What Problems Can Menstruation Cause?

Menstruation is a recurring biological process that prepares the body for pregnancy each month. During menstruation, the lining of the uterus, or endometrium, is shed. Periods can also include symptoms such as headaches, bloating, fatigue and cramping.

But can your period cause other problems?

What are the most common menstrual problems?

Varying factors can affect the menstrual cycle or cause irregularities such as infrequent menstruation, the absence of menstruation (amenorrhea), severe symptoms, erratic cycles or abnormal bleeding.

Menstrual irregularities are common and affect between 14 and 25 percent of reproductive-age women, according to the U.S. Department of Health and Human Services. These happen for a multitude of reasons, such as underlying disorders, stress and lifestyle, which can affect the frequency of periods and the severity of associated symptoms.

Common complications that result from menstruation include absent or irregular periods, said Arielle Bayer, M.D., a reproductive endocrinologist with CCRM Fertility in New York City.

Ovulation—when the ovaries release a mature egg every month—could be a cause of menstrual infrequency. If the egg is not fertilized by a sperm cell, menstruation will occur.

"If your body is not regularly ovulating an egg every month, your period may be off with timing or may be absent altogether," Bayer said.

The lack of a period could indicate pregnancy.

"Risk factors such as unprotected intercourse can lead to pregnancy and cause absent periods," Bayer said. "Severe cramping and pain are also complications that can occur with your period, as your uterus is shedding the lining, the muscle walls are cramping down and responding to hormonal changes."

Pain associated with the menstrual cycle, or dysmenorrhea, is common, but the following symptoms could indicate a complication:

• Cramps that last longer than the first few days
• Cramps that are unmanageable with over-the-counter treatment
• Cramps that become more severe over time

"Another complication with menstruation can be very heavy bleeding with large clots, which can lead to anemia or low blood levels," Bayer said.

Menstruation is typically heaviest toward the beginning of a cycle, but there are times you may need to schedule a visit with your healthcare provider.

The symptoms requiring a doctor's visit include the following, according to the Centers for Disease Control and Prevention (CDC):

• Changing a pad or tampon or other period product within two hours
• Passing clots larger than the size of a quarter

Heavy vaginal bleeding during menstruation, or menorrhagia, can be a sign of an underlying condition.

Another irregularity is bleeding at inconsistent intervals or between periods (metrorrhagia). Light bleeding between periods can sometimes be a sign of an underlying condition. Periods that last longer than seven days may be a sign of a menstrual complication.

Risks and causes of menstrual irregularities

A variety of factors can cause menstrual irregularities, Bayer said, such as a lack of ovulation or anovulation. Several disorders can also lead to complications.

"Conditions like PCOS [polycystic ovary syndrome], thyroid disease, hypothalamic amenorrhea or pregnancy can result in no periods," Bayer said.

Pelvic inflammatory disease (PID) and cervical cancer could create menstrual irregularities.

"Uterine fibroids, benign muscle growths in the uterus, can cause extreme symptoms with periods. Endometriosis can lead to very painful periods as well," Bayer said.

Sometimes, the cause of a menstrual irregularity is a reproductive organ abnormality.

"An abnormally shaped uterus, uterine anomaly, that you were born with can also lead to a lack of a period," Bayer said.

An abnormally shaped uterus can impact fertility in addition to menstruation. About 5 percent of people have a uterine abnormality, according to the University of Utah Health.

The birth control pill and other contraceptives are a common cause of menstrual irregularities.

"If you are taking a form of hormonal birth control like the pill, Depo-Provera shot or have a progestin-containing IUD, you can also have light, irregular periods or even absent periods," Bayer said. "Lifestyle factors such as extreme dieting or over-exercising can cause irregular periods [too]."

In addition, certain medications can lead to menstrual problems. Antidepressants, steroids or weight-loss medications could impact the frequency of your period. Sometimes, trauma or post-traumatic stress disorder (PTSD) can cause fluctuations within the menstrual cycle. A hormonal imbalance could also cause menstrual irregularities.

Hormone level fluctuations during your period are normal. It's also common for menstruation to become irregular during perimenopause, or the stage before menopause.

Treating menstrual disorders

Treatment options for menstrual disorders depend on the specific menstrual irregularity, Bayer said.

Sometimes, variations in a menstrual cycle, such as the symptoms or length of your period, happen. They aren't always the sign of a bigger problem. Painful menstrual cramps can be relieved by over-the-counter pain relievers.

When should you see a doctor?

"If you are not having regular periods, you should see your doctor, a gynecologist," Bayer said. "If you are having severe pain or severe symptoms with your period that are interfering with your regular activities, it is also a good idea to see your doctor."

See a doctor if a fever or vomiting accompanies your menstrual period. If you experience heavy menstrual bleeding or severe premenstrual syndrome (PMS), it's worth checking in with your doctor to learn about your treatment options.

"Certain medications can alleviate pain, other medications can help with symptoms like mood changes, and there are treatments for very heavy periods as well, pending the cause," Bayer said. "For example, a large fibroid may need to be removed if [it is] causing extreme symptoms. Iron pills may also be necessary for those with anemia from heavy periods."

Doctors may recommend lifestyle changes for period complications. Treating an underlying disorder causing the menstrual irregularity may be the recommended course of action. Sometimes, providers will prescribe contraceptives for severe pain, and hormones may be prescribed, depending on the menstrual irregularity.

Regardless of whether or not someone has a menstrual complication, Bayer said to pay attention to your period.

"In the field of OB-GYN, we always ask many detailed questions about your period because we treat it as a sixth vital sign," she said. "It can tell so much about what is going on with your body, so it's always a good idea to be aware of any changes or irregularities."

Now would be an excellent time to begin if you aren't tracking your period. Consider monitoring your side effects and note any new and recurring symptoms of PMS or unexpected conditions, such as pelvic pain. See your doctor if you have questions or concerns.