The menstrual cycle

Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist and Dr Jeni Worden, GP

What causes painful periods?

There is no single proven theory, but there are several possible reasons:

contractions of the uterus similar to those felt in childbirth due to the hormone prostaglandin.

the pain can be caused by the cervix dilating when the blood and the tissue are passed out of the womb.

the pain can be due to earlier infections or inflammations of the uterus, or benign tumours in the uterus.

in some cases, painful periods are hereditary. If a woman has painful periods, her daughters may later be affected in the same way.

Why do some women's periods stop altogether (amenorrhoea)?

Periods can stop for a number of reasons. The most common are:

pregnancy.

premature menopause (this can affect women in their early twenties).

weight loss.

weight gain.

some forms of medication including the contraceptive pill or injections.

drug abuse.

stress.

hormonal imbalances such as an underactive thyroid gland or the overproduction of a hormone called prolactin.

a condition called polycystic ovaries (see below) is a very common cause of irregular or absent periods.

The treatment suggested will depend upon the diagnosis. If you are uncertain as to why your periods have stopped, seek advice from your doctor. Investigation usually involves a blood test to measure the levels of various hormones in your body.

Irregular, infrequent periods (oligomenorrhoea)

Periods are often light or infrequent both when a young woman starts having periods, and also when a woman is nearing menopause. This is normal because they are not producing an egg every month.

Many women experience one or two irregular periods every six months. This is not usually caused by any serious condition; however, many women do seek an explanation and reassurance from their GP or gynaecologist.

The most common cause of infrequent periods is a condition called polycystic ovaries. This is a common condition affecting as many as 10 per cent of women, in which a large number of very small (less than 1cm) cysts on the ovaries appear in association with a hormone imbalance.

This condition results in irregular ovulation and thus periods are usually infrequent. The diagnosis of polycystic ovaries is made on the basis of one or more blood tests to measure hormones; a pelvic ultrasound scan of the ovaries is often taken as an additional test.

Treatment is only necessary if there is concern about the irregularity of periods or if a woman is having difficulty becoming pregnant.

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