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Menstrual Irregularities

Skipped periods, pain with menstruation, and abnormal vaginal bleeding are common problems for women. If you are unaccustomed to dealing with these problems, they can be alarming and add great stress to a vacation.

Pain with Menstruation

For many women, cramping and/or pelvic pain is an unfortunate yet common aspect of normal menstruation. Headache, nausea, back pain, fatigue, and diarrhea are other common complaints. These “normal” events typically begin with the first day of menstruation and last about two to three days. In fact, if your pain persists longer than three days, it may be important for you to seek medical evaluation.

In most cases, menstrual pain results when a hyperactive uterus contracts under the influence of hormones released during ovulation. Increased pain may be caused by structural or anatomic abnormalities of the uterus, such as endometriosis, uterine fibroids, cancer, Pelvic Inflammatory Disease, internal scar tissue (adhesions), or the presence of an intrauterine device (IUD). In these situations, you may experience pain outside of the bleeding interval or it may persist beyond the first two to three days of your period.

You can ease routine menstrual pain with non-steroidal, anti-inflammatory medications (NSAIDs) such as Naprosyn or Ibuprofen. This is effective in about 80 percent of women (see MedToGo’s pharmaceutical guide for medication guidelines.) Start using these over-the-counter medications with the onset of bleeding (whether or not the pain is present) and continue for three days.

Skipped Periods

The typical menstrual cycle lasts 28 days, but a range between 21 to 45 days is considered normal. At both ends of a woman’s reproductive life (during the first year after starting the menstrual cycle or during the perimenopausal years) it is common for a woman’s period to be late or for her to skip a period entirely. Some women skip a period occasionally no matter how old they are. Emotional factors, stress, weight loss, strenuous physical activity, and smoking may cause periods to start late or be skipped.

If you have missed one or more periods, pregnancy may be suspected, particularly if accompanied by breast swelling, nausea, and/or vomiting. Medical conditions associated with menstrual irregularities include thyroid disease, rheumatoid arthritis, lupus, tuberculosis, diabetes, and anorexia nervosa.

Prescription or recreational drug use may also cause irregularities. Common prescription drugs known to cause skipped periods include antipsychotics, tricyclic antidepressants, narcotics, barbiturates, steroids, and some high blood pressure medications. When common causes are not present, or if you frequently miss your period, it is best to consult with a physician for hormonal and physical evaluation.

Abnormal Vaginal Bleeding

Abnormal bleeding is very common, affecting most women at some time. Any vaginal bleeding that does not occur at routine intervals can be considered “abnormal.” Typically if you have had three abnormal cycles in the preceding six months, it is wise to consult a doctor. The quantity of blood loss considered abnormal varies from woman to woman. If bleeding produces clots or if you soak through more than three tampons in a 24-hour period, consider this excessive. Most important, a persistent change in your bleeding pattern should warrant medical attention.

Of the many potential causes of abnormal bleeding, the most common occurs when normal ovulation is not achieved. Bleeding irregularities are common for one to two years after a girl’s first period. This can also commonly occur in the time around menopause, when hormones and signals from the brain are no longer functioning as they once did. These “anovulatory” cycles often result in a few skipped periods followed by prolonged intervals of heavy blood flow.

Many women experience premenstrual symptoms such as bloating, irritability, and breast engorgement during normal ovulation. These clues can be used to determine if abnormal bleeding is a result of ovulation or some other factor. Obesity can also result in non-ovulatory cycles and irregular bleeding.

There are many other potential causes of abnormal bleeding. If you are not in the initial stages of puberty or near menopause, consider other causes, including pregnancy. A sexually active woman of childbearing age should consider doing a home pregnancy test and having a medical evaluation.

Other causes of abnormal bleeding may be:

If bleeding is prolonged or excessive as outlined above, be sure to contact your physician.