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Menstrual history What was the first day of your last menstrual period? (dd/mm/yy) Don’t know _________________________ Are you sure of that date? Yes No N/A _________________________ How many days does your period last? days _________________________ How many days are there between your periods? days _________________________ Are your periods regular? Yes No N/A _________________________ Specific Questions to Ask Your doctor About Menorrhagia (Heavy Bleeding) What could be causing my heavy bleeding? What kinds of tests should I have? How serious is my condition? Where can I get more information? About Your Risk of Developing Complications of Menorrhagia Am I at risk for anemia? Do I need to be concerned about infertility? How can I reduce my risk of toxic shock syndrome? Are their any other complications I should be concerned about? About Treatment Options for Menorrhagia What treatments are available for heavy bleeding? Are there medications that can help me? If so, What benefits can I expect? What side effects can I expect? Are there any surgeries that can help heavy bleeding? If so: What benefits can I expect? What risks may be involved? Are there any alternative or complementary therapies that may help? Is there anything else I can do to reduce the bleeding? About Amenorrhea (Lack of Menstruation) Why have I not been having menstrual periods? What kinds of tests should I have? How serious is my condition? Where can I get more information? About Your Risk of Developing Complications of Amenorrhea Am I at risk for bone loss and osteoporosis? Do I need to be concerned about infertility? Are there any other complications I should be concerned about? About Treatment Options for Amenorrhea What treatments are available for this condition? Are there medications that can help me? If so: What benefits can I expect? What side effects can I expect? Is there anything else I can do to make my periods regular? Are there any alternative or complementary therapies that may help? About Your Outlook What are the chances of my condition improving? What should I do if this problem returns? About Lifestyle Changes What lifestyle changes can I make to improve my condition? Do I need to do anything about my: diet, exercise routine, weight, stress, or other habits? What is menstruation? What is the menstrual cycle? What happens during the menstrual cycle? What is a typical menstrual period like? What kinds of problems do women have with their periods? When does a girl usually get her first period? How long does a woman have periods? How long does a period last and how much blood is there? Are pads or tampons better? Do girls always have cramps with their periods? Menstrual Disorders What are Menstrual Disorders? The most common menstrual disorders are: Amenorrhea Dysmenorrhea Menorrhagia Oligomenorrhea Toxic Shock Syndrome Irregular Menstrual Periods
How much do you exercise? Have you ever had an eating disorder? Have you lost weight recently? Have you been intolerant of heat or cold? Have you had rapid heartbeats, dry skin, hair loss, constipation or diarrhea, or a change in weight (these are symptoms of thyroid abnormalities, which can cause irregular periods)? Do you have abnormal body hair? Have you gained weight? Do you have regular menstrual cycles? Is your bleeding always heavy or prolonged? How old were you when you started menstruating? How long ago did you develop irregular periods? When you do have your period, is it accompanied by symptoms such as abdominal cramping, mood changes, and bloating? Are you sexually active? When was your last period? How many times have you been pregnant? What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)? Have you ever had difficulty getting pregnant? Your Doctor Might Examine the Following Body Structures or Functions: Heart rate, blood pressure, and weight Heart and lungs Pelvic examination Your Doctor Might Order the Following Lab Tests or Studies: Pregnancy test Blood tests for certain hormone levels (thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, 17-hydroxyprogesterone, testosterone, DHEA) 24-hour urine collection for free cortisol Pelvic ultrasound Pap smear Dysfunctional Uterine Bleeding
Is your bleeding always heavy or prolonged? How old were you when you started menstruating? How long ago did you develop abnormal bleeding? Have you gone through menopause yet? Are you sexually active? When was your last period? How many times have you been pregnant? What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)? Have you ever had difficulty getting pregnant? What medications are you taking (including over-the-counter drugs and herbal remedies such as ginseng)? Are you taking hormone replacement therapy or birth control pills? Have you ever had medications injected (Depo-Provera or Norplant) for birth control? Have you ever taken estrogen or tamoxifen? Are you taking warfarin or other blood thinners? Have you ever had cancer of any type? Have you ever had an abnormal Pap smear? Do you bruise easily? Do your gums bleed? Do you get nosebleeds? Do you have a blood-clotting abnormality or does one run in your family? Do you have kidney or liver disease? Your Doctor Might Examine the Following Body Structures or Functions: Blood pressure, heart rate, weight Abdominal examination Pelvic exam Your Doctor Might Order the Following Lab Tests or Studies: Pregnancy test Blood tests such as complete blood count, coagulation (clotting) studies, and certain hormone tests (such as thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, testosterone) Pelvic ultrasound Pap smear Rare Endometrial biopsy What is considered normal menstruation? Menstruation is the discharge of blood and tissue that occurs each month as part of a woman's menstrual cycle. It usually begins when a girl is about 12 or 13 years old (puberty) and continues until menopause (typically in a woman's early 50s). Menstrual periods usually occur once a month and last for several days during each month. Cycle length varies by the woman, but it averages about 28 days. The blood flow of menstruation may vary from month to month and from woman to woman. Before and during menstruation, women may experience some mild to moderate cramps, water retention and irritability. Abnormally heavy blood flow, irregular cycle length or severe premenstrual syndrome (PMS) symptoms may indicate a menstrual disorder. What are common menstrual disorders? Menstrual disorders involve periods that are unusually: * Heavy or long (menorrhagia) * Light (hypomenorrhea) * Frequent (polymenorrhea) * Infrequent (oligomenorrhea) * Painful (dysmenorrhea) Amenorrhea (lack of menstruation) may also be considered a menstrual disorder, depending on the circumstances. Primary amenorrhea refers to girls who have not experienced their first periods and is considered normal until the typical age of puberty is passed. A girl who has not had her first period by age 16 should consult her physician. Secondary amenorrhea refers to someone who has menstruated previously but has stopped. Is PMS considered a menstrual disorder? Yes. Most women experience some symptoms of PMS including irritability, mood swings, anxiety, depressed mood, appetite changes, fluid retention and fatigue. Menstrual cramps are not considered a PMS symptom. The exact cause of PMS is not known. Up to 40 percent of menstruating women have PMS symptoms severe enough to require treatment according to National Women's Health Resource Center. Between 3 and 8 percent of women experience a related, but more serious, condition called premenstrual dysphoric disorder (PMDD). Menstrual Disorders
Dysmenorrhea Hypomenorrhea Menometrorrhagia Menorrhagia, or hypermenorrhea Metrorrhagia Oligomenorrhea Polymenorrhea Postmenopausal bleeding Premenstrual syndrome Primary amenorrhea Secondary amenorrhea Deciphering Medical Terms for Menstrual Disorders* Term Description Amenorrhea No periods Dysmenorrhea Painful periods Hypomenorrhea Unusually light periods Menometrorrhagia Prolonged bleeding that occurs at irregular intervals Menorrhagia, or hypermenorrhea Unusually long and heavy periods Metrorrhagia Bleeding that occurs at frequent, irregular intervals Oligomenorrhea Unusually infrequent periods Polymenorrhea Unusually frequent periods Postmenopausal bleeding Bleeding that occurs after menopause Premenstrual syndrome (PMS) Physical and psychologic symptoms that occur before the start of a period Primary amenorrhea No periods ever starting (at puberty) Secondary amenorrhea Periods that have stopped http://www.umm.edu/patiented/articles/what_home_remedies_severe_menstrual_cramps_000100_7.htm http://www.merck.com/mmhe/sec22/ch244/ch244a.html http://www.menstrualdisorders.com/ http://www.ivillage.com/menstrual-disorders-key-qa/4-a-108222 When was the first day of your last menstrual period? 1. How old were you when you started having menstrual periods? Age: _________ 1a. If you cannot remember your exact age, were you: Younger than 10 16 or older 10-12 yrs old Don�t Know 13-15 yrs old 2. At present which statement best describes your menstrual cycle? I�m still having regular periods: The date of my last period was: ___/___/_____ My periods are irregular: The date of my last period was: ___/___/_____ I�m pregnant, or my last pregnancy ended within the past 2 months, or I�m breast feeding My periods have stopped on their own. (I�ve had menopause.) I�ve had menopause, but now have periods because I am taking hormones. I�ve had an operation (surgery) which stopped my periods. If your menstrual periods ceased because of surgery, what did you have removed? One ovary only Uterus only Both ovaries Uterus and one ovary Uterus and both ovaries Don�t know I�ve taken medication which has stopped my periods. If your periods stopped because of medication, which medication were you taking? Medication name: _____________________________________ I�ve had chemotherapy which has stopped my periods. I�ve had radiation therapy which has stopped my periods. Other: _____________________________________________________ 3. If your menstrual periods have stopped, how old were you when your menstrual periods stopped? (Please provide us with the age at which your menstrual periods stopped regardless of why they have stopped � naturally, due to surgery, medication, chemotherapy, or radiation therapy. If your periods have stopped, but you now have periods because of taking hormones, answer with the age at which your periods first stopped.) Were you: Younger than 20 45-49 yrs old 20-29 yrs old 50-54 yrs old 30-39 yrs old 55 � 59 yrs old 40-44 yrs old 60 or older OR My menstrual periods have not stopped. 4. If your menstrual periods have stopped, how old were you when you first experienced symptoms of menopause such as hot flashes or night sweats? _____ Years old Did not experience symptoms Don�t Know OR My menstrual periods have not stopped. All women should answer the next two questions, whether they currently have menstrual periods or not. 5. When you are (were) having regular menstrual cycles, how many days are (were) there between periods? _______ Days between periods For how many days do (did) you have your period? _______ Days 6. Between the ages of 18 and 40, excluding times when you may have been on the pill, pregnant, or nursing, which of the following statements BEST describes your menstrual periods? They are (were)� Nearly always regular, that is, you could usually predict when you would start bleeding to within two or three days Fairly Regular Irregular Don�t Know What if my period stops but I'm sure I'm not pregnant? The absence of menstruation is called amenorrhea. While the most common cause of amenorrhea is pregnancy, it can also be a common symptom of underlying reproductive system conditions,4. Danforth's Obstetrics & Gynecology, p. 625A, 640A,B or due to excessive weight gain or loss.7. Dorland's Medical Dictionary, p. 59 Talk to your health care professional about your symptoms. What if I have a period each month, but it's really light or short? Regularly timed menstruation cycles that have a decreased amount of bleeding (also known as hypomenorrhea) 10. Berek, p. 159 A may occur in women on oral contraceptives.2. Mishell, p. 904A Women on the Pill experience a withdrawal bleed, which usually lasts 3 to 4 days, as opposed to a normal menstrual period, which lasts, on average, 5 days, and averages less blood loss than a normal period.2. Mishell, p. 904A However, it can be normal for women not on the Pill to have light or short periods, too. Talk to your health care professional if you're concerned about light or short periods. What if my period is infrequent? Also called oligomenorrhea, infrequent menstruation is defined as having irregularly timed episodes of bleeding, which usually occur at intervals of more than 35 days.10. Berek, p. 159 A Usually, it is caused by common factors such as age, hormones, or infection, but it can possibly be associated with other factors such as pregnancy or cancer.4. Danforth�s Obstetrics & Gynecology, p. 644BC; 647FG; 10. Berek, p. 159D Be sure to discuss your symptoms with your health care professional. What if my period is irregular? Women with metrorrhagia or irregularly timed periods have inconsistent menstrual cycles.10. Berek, p. 159 A Irregular periods are most common during the first few years of menses, and the years right before menopause.10. Berek, p. 159 D; 20. Treloar p. 124 C Some women continue to have irregular periods throughout their childbearing years, which can be common due to age, but should be evaluated by a health care professional.18. Speroff, p. 549B; 10. Berek, p. 159 A Oral contraception is one treatment option that can help regulate menstrual cycles.18. Speroff, p. 540; 39. Alesse PI p. 20 What if my period is too frequent? Some women have periods that occur more frequently than every 21 days. This is known as polymenorrhea.10. Berek, p. 159 A Variations in menstrual cycles are most common during the few years right after menarche (first period) and in the years right before menopause. 20. Treloar p 124 C, 10. Berek p 159 Even though frequent periods can be common, women who have them should have a thorough medical history and physical exam conducted by a health care professional to rule out any other causes.18. Speroff, p. 555 What if my period is heavy or prolonged? Having regularly timed episodes of heavy or prolonged menstrual bleeding is called menorrhagia.10. Berek, p. 159 A Women with a consistent menstrual flow for 7 or more days,18. Speroff, p. 549 B or blood loss exceeding a little more than 5 tablespoons (>80 mL)34. Hallberg, p. 349-350 should be evaluated by a physician.18. Speroff, p. 549 B Occasionally, heavy periods can indicate other health problems, and can also cause anemia.18. Speroff, p. 555 Talk to your health care professional if you experience heavy or prolonged bleeding so he or she can conduct tests to rule out more serious conditions.18. Speroff, p. 555 If the bleeding is not part of a more serious condition, oral contraceptives are one treatment option that can provide a beneficial impact on menstrual flow.Speroff, p. 540 What if my period is painful? Painful periods (also called dysmenorrhea) usually involve cramping in the lower abdomen or back.18. Speroff, p. 539 For some women, painful periods subside after their first pregnancy. 18. Speroff, p. 539 Oral contraceptives are one treatment option that can provide a beneficial impact on dysmenorrhea.18. Speroff, p. 540 Talk to your health care professional about what you can do to treat painful periods. Does bleeding every month guarantee that you're not pregnant? Not necessarily. The most common symptom of pregnancy is amenorrhea (the absence of menstruation). First trimester vaginal bleeding is very common, occurring in approximately 25% of patients who are known to be pregnant.6. Fleischer, p. 14; 640B; 644B Other symptoms of pregnancy include nausea, enlargement of the breasts, and a growing abdomen.7. Dorland's Medical Dictionary, p. 1500 Contact your health care professional if pregnancy is suspected. What is a withdrawal bleed? When a woman is taking an oral contraceptive, her period is called a withdrawal bleed, because it happens during the time when she's taking placebo pills (inactive pills, without hormones).1. Pincus, p.1344A ; 2. Mishell, p. 904A; 39. Alesse PI, p. 21 The Pill was originally designed this way so that it would more closely mimic the experience of menstruation when not on the Pill.3. Loudon, p. 487C What about extended-cycle contraceptives? Is it safe to skip periods by using an oral contraceptive? Recent surveys have questioned the necessity of monthly withdrawal bleeds.40. Sulak, Keuhl, p. 1142; 41. Sulak, Cressman, p. 179; 42. Nakajima, p. 32 Many health care professionals agree that it is not medically necessary for a woman to get her period. What is menstruation? What is the menstrual cycle? What happens during the menstrual cycle? What is a typical menstrual period like? What kinds of problems do women have with their periods? When does a girl usually get her first period? How long does a woman have periods? How often should I change my pad/tampon? For More Information What is menstruation? Menstruation is a woman's monthly bleeding, also called a period. When you menstruate, your body is shedding the lining of the uterus (womb). Menstrual blood flows from the uterus through the small opening in the cervix, and passes out of the body through the vagina. Most menstrual periods last from three to five days. What is the menstrual cycle? Menstruation is part of the menstrual cycle, which prepares your body for pregnancy each month. A cycle is counted from the first day of one period to the first day of the next period. The average menstrual cycle is 28 days long. Cycles can range anywhere from 21 to 35 days in adults and from 21 to 45 days in young teens. Body chemicals called hormones rise and fall during the month to make the menstrual cycle happen. What happens during the menstrual cycle? In the first half of the cycle, levels of estrogen (the �female hormone�) start to rise and make the lining of the uterus (womb) grow and thicken. At the same time, an egg (ovum) in one of the ovaries starts to mature. At about day 14 of a typical 28-day cycle, the egg leaves the ovary. This is called ovulation. After the egg has left the ovary it travels through the fallopian tube to the uterus. Hormone levels rise and help prepare the uterine lining for pregnancy. A woman is most likely to get pregnant during the three days before ovulation or on the day of ovulation. Keep in mind, women with cycles that are shorter or longer than average may ovulate earlier or later than day 14. If the egg is fertilized by a man�s sperm cell and attaches to the uterine wall, the woman becomes pregnant. If the egg is not fertilized, it will break apart. If pregnancy does not occur, hormone levels drop, and the thickened lining of the uterus is shed during the menstrual period. In the picture below, the egg has left the ovary and is on its way through the fallopian tube to the uterus. What is a typical menstrual period like? During your period, the thickened uterine lining and extra blood are shed through the vaginal canal. Your period may not be the same every month and it may not be the same as other women's periods. Periods can be light, moderate, or heavy, and the length of the period also varies. While most periods last from three to five days, anywhere from two to seven days is normal. For the first few years after menstruation begins, longer cycles are common. A woman's cycle tends to shorten and become more regular with age. Most of the time, periods will be in the range of 21 to 45 days apart. What kinds of problems do women have with their periods? Women can have a range of problems with their periods, including pain, heavy bleeding, and skipped periods. Amenorrhea � the lack of a menstrual period. This term is used to describe the absence of a period in: young women who haven't started menstruating by age 15 women who used to have regular periods, but haven't had one for 90 days young women who haven't had a period for 90 days, even if they haven't been menstruating for long Causes can include pregnancy, breastfeeding, and extreme weight loss caused by serious illness, eating disorders, excessive exercising, or stress. Hormonal problems, such as those caused by polycystic ovarian syndrome (PCOS) or problems with the reproductive organs, may be involved. It is important to talk to a doctor. Dysmenorrhea � painful periods, including severe cramps. When menstrual cramps occur in teens, the cause is too much of a chemical called prostaglandin. Most teens with dysmenorrhea do not have a serious disease even though the cramps can be severe. In older women, a disease or condition, such as uterine fibroids or endometriosis, sometimes causes the pain. For some women, using a heating pad or taking a warm bath helps ease their cramps. Some pain medicines available over the counter, such as ibuprofen (for instance, Advil�, Motrin�, Midol� Cramp), ketoprofen (for instance, Orudis� KT�), or naproxen (for instance, Aleve�), can help with these symptoms. If pain is not relieved by these medicines or the pain interferes with work or school, you should see a doctor. Treatment depends on what is causing the problem and how severe it is. Abnormal uterine bleeding� vaginal bleeding that is different from normal menstrual periods. It includes very heavy bleeding or unusually long periods, periods too close together, and bleeding between periods. In both teens and women nearing menopause, hormonal changes can cause long periods along with irregular cycles. Even if the cause is hormonal changes, treatment is available. These changes can also go along with other serious medical problems such as uterine fibroids, polyps, or even cancer. You should see a doctor if these changes occur. Treatment for abnormal bleeding depends on the cause. When does a girl usually get her first period? In the United States, the average age is 12. This does not mean that all girls start at the same age. A girl can start her period anytime between the ages of eight and 15. Usually, the first period starts about two years after breasts first start to grow. If a girl has not had her first period by age 15, or if it has been more than two to three years since breast growth started, she should see a doctor. How long does a woman have periods? Women usually have periods until menopause. Menopause occurs between the ages of 45 and 55, usually around age 50. Menopause means that a woman is no longer ovulating (producing eggs) and can no longer get pregnant. Like menstruation, menopause can vary from woman to woman and these changes may take several years to occur. The time when your body begins its move into menopause is called the menopausal transition. This can last anywhere from two to eight years. Some women have early menopause because of surgery or other treatment, illness, or other reasons. If a woman doesn�t have a period for 90 days, she should see her doctor to check for pregnancy, early menopause, or other medical problems that can cause periods to stop or become irregular. How long does a period last and how much blood is there? It varies for each girl, but some have their period for 3 days and others have it for a week. Periods can be light, moderate, or heavy, and there can be a total of 2�4 tablespoons (30�59 milliliters) of blood. And this can vary from period to period in the same girl. Are pads or tampons better? In choosing between the two, what matters is a girl's physical and emotional comfort. A tampon can be uncomfortable in the years right after menstruation starts, when the pelvis and vagina are still growing. Usually, girls are more comfortable using pads at first, but they may want to start using tampons when they get older (although they don't need to wait to use tampons until a certain age). Their friends may have started using them, and the freedom tampons can give may be appealing. Each box of tampons includes instructions, so be sure to read them with your daughter. Although the first few times using a tampon can be frustrating, explain to your daughter that it will soon be easy with a little practice. Because the muscles of the vagina can become tense when a girl is nervous, it can be difficult to insert a tampon at first. It's important to relax as much as possible. It's a good idea to start with a slim tampon with an applicator because they can be easier to insert. It can also help to first try a tampon on a day with heavier flow, so that it is easier to put in. Do girls have to stop playing sports or swimming while they have their periods? Girls should understand they can do everything they normally would do � as long as they're comfortable. For example, girls may choose to wear a tampon so they can continue to swim while menstruating. What's toxic shock syndrome (TSS)? TSS is a rare but serious bacterial infection that can be associated with tampon use. Fortunately, TSS that is associated with menstruation can almost always be prevented by changing tampons regularly and by using the smallest absorbancy needed (for example, "slender regular" instead of "super plus"). A reasonable precaution is to change tampons every 4 hours or more frequently if the blood flow is heavy. Do girls always have cramps with their periods? Concern about cramps is a big issue for some girls. While most girls eventually have some cramps, many do not for the first year or two of getting their periods. It's important to tell girls that cramps usually only last a few days. Sometimes, a hot water bottle or a hot bath can help ease discomfort. Some find that deep breathing and exercising help, too. If cramps become too uncomfortable, your daughter might want to take an over-the-counter (OTC) medicine like ibuprofen (such as Advil or Motrin). Having cramps for a day or two each month is common, but signs of dysmenorrhea � severely painful menstruation that interferes with a girl's ability to attend school or study or sleep � or other menstrual problems should be discussed with your doctor. What's PMS? Premenstrual syndrome (PMS) includes physical and emotional changes (mood swings and irritability, tension, bloating, and breast tenderness) that can occur during the time right before some girls get their periods. But girls usually don't develop symptoms associated with PMS until several years after menstruation starts � if ever. While not all girls experience PMS, for those who do, plenty of rest, exercise, and eating a balanced diet may help. Do girls need to douche or use deodorant spray when they have their periods? No. In fact, douching can increase a girl's possibility of infection by disrupting the normal balance of bacteria in the vagina. SYMPTOMS DIAGNOSIS SELF-CARE Begin here 1. Have your periods become painful? No --> Go to Question 5.* Yes, go down 2. Have you been more emotional, fatigued or irritable, or do you have more bloating or weight gain than usual, or do you have trouble concentrating or sleeping just prior to your periods? Yes --> This may be normal MENSTRUAL CRAMPS, or you may have PREMENSTRUAL SYNDROME (PMS). --> Use over-the-counter medicine such as ibuprofen or naproxen for bloating and pain. Avoid caffeine and alcohol. Make changes to the way you eat and exercise. Eat smaller, more frequent meals that are high in complex carbohydrates such as fruits,vegetables and whole grains, and take a daily multivitamin and calcium. See your doctor if symptoms get worse. No, go down 3. Do you have a sexually transmitted disease, or do you have a fever or foul-smelling vaginal discharge? Yes --> You may have a serious infection around your ovaries, fallopian tubes, and uterus called PELVIC INFLAMMATORY DISEASE (PID). --> URGENT See your doctor right away. Any infection in the abdomen can be serious. No, go down 4. Do you have pain at other times such as during sex, ovulation or bowel movements? --> You may have ENDOMETRIOSIS, a problem with the lining of the uterus, or OVARIAN CYSTS. --> See your doctor. *5. Are your periods heavier or are you bleeding longer than usual? No --> Go to Question 9.** Yes, go down 6. Do you use an IUD? Yes --> The IUD may have caused this change in the pattern of your bleeding. --> See your doctor. No, go down 7. Do you have a constant feeling that you need to urinate, or do you have pelvic pressure, constipation or pain in your back or legs? Yes --> Your symptoms may be from FIBROIDS, noncancerous tumors of the uterus. --> See your doctor. No, go down 8. Do you have muscle aches, swelling or stiffness in your joints, tightness or swelling in your throat, and/or weakness in your legs? Yes --> You may have a problem with your THYROID GLAND such as HASHIMOTO'S DISEASE. --> See your doctor. **9. Are your periods irregular, infrequent or have they stopped? No --> Go to Question 14.*** Yes, go down 10. Do you have breast tenderness, abdominal fullness or nausea? Yes --> You may have an OVARIAN CYST, or you may be PREGNANT. --> If you could be pregnant, do an at-home pregnancy test. If it's positive, see your doctor for confirmation. If you don't think you're pregnant and symptoms continue, see your doctor. No, go down 11. Are you on birth control pills? Yes --> Some women will miss a period while on BIRTH CONTROL PILLS. There is a small chance you could be PREGNANT. --> Wait to see if you have a period at the end of your next pack of pills. See your doctor if you have signs of pregnancy or you don't have a period after the second month. No, go down 12. Are you 35 years old or older? Yes --> Periods that stop after years of regularity may be caused by normal or premature MENOPAUSE. Irregular periods may be due to FIBROIDS, HORMONE PROBLEMS, or other medical conditions. --> See your doctor. No, go down 13. Have you felt sluggish, or have you gained or lost weight without trying? Yes --> You may have a HORMONE PROBLEM, such as a THYROID GLAND problem. Periods may stop or become irregular if your weight falls dramatically, as can occur with ANOREXIA NERVOSA. --> See your doctor. No, go down ***14. Are you bleeding at times other than your period, or again after having gone through menopause? Yes --> Your bleeding could be from FIBROIDS, ENDOMETRIOSIS, or from a serious condition such as ENDOMETRIAL CANCER. --> See your doctor right away. Early detection of endometrial cancer is important for successful treatment. No, go down For more information, please talk to your doctor. If you think the problem is serious, call your doctor right away. Will everyone be able to tell when I am having my period? Not unless you tell them. Today's pads are comfortable and thin. It is impossible to tell just by looking that someone is wearing one. Tampons are worn inside the vagina and cannot be seen through clothing. Will I have to miss gym class or take things easy when I am having my period? Not unless you want to. You might experience some cramping or feel a little bit more tired than usual, but it is not enough to put you on the sidelines. You can live a normal life when you are having your period. In fact, exercise can help relieve cramps and give you energy. It seems like I am losing an awful lot of blood. Should I worry? Chances are, what looks like a lot of blood to you is not really a lot of blood. It is just strange at first to see blood being lost when you have not been injured. Remember, the blood that you shed during your period is supposed to be lost. During an average period, you will lose only 4�12 teaspoons of menstrual fluid. But it might look like a lot more when you see it on your pad. If you are using more than 10 pads or tampons per day or soaking through a pad or tampon every hour, this may be a sign of problem. If you truly feel you are losing a great deal of blood, talk to your doctor. He or she will tell you whether it is normal or not, and what to do. Your doctor may prescribe iron pills if he or she feels you are losing too much iron in your blood. How will I know when my period is about to start? If you are keeping track on a calendar, and if your periods are regular, you should be able to tell each month about when your period will begin. If your periods are not regular, you might still have some signs. Some girls begin to feel mild cramps right before their periods begin. Others might feel bloated or have other symptoms. Sometimes, though, your periods can catch you by surprise. It is good to be prepared. Always carry an extra pad or tampon in your purse, just in case. Can tampons be worn while swimming? Yes. Tampons do not interfere with physical exercise, including swimming. When should I see a doctor about my period? You should see your doctor if: you have not started menstruating by the age of 15, or by three years after breast growth began, or if breasts haven't started to grow by age 13 your period suddenly stops for more than 90 days your periods become very irregular after having had regular, monthly cycles your period occurs more often than every 21 days or less often than every 45 days you are bleeding for more than seven days you are bleeding more heavily than usual or using more than one pad or tampon every one to two hours you bleed between periods you have severe pain during your period you suddenly get a fever and feel sick after using tampons How often should I change my pad/tampon? Pads should be changed as often as needed, before the pad is soaked with blood. Each woman decides for herself what works best. Tampons should be changed at least every four to eight hours. Make sure that you use the lowest absorbency tampon needed for your flow. For example, use junior or regular absorbency on the lightest day of your period. If you use a super absorbency tampon on your lightest days, you may have a higher risk for toxic shock syndrome (TSS). TSS is a rare but sometimes deadly disease. Young women may be more likely to get TSS. Using any kind of tampon, at any absorbency, puts you at greater risk for TSS than using pads. The risk of TSS can be lessened or avoided by not using tampons, or by alternating between tampons and pads during your period. The Food and Drug Administration (FDA) recommends the following tips to help avoid tampon problems: Follow package directions for insertion. Choose the lowest absorbency for your flow. Change your tampon at least every four to eight hours. Consider alternating pads with tampons. Know the warning signs of TSS (see below). Don't use tampons between periods. If you have any of these symptoms of TSS while using tampons, take the tampon out, and contact your doctor right away: sudden high fever (over 102 degrees) muscle aches diarrhea vomiting dizziness and/or fainting sunburn-like rash sore throat bloodshot eyes Menstrual irregularities Questions Your Doctor May Ask - and Why! During a consultation, your doctor will use various techniques in his assesment of the symptom: Menstrual irregularities. These may include a physical examination or other medical tests. Your doctor may ask several questions when assessing your condition. It is important to remember that your consultation is a two-way process and any extra information you can share with your doctor may help them with their diagnosis. Some of the questions your doctor may ask are listed below: 1. How long have you had menstrual irregularities? 2. Age of menarche (when first got menstrual period)? 3. Duration of the menstrual period? Why: i.e. how many days do you bleed for? 4. Is the menstrual interval regular? Why: i.e. from Day 1 of menstruation to the onset of the next period. "Metrorrhagia" is menstrual bleeding that is irregular in quantity, acyclical in nature and often prolonged in nature. The condition is usually due to a pathological condition in the uterus or other internal genital organs. It's presence demands that the doctor investigate further. 5. What is the interval of your menstrual cycle? Why: i.e. from day 1 of menstruation to the onset of the next menstrual period. Average interval is 28 days. 6. What is the age of the woman with irregular menstrual bleeding? Why: e.g. low levels of estrogen, as found around the time of puberty may be associated with irregular bleeding. 7. Past medical history? Why: some medical conditions can present with abnormal menstrual bleeding e.g. hypothyroidism, iron deficiency anemia, lupus erythematosus, cirrhosis of the liver, leukemia, lymphoma, Acromegaly, cystic fibrosis. 8. Medications? Why: e.g. Depo - Provera contraceptive (intramuscular injection of progesterone) may cause irregular menstrual bleeding; irregular bleeding is common during the first few months of starting a contraceptive pill, but nearly always disappears by 3 to 6 months; the risk of irregular bleeding with the oral contraceptive pill is increased if pills are missed; about 25% of regularly menstruating women give the progesterone-only contraceptive pill develop break through bleeding (irregular bleeding); if peri-menopausal women are given continuous (rather than cyclical) hormone replacement therapy they may develop irregular bleeding. 9. Cigarette smoking? Why: cigarette smokers are five times more likely to have abnormal periods. 10. Alcohol history? Why: alcoholism may cause heavy menstrual flow and other menstrual disorders. 11. Illicit drug use? Why: e.g. marijuana is associated with irregular menstruation. 12. Family history? Why: e.g. fibroids, endometriosis, thyroid disorders, bleeding disorders. Questions your doctor may ask about related symptoms: Sometimes, other symptoms may be present and may help your doctor analyse your condition. These may include: 1. Heavy periods, and if so how many pads or tampons would you use per day whilst bleeding, and how saturated are they? Do you get clots, if yes how big would the clots be? Why: e.g. size of little finger nail, thumb nail, 20 cent coin, 50 cent coin, apricot. Do you get "flooding" i.e. gushing of blood from the vagina when you stand up? See also heavy_periods. 2. Dysmenorrhea (pain with menstruation)? Why: should consider pelvic inflammatory disease, endometriosis, ectopic pregnancy. See also menstrual_cramps or dysmenorrhea. 3. Inter-menstrual bleeding i.e. spotting between your menstrual periods? Why: usually indicate cervical "erosion", cervical polyp, presence of an IUCD and the oral contraceptive pill. Cervical cancer and intrauterine cancer must however be ruled out. See also bleeding_between_periods. 4. Bleeding after intercourse? Why: i.e. post-coital bleeding? - usually indicate cervical "erosion", cervical polyp, presence of an IUCD and the oral contraceptive pill. Cervical cancer and intrauterine cancer must however be ruled out. See also bleeding_after_sex. 5. Dyspareunia (pain during sexual intercourse), if so is the discomfort superficial within the vagina or deep within the pelvis? Why: if pain is deep may suggest endometriosis, pelvic inflammatory disease. 6. Vaginal discharge, if so what is the nature of the discharge? Why: may suggest pelvic inflammatory disease especially if abnormal offensive pus-like vaginal discharge. 7. Symptoms of endometriosis? Why: e.g. Menstrual pain that begins after years of pain free menstrual periods, pain with intercourse, non-specific pelvic pain, rectal pain especially before and during menstruation, heavy menstrual periods, irregular menstrual bleeding, reduced fertility or infertility. 8. Symptoms of pelvic inflammatory disease? Why: e.g. lower abdominal pain with or without a fever, pain with sexual intercourse, painful heavy or irregular periods, bleeding between the periods, abnormal perhaps offensive pus-like discharge from the vagina, painful or frequent urination. 9. Symptoms of pregnancy? Why: e.g. missed periods, nausea, breast tenderness, urinary frequency - may suggest ectopic pregnancy or miscarriage. 10. Symptoms of ectopic pregnancy? Why: e.g. history of a missed period, lower unilateral abdominal pain, abnormal vaginal bleeding, may have signs of pregnancy such as enlarged tender breasts. Call your health care provider if: * Your daughter has never had a menstrual period and is 16 or older, or is 14 or older and shows no other signs of puberty * You have previously menstruated but have missed 3 or more periods in a row What to expect at your health care provider's office: The first step is to rule out pregnancy. This is done with a urine or blood test. (See: Pregnancy test ) The doctor will perform a physical exam and ask questions about your medical history. Questions may include: * Menstrual history o Are you a woman presently in a menstruating age range (over 12 and under 55)? o Are you sexually active? o Do you use birth control ? What type? * Quality o Was the previous menstrual period a normal amount? o Are the menses absent or decreased? o Do you usually have regular periods? * Time pattern o When was your last menstrual period? o At what age did you have your first menstrual period? o Have you ever had normal periods? * Aggravating factors o What medications do you take? o How much do you exercise? o Have you lost or gain a lot of weight? * Other symptoms o What other symptoms do you have? o Is there breast tenderness ? o Is there morning nausea and vomiting ? o Is there a headache ? o Is there a nipple discharge (and not breast feeding)? o Is there vision loss or change in vision? o Is there an unintentional weight gain ? o Is there an unintentional weight loss ? o Is there hair growth in a male pattern? o Is there excessive anxiety ? Tests that may be performed include: * Progestin withdrawal (take a hormonal medicine for 7 to 10 days to trigger bleeding) * Prolactin level * Serum hormone levels such as testosterone levels * Thyroid function studies , includingTSH (thyroid stimulating hormone * FSH (follicle stimulating hormone level) * LH (luteinizing hormone level) * Pelvic ultrasound * CT scan of the head may be done if a pituitary tumor is suspected Treatment depends on the cause of the amenorrhea. Your doctor may tell you to make lifestyle changes if the absent menstruation is due to weight changes, physical activity, or stress level. If you have polycystic ovarian syndrome or athletic amenorrhea, you may be given hormonal contraceptives to treat the problem. If the absent menstruation is caused by another systemic disorder, normal menstrual function usually returns after the primary disorder is treated. For example, if the primary disorder is thyroid or pituitary disease, medicines will be prescribed. Young women with primary amenorrhea that is caused by birth defects may require medicine, surgery, or both. In any case, psychosocial support and counseling for the patient and family is necessary to address specific concerns and provide guidance regarding anticipated sexual development. Questions for your doctor Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions related to menstrual disorders: 1. Do my symptoms indicate a menstrual disorder? 2. What tests will you use to determine the cause of my menstrual disorder? 3. What type of menstrual disorder do I have? 4. What may have caused me to develop a menstrual disorder? 5. Does having this menstrual disorder pose any danger to my overall health? 6. What are my treatment options? 7. Will my menstrual disorder affect my ability to get pregnant now or in the future? 8. Will I be able to achieve a normal menstrual cycle with treatment? If so, when can I expect to see results? 9. Are my daughters more likely to develop menstrual disorders because I have one? 10. Will my menstrual problems go away after menopause? Menstrual Disorders What are Menstrual Disorders? Menstrual disorders can be either a temporary or permanent condition. Both menstrual disorders can interfere with a woman's ability to become pregnant. A woman with menstrual disorders needs to see her ob/gyn or family doctor as menstrual disorders may be signs or symptoms of more serious medical conditions. Menstrual disorders can be caused by a number of differing problems or reasons. For normal menstruation to occur, a woman's hormonal glands must function normally for menstrual periods to occur. Menstrual disorders can result from conditions that affect a woman's hormone-producing glands and organs that may include her cervix, hypothalamus, ovaries, pituitary gland, uterus, or vagina. The most common menstrual disorders are: Amenorrhea - which is the absence of of a woman's menstrual periods. Dysmenorrhea - also known as painful periods with severe menstrual cramping. Menorrhagia - excessive menstrual bleeding. Oligomenorrhea - which is infrequent (less than 8 periods/menstrual cycles per year) menstruation. Toxic Shock Syndrome - starting out with flu-like symptoms, Toxic Shock Syndrome is related to tampon use and the Amenorrhea is the absence of menstruation or a woman's monthly menstrual periods. Amenorrhea is classified as either "primary" Amenorrhea, which is the absence of "menarche" a girl's first menstrual period by age 16, or "secondary" Amenorrhea, which is the absence of menstrual periods for more than three to six months in a woman who previously had monthly menstrual periods. Causes of primary amenorrhea which are normally present at the birth of a baby girl, but are not known until she reaches the age of puberty, and when she should be experiencing menarche. Conditions causing primary amenorrhea may include genetic or chromosomal abnormalities, and structural abnormalities of the reproductive tract. All of the conditions that lead to secondary amenorrhea can also cause primary amenorrhea. Pregnancy is the leading cause of secondary amenorrhea. Among non-pregnant women, ovarian conditions are the most common cause of secondary amenorrhea; these conditions include polycystic ovary syndrome and premature ovarian failure also known as early premature menopause. The most common reasons for Amenorrhea, skipped menstrual periods or missing menstrual periods include: * Emotional stress * Excessive exercise or physical stress * Poor nutrition * Pregnancy * Illness Dysmenorrhea or painful periods is the medical term for severe menstrual cramping. "Primary dysmenorrhea" is not usually associated with other more serious medical conditions. Dysmenorrhea usually begins when a girl starts having her menstrual periods, and can start as soon as her first period or menarche. Menorrhagia - or excessive menstrual bleeding, is normally indicated when a woman's menstruation lasts more than seven to eight days each monthly menstrual period, or if she loses more than 80 milliliters or about 1/3 of a cup of menstrual blood each monthly cycle. A woman's doctor may classify or diagnose her as having dysfunctional uterine bleeding (DUB), which often leads to an iron deficiency or anemia unless she begins taking iron supplements, as prescribed by her doctor. Iron deficiency, as caused by the excessive menstrual bleeding, may lead to increased fatigue, dizziness, shortness of breath, and in severe cases - angina. Menorrhagia's most likely causes include: * Abortion-related problems * Cervical or endometrial polyps * Cervical cancer * Endometrial cancer. * Hormone imbalance * Intrauterine Devices (IUDs) * Menopause * Pelvic inflammatory disease (PID) * Perimenopause * Premature Ovarian Failure * Uterine fibroids or tumors (benign or cancerous) Oligomenorrhea is another menstrual disorder that refers to infrequent or sporadic menstrual periods which are generally defined to mean fewer than six to eight periods per year. Toxic Shock Syndrome (TSS) What is " Toxic Shock" and Toxic Shock Syndrome? Toxic shock syndrome is a rare infection that can happen during a woman's period. The symptoms include a sudden fever of over 101 degrees or more, diarrhea (the runs), vomiting (throwing up), muscle aches and a sunburn-like rash. If you have these symptoms during you period, see a doctor right away. To help prevent Toxic Shock Syndrome, you should follow these guidelines: 1. Wash your hands before unwrapping and placing a new tampon in your vagina. 2. Never use super-absorbent or deodorant tampons. 3. Change your tampon at least every 4-6 hours (read the tampon manufacturers information inside the box). 4. Do not use tampons all the time and switch to a pad for part of each day. 5. Do not use a birth control sponge or diaphragm during your period. During your period it is preferable to use other methods such as condoms and/or foam. There are allegations that tampons made from rayon, or cotton with rayon, may cause or be a contributing factor to Toxic Shock Syndrome, as well as vaginal dryness or ulcerations of vaginal tissues. Toxic Shock Syndrome is a rare but potentially fatal disease caused by a bacterial toxin. (Different bacterial toxins may cause Toxic Shock Syndrome, depending on the situation, but most often streptococci and staphylococci are responsible.) The number of reported Toxic Shock Syndrome cases has decreased significantly in recent years. Approximately half the cases of Toxic Shock Syndrome reported today are associated with tampon use during menstruation, usually in young women. Toxic Shock Syndrome also occurs in children, men, and non-menstruating women. In 1997, only five confirmed menstrual-related Toxic Shock Syndrome cases were reported, compared with 814 cases in 1980 [according to data from the Centers for Disease Control and Prevention (CDC)]. Although scientists have recognized an association between Toxic Shock Syndrome and tampon use, the exact connection remains unclear. Research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of Toxic Shock Syndrome in menstruating women. A few specific tampon designs and high absorbency tampon materials were also found to have some association with increased risk of Toxic Shock Syndrome. These products and materials are no longer used in tampons sold in the U.S. Tampons made with rayon do not appear to have a higher risk of Toxic Shock Syndrome than cotton tampons of similar absorbency. Vaginal dryness and ulcerations may occur when women use tampons more absorbent than needed for the amount of their menstrual flow - at that time they are changing their tampon. Ulcerations have also been reported in women using tampons between menstrual periods to try to control excessive vaginal discharge or abnormal bleeding. Women may avoid problems by choosing a tampon with the minimum absorbency needed to control menstrual flow and using tampons only during active menstruation. |