anxiety. 

Understanding PMS

The exact cause of PMS remains unclear, although it’s thought to involve the interaction of certain brain chemicals with progesterone. Various factors, including mental health, stress levels, physical well-being, weight, and medical history, can influence its onset and severity. 

Diagnosis and Management

Diagnosing PMS relies on tracking symptoms over multiple menstrual cycles and discussing patterns with a doctor, as there are no specific tests for its diagnosis. 

Managing PMS involves adopting lifestyle changes such as increasing physical activity, maintaining a healthy diet, staying hydrated, managing stress, practicing relaxation techniques like yoga and meditation, and ensuring adequate sleep and rest. These adjustments can help alleviate symptoms and improve overall well-being during the premenstrual phase. 

What is premenstrual dysphoric disorder (PMDD)?

Premenstrual dysphoric disorder (PMDD) stands out as a notably severe version of premenstrual syndrome (PMS) and may impact individuals of childbearing age. It presents as a significant and persistent health concern requiring careful attention and treatment. Both lifestyle modifications and, in some cases, medications can assist in symptom management. 

What causes PMDD?

The precise origins of PMDD remain elusive. It may stem from an abnormal response to routine hormonal fluctuations that occur with each menstrual cycle. These hormonal shifts can trigger a deficiency in serotonin, a neurotransmitter naturally found in the brain and intestines, which can influence mood and induce physical symptoms. 

Who is at risk for PMDD?

While PMDD can affect anyone, certain individuals may face an elevated risk, including those with a familial history of PMS or PMDD, a personal or familial background of depression, postpartum depression, or other mood disorders. Other potential risk factors encompass lower educational attainment and cigarette smoking. Consulting with a healthcare provider can provide further insights. 

What are the symptoms of PMDD?

PMDD symptoms typically arise during the week preceding menstruation and subside within a few days after its onset. These symptoms disrupt daily activities significantly, making functioning at home, work, and in relationships challenging during this period. They include mood swings, irritability, fatigue, changes in appetite and sleep patterns, and physical discomforts like breast tenderness and headaches. It’s essential to seek professional evaluation for an accurate diagnosis, as symptoms may resemble those of other health conditions such as thyroid disorders, depression, or anxiety disorders. 

How is PMDD diagnosed?

Diagnosis of PMDD relies largely on a thorough health history, physical examination, and pelvic assessment, supplemented by symptom tracking over several months. The diagnosis typically requires the presence of five or more symptoms during the premenstrual week across most menstrual cycles, accompanied by distress or impairment in social, occupational, or other areas of functioning. Additionally, symptoms should not be attributable to another underlying health condition. 

How is PMDD treated?

Addressing PMDD involves a multi-faceted approach aimed at alleviating symptoms and enhancing overall well-being. Strategies include dietary adjustments, regular exercise, stress management techniques like relaxation and meditation, and the potential use of supplements or medications such as selective serotonin reuptake inhibitors (SSRIs) or birth control pills. Treatment may require ongoing management tailored to individual needs, with adjustments in medication dosage as necessary over time. 

Key points about PMDD  

PMDD represents a notably severe manifestation of premenstrual syndrome (PMS). Its exact etiology remains uncertain. Distinguished by the timing and duration of symptoms, PMDD significantly impacts daily functioning. Treatment encompasses a range of lifestyle adjustments and medication options to manage symptoms effectively. 

Period Management 

Painful periods 

Menstrual pain, known as dysmenorrhea, is a widespread occurrence that can hinder individuals from carrying out their usual routines. 

How does menstrual pain feel?

Menstrual pain, known as dysmenorrhea, is a widespread occurrence that can hinder individuals from carrying out their usual routines. 

The experience of menstrual pain varies from person to person and can range from mild to intense. Sensations may include cramping, aching, or a feeling of heaviness, typically felt in the lower abdomen, lower back, or legs. 

What causes menstrual pain?

There are two primary types of menstrual pain: primary dysmenorrhea and secondary dysmenorrhea. 

Primary dysmenorrhea, a normal yet uncomfortable aspect of the menstrual cycle, is triggered by chemicals known as prostaglandins, naturally produced in the uterine lining. Elevated levels of prostaglandins can lead to stronger and more painful uterine contractions, commonly experienced by individuals within a few years of their first period. 

Secondary dysmenorrhea, however, stems from an underlying health condition such as endometriosis, fibroids, pelvic inflammatory disease, adenomyosis, or as a side effect of the copper intrauterine device (IUD). 

How is menstrual pain managed?

For secondary dysmenorrhea, addressing the root cause is essential. 

Various treatments are available to alleviate menstrual pain: 

Pain-relieving medications: Anti-inflammatory drugs like ibuprofen, mefenamic acid, and naproxen can inhibit prostaglandin production. Starting these medications as soon as pain begins or 48 hours before the expected period onset is most effective. Paracetamol may suffice for milder cramps, while stronger pain relievers containing codeine require a prescription. 

Hormone treatments: Long-term management may involve hormonal contraceptives such as the combined oral contraceptive pill or contraceptive vaginal ring, which can reduce pain and potentially lessen the frequency of periods. Long-acting contraceptives like the progestogen implant or hormonal IUD are also effective in minimizing pain and may lead to lighter or absent periods. 

Other pain relief options:  

  • heat packs
  • gentle exercise 
  • transcutaneous electrical nerve stimulation (TENS) 
  • acupuncture 
  • relaxation techniques 
  • supplements like magnesium, fish oil, vitamin B1, B6, and E. However, it’s crucial to consult with a healthcare professional before trying any supplements. Come and see us at Brightwell Health to work out the best option for you.

Heavy periods

If you’re experiencing heavy periods, you should see your doctor or one of our lovely specialist general practitioners so that your medical history can be recorded, and an examination can be performed. For sexually active women, you should make sure you have a Cervical Screening Test (CST) once every five years. A pelvic ultrasound scan is also a good idea, looking for physical problems such as fibroids.

What are heavy periods?

On the first day of menstruation, it is mostly tissue that is secreted from the body. After that, the blood lost comes from exposed blood vessels and this is where a period can become problematic. During a normal period, around 40ml of blood is lost. During a heavy period, somewhere between 60 and 80ml of blood is lost.

Blood loss is not typically measured during a period and the diagnosis is made based on symptoms, examination findings and investigations. Heavy periods can be particularly concerning if they result in anaemia or low iron levels. If your periods are impacting your quality of life, please seek medical advice. 

What causes heavy periods?

In most cases, no obvious cause can be found. However, some of the known causes include:

  • Hormonal irregularities
  • Polyps: usually a non-cancerous growth inside the womb or on the cervix
  • Endometrial hyperplasia: thickening of the lining of the womb
  • Fibroids: usually a non-cancerous ball of fibrous tissue in the muscle wall of the womb
  • Adenomyosis: where the tissue lining the inside of the womb is found growing into the muscle wall of the uterus.
  • Bleeding disorders: predisposing an affected person to excessive bleeding/bruising.
  • Pelvic Inflammatory Disease (PID): infection of the pelvis
  • Endometriosis: where the tissue lining the inside of the womb is found elsewhere in the pelvis
  • Thyroid problems
  • Polycystic ovarian syndrome (PCOS)
  • Certain types of contraception
  • Blood thinning medications
  • Cancer

How do I know if I have heavy periods?

Symptoms commonly include:

  • Soaking through a pad or tampon in an hour or less
  • Passing blood clots during the period
  • Having to wear both a tampon and pad at the same time
  • Flooding onto underwear, clothes or bedding
  • Feeling faint, dizzy, or short of breath
  • Marked tiredness and lethargy.

How are heavy periods treated?

There is a range of treatment options, and the best one for you will depend on your age and reproductive needs. The good news is that in most cases a surgical approach can be avoided. Medical management can be initiated by your GP, our specialist GPs or specialists, Frida and Ashmita

Tranexamic acid

Tranexamic acid helps stop blood clots from breaking up within the womb and therefore reduces the amount of blood lost during a period. The dose is usually two tablets taken three to four times a day on the heavy days of menstruation. It typically halves menstrual blood loss and side effects are relatively uncommon. This particular treatment may not be suitable if you have a history of blood clotting problems or kidney disease.

Anti-inflammatory drugs

These include Ponstan and Naprogesic and are best known for helping to relieve period pain. However, if a full dose is taken continuously for the first five days of menstruation, they can reduce blood loss by around 25%.

They work well in combination with Tranexamic acid.

The contraceptive pill

Taking the Pill is an effective method of birth control and can reduce menstrual blood loss by 30-50%.

The Mirena® device

A highly effective form of contraception, this device can also reduce blood loss during menstruation by as much as 90%. After the initial insertion, bleeding is typically irregular for around three to six weeks, but then after that periods stabilise. We are able to insert the device with local anaesthetic gel, spray or blocks, use an inhalational agent to help minimise discomfort or insert the device under sedation in the rooms to make the procedure as comfortable as possible for you. The insertion can also be performed under an anaesthesia in exceptional circumstances or in conjunction with another surgical procedure.

Progestins

Progesterone is a female hormone that thins the lining of the womb and helps to reduce menstrual blood loss. It can be given as tablets, vaginally or as an injection and can also substantially reduce menstrual blood loss. Around one in eight women will experience side effects with progestins such as mood swings, bloating, irritability and depression.

Surgical – performed by Frida and Ashmita

Surgery would be recommended when medical management has been ineffective. There are several operations with different rates of effectiveness and varying levels of risk, summarized below.

Removal of polyps: a polyp is a non-cancerous growth in the womb that can be the cause of heavy periods. A camera is inserted inside the womb and the polyp is identified and removed.

Myomectomy: fibroids causing heavy blood loss depending on their size and location and can be surgically removed from the womb if they are thought to be the cause of the heavy bleeding.

Endometrial ablation: the lining of the womb is treated so that it can no longer bleed during a period. The efficacy of this treatment will depend on the indication and will vary between patients. Click for further information about endometrial ablation or scan the QR code below.

Hysterectomy: the surgical removal of the womb. This can be performed through different routes- vaginal, laparoscopic, robotic or through open surgery depending on the size of the uterus and individual patient factors. Click for further information about hysterectomy or scan the QR code below.

Further information about heavy menstrual bleeding:

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