When that time of the month is not normal


Painful and heavy menses are usually a sign of underlying disorders.

Tuesday May 14 2019

Natalie* is a 21-year-old college student with excruciatingly painful periods. Her gynaecologist says that she likely has endometriosis, a condition where the tissue that forms the inner lining of her uterus has migrated to other parts of her pelvis. Since this tissue is responsive to hormones, it bleeds every month in places where it should not, causing inflammation and unbearable pain.
Seline* a 27-year-old banker has menses 12 days every month. Her periods are so heavy that she has undergone repeat blood transfusions to stay alive. She was diagnosed with Von Willebrand disease, a rare condition where her blood clots poorly, making her susceptible to heavy bleeding. She wishes she could get rid of her uterus, but her gynaecologist is hesitant and encourages her to have children before taking such drastic action. But Seline dreads the risk of bleeding to death during delivery.
Monique’s challenge is different. She has no menstrual problems, but her 19-year-old daughter, Ruby*, has Down syndrome with limited cognitive development, posing a significant intellectual disability. She started her menses at 15 and four years down the line, they are still struggling with her menstrual hygiene management especially during the day when she is away at school.
Painful periods (severe dysmenorrhea) are not normal by any long shot. The causes of painful periods are varied. For the young adolescents who are new to menstruation, as the menstrual cycle stabilises, not all cycles are accompanied by ovulation. These menses without ovulation can be painful but are generally short-lived and this settles with time.

However most painful menses are associated with underlying disorders such as adenomyosis, endometriosis, polycystic ovarian syndrome, uterine fibroids, polyps, pelvic inflammatory disease or uterine synechiae (scar tissue within the uterine cavity). All these are gynaecological conditions that require a proper diagnosis and appropriate management to relieve the pain.
Menorrhagia (heavy menses) is described as periods that come regularly but the total amount of blood lost per period is more than 80 millilitres.
Alternatively, periods lasting more than seven days may be considered to be menorrhagia. Most women will not be able to quantify the amount of blood loss but are more likely to see the doctor when the blood loss causes uncomfortable symptoms.
Menorrhagia could result from a myriad underlying medical conditions too that require urgent diagnosis and treatment. Conditions of the reproductive tract such as fibroids, polyps, endometritis (inflammation of the inner uterine lining), endometrial cancer and adenomyosis can cause the woman grief.
Endocrine disorders (disorders affecting hormone systems in the body) such as thyroid disease, bleeding disorders such as platelet dysfunction or Von Willebrand disease, polycystic ovarian syndrome, approaching menopause, chronic liver disease, some contraceptive methods and certain medications will also lead to heavy periods.

Left unchecked, menorrhagia will lead to anaemia, which in the long run, can result in heart failure and even death. Therefore, the cause must be aggressively sought and treated, to avert unnecessary complications. Women must be aware that changing the pad hourly is a sign that something is not right. Bleeding until one passes out is an emergency.
Treatment options for these complications may be surgical (such as in removal of fibroids or polyps) or may be medical (using non-steroidal anti-inflammatory drugs, hormones or hormone-receptor blockers). Treatments resulting in heavy bleeding may need to be stopped, adjusted or replaced.
What of special category ladies like Ruby? Ruby’s periods may be regular, non-painful and of normal volume. However, her incapacity to change her own pad is a challenge when she is away from her mother, who is her primary caregiver.

Despite Ruby’s intellectual disability, her reproductive health rights must be fully protected and solutions for her challenges must align with the law.
Monique was never prepared for this, especially as Ruby’s development was slower than her age mates. This, coupled with Ruby’s child-like appearance, means that even the doctors taking care of Ruby did not remember to discuss with Ruby’s mother on alternatives to help make womanhood for Ruby easier.
It was such a relief for Monique to know that there were safe options for Ruby. We settled on putting Ruby on a ‘menstrual holiday’ through the use of hormones.
Now Ruby can have periods once every three months, which coincides with her school breaks. Monique only has to worry about her baby’s menstrual hygiene at her convenience. No more soiled skirts in class, no more stained PE shorts, no more burdening Ruby’s caregivers in school with such personal matters as Ruby’s menstrual hygiene!
For some women, menstrual holidays are the only way to deal with heavy or painful menses. Keeping the periods away for a given duration helps the anaemic woman build back her blood to normal levels. For the one suffering pain, no periods means no pain. In the world of sports, periods are kept on hold during major competitions.