The average woman has around 480 periods during her lifetime, or fewer if she has any pregnancies (i). Biologically speaking, this means the lining of your uterus will shed as a bleed and renew itself around 480 times, and your ovaries will produce about 480 eggs – in other words, 480 menstrual cycles.
During this cycle – which usually lasts anything from 21 to 40 days – your reproductive organs are in a constant state of activity and your hormone levels can go through more ups and downs than a rollercoaster.
One of the problems thought to be linked to these changing hormone levels is premenstrual syndrome (PMS), which – according to the Royal College of Obstetricians & Gynaecologists – affects up to 40 per cent of women, including up to eight per cent who have symptoms severe enough to stop them from getting on with their daily lives (ii).
Endometriosis is also a condition that’s associated with the menstrual cycle, causing a range of symptoms.
But some women experience other period-related problems too.
Heavy periods (menorrhagia) can be very distressing, and according to Women’s Health Concern it’s one of the most common reasons for women to visit their GP (one in 20 sees their doctor each year for this problem, the charity claims)(iii).
Painful periods (dysmenorrhoea) is also very common, affecting around 80 per cent of women (iv). In fact, most women experience some degree of discomfort during their period, particularly on the first day. Some, however, have such severe pain that their lives can be disrupted.
Amenorrhoea is the term for not having any periods. This can affect women who have had a menstrual cycle in the past (secondary amenorrhoea) or young women of menstrual age – usually 16 – who still haven’t started their periods (primary amenorrhoea).
Irregular periods usually means your menstrual cycle differs widely from a regular cycle that lasts around 28 days (that is, it’s 28 days from the start of one period to the next) and causes bleeding of three to seven days each cycle. It can also describe periods that are very heavy or very light.
Cyclical breast pain – or mastalgia – is also linked to the menstrual cycle as women who are affected by it experience pain during their periods. Symptoms often start one to three days before the start of a period and improve by the time a period ends.
What happens during a period
In biological terms, the menstrual cycle is split into two phases: the follicular phase, which lasts on average from days one to 14, and the luteal phase from days 15 to 28. During this time, the key hormones involved are the sex hormones oestrogen, progesterone, follicle-stimulating hormone (FSH) and luteinising hormone (LH).
Here’s what happens during an average cycle:
The day your period starts marks the beginning of the cycle. In terms of hormones, your levels of oestrogen and progesterone are low while your brain starts producing follicle-stimulating hormone (FSH), which stimulates the growth of new egg follicles. If you have PMS, you’ll usually start feeling much better during this phase. But if you suffer from painful periods (dysmenorrhoea) or menstrual migraines, your symptoms will usually start kicking in about now.
During the four or five days after your period finishes, your hormone levels are still relatively low. Right now most women feel good because their energy levels and concentration abilities are at their peak. During this time, your brain continues to produce FSH while the follicles in your ovaries start producing more oestrogen.
For the next three or four days your oestrogen levels start to rise while tiny amounts of testosterone increase your sex drive. In biological terms, your body is preparing to release an egg, and you should feel more confident and assertive than usual.
Over the next few days your production of hormones goes into overdrive. Your oestrogen levels remain high and your brain produces a surge of lutenising hormone (LH). This triggers the release of an egg from one of your follicles – that is, the process of ovulation – usually around day 14 of your cycle. This is when you’re at your most fertile, and your sex drive should be at its peak.
Some women, on the other hand, experience a pain in their lower abdomen during ovulation (either on one side or the other). This can be dull or sharp, and can last anything from a minute or two to a couple of days. Some vaginal bleeding may also accompany the pain.
After ovulation, the follicle that released the egg becomes empty and turns into a gland called a corpus luteum. This gland secretes high levels of progesterone and oestrogen in preparation for the egg – which is travelling down one of your fallopian tubes – to be fertilised. The high levels of both progesterone and oestrogen at this time may be partly responsible for PMS symptoms.
During the next five or six days, oestrogen stays high and progesterone peaks. If you suffer from PMS it's likely your symptoms will now be at their worst. If the egg hasn’t been fertilised at the end of this phase, oestrogen and progesterone production stops, making your levels drop, and your period starts, marking the beginning of another cycle.
About 50 years ago, Professor Martha McClintock from the University of Chicago proved that women who live or work together often have their periods at the same time.
The effect is thought to be caused by pheromones, chemicals that have no smell but are detected by the vomeronasal organ in the nose. Pheromones produced in the late first half of your cycle, said Professor McClintock, can manipulate the timing of ovulation in other women. Nobody really knows why, but some experts believe there is an evolutionary benefit to women ovulating at the same time, as it means they may have babies at the same time.
Heavy or painful periods
Menorrhagia, or heavy periods, is caused by a higher than normal amount of bleeding. The amount of blood lost during a period can vary a lot between women, so whether or not you suffer from heavy periods boils down to what is normal for you. According to experts from the National Institute for Health and Care Excellence (NICE), five per cent of women aged 30 - 49 in the UK see their GP each year because of heavy bleeding during their period (vi).
The problem with heavy periods is that they can disrupt your daily activities and are often accompanied by pain. But in almost 50 per cent of cases, there is no underlying cause (vii).
If your periods become unusually or suddenly heavy, however, it's a good idea to see your GP, just to check that there's nothing else going on. Some causes of heavy periods, for instance, can include endometriosis, pelvic inflammatory disease, fibroids or polyps (non-cancerous growths), polycystic ovary syndrome (PCOS) or a intrauterine contraceptive device (IUD, or the coil).
What should you do?
There are various treatment options for menorrhagia. These include the combined contraceptive pill, an intrauterine system (IUS) that releases the hormone progestogen into your uterus and other treatments in tablet form.
You can also take over-the-counter anti-inflammatory painkillers (NSAIDs) such as ibuprofen, which have been shown to reduce blood loss by up to 40 per cent (viii). In more severe cases, there may be a need for one of several types of surgery.
To prevent anaemia, one of the side effects of long-term menorrhagia, you can also take iron tablets. These are also available over the counter at pharmacies.
The charity Women’s Health Concern suggests around 80 per cent of women experience period pain at some point (iv). And in around 5-10 per cent of women, the pain is so severe that it seriously affects their daily lives and activities.
The pain is generally felt in the lower abdomen, and sometimes in the back and thighs. This is caused by muscle cramps or spasms as your uterus (womb) tries to push out its lining, which is shed every time you have a period, causing bleeding.
Period pain normally lasts from 48-72 hours. It’s usually at its worst when the bleeding is heaviest. Some women may also be affected by other symptoms such as headaches, nausea, dizziness, light-headedness, tiredness and diarrhoea.
While period pain is a normal part of the menstrual cycle, in some cases there may be another cause, such as fibroids, pelvic inflammatory disease or endometriosis. So if you experience a big change in your periods, always see your GP so that any underlying problem can be ruled out.
What should you do?
For most women, period pain can be treated at home with over-the-counter painkillers, particularly anti-inflammatory painkillers such as ibuprofen. If simple painkillers don't do the trick, your GP can prescribe stronger medicines.
Women who have severely painful periods may also be advised to take a combined oral contraceptive pill, which can help in many cases.
Meanwhile there are other things you can do help yourself. Heat pads can ease the pain in your abdomen if you apply them where it hurts – try using a hot water bottle (but be careful not to use water that's too hot). Alternatively a warm bath or shower can provide relief.
Some experts also claim exercise can help when you have period pain – even though it may be the last thing you feel like doing. A gentle walk, for instance, may do the trick.
See our guide to pain relief remedies for more top tips on how to manage pain.
Irregular or absent periods
If your period is early or late, and you never know how long it's going to last or how heavy it's going to be, then your periods are described as irregular. The time when you're most likely to have irregular periods is during puberty or in the run-up to the menopause.
There are also various things that can affect your hormones and make them unbalanced – such as PCOS, stress, a thyroid disorder, losing an extreme amount of weight or excessive exercising – all of which can result in irregularity. For a range of in-depth articles on PCOS, feel free to visit our dedicated PCOS Hub.
If your period is suddenly late, however, it could be a sign that you're pregnant (in which case a home pregnancy test kit may be what you need to put your mind at rest, one way or the other).
Otherwise see your GP if your periods last for longer than seven days, if you have bleeding or spotting between periods or if your periods come less than three weeks apart.
The approach you should take with regards to irregular periods will depend on whether something is causing the problem. Girls and younger women who have irregular periods may not need any treatment at all, as it may be caused by hormone changes that are common during puberty.
But if you’re older and you have PCOS, for instance, you may need hormone treatment or prescription medicines. If you have a thyroid disorder, taking medication to treat an overactive or underactive thyroid should see your menstrual cycle return to normal.
Changing your contraception may also help in certain cases. If stress is the problem, learning some relaxation techniques may do the trick too.
Read our helpful guide for more information on how to cope with irregular periods.
Lack of periods
Amenorrhoea, or absent periods, is when your periods don't start at all (primary amenorrhoea) or when they stop for six consecutive months or more (secondary amenorrhoea).
There are many reasons why you may have secondary amenorrhoea. You may, for instance, have an underlying medical condition such as PCOS, heart disease, an overactive thyroid, uncontrolled diabetes or premature ovarian failure. More common reasons, however, include the following:
You may be pregnant.
You may be under a lot of stress.
You may have lost or gained a lot of weight.
You may be exercising too much (running more than 50 miles a week, for instance, can make you significantly more likely to have amenorrhoea (x)).
You may be going through the menopause.
You may be taking the contraceptive pill.
Like irregular periods, if you have amenorrhoea the treatment will usually depend on what's causing the problem. If you’re not pregnant and you’ve missed more than three periods in a row, see your GP, who can also talk you through the various treatment options.
Natural remedies for period problems
With one in 10 women thought to be affected by heavy periods, one of the most common consequences of period problems is low iron levels and, for those who have very heavy periods, iron-deficiency anaemia. Taking an iron supplement is the conventional treatment for anaemia, with one study suggesting taking iron supplements might even help reduce menstrual bleeding in women with menorrhagia and anaemia (xi).
If you’re diagnosed with anaemia, your GP will most likely prescribe an iron supplement to correct the deficiency. You can also protect against iron deficiency by taking a good-quality multivitamin and mineral supplement – look for one with a good spread of nutrients, including iron, vitamin B6, selenium, chromium and iodine.
On the other hand, if you suffer from cramps and painful periods, there is some evidence that taking a magnesium supplement may be useful. A couple of double-blind, placebo-controlled studies involving women with dysmenorrhoea suggests taking magnesium may significantly improve symptoms (one of the studies suggests magnesium may work by reducing levels of a prostaglandin (hormone) thought to cause period pain) (xii). More recently, experts investigating the use of magnesium in several women’s gynaecological health conditions suggest magnesium supplements may be effective for the prevention of dysmenorrhoea, PMS and menstrual migraine (xiii).
The omega-3 fatty acids found in fish oils – called eicosapentaenoic acid (EPA and docosahexaenoic acid (DHA) – are widely considered to help reduce inflammation, which may soothe period pain. Indeed, there is some evidence that suggests omega-3s may relieve dysmenorrhoea by affecting the metabolism of prostaglandins and other factors that cause pain and inflammation (xiv).
The study, where female volunteers received 1,080mg EPA and 720mg DHA every day for two months, showed the women experienced significantly less period pain compared to when they were taking a placebo (dummy pill) for two months.
Another study has also found that taking omega-3 supplements reduces the symptom intensity of primary dysmenorrhoea (xv).
Meanwhile, many women with allergies such as asthma claim their allergy symptoms are worse during their period (xvi). In such cases, a supplement containing anthocyanidins may be worth trying. Anthocyanidins – antioxidant compounds belonging to the flavonoid family of plant chemicals – are thought to suppress the body’s allergic responses. They can be found in the skin of dark and richly coloured fruit, such as blueberries, blackberries, raspberries and red grapes, as well as in supplement form.
A supplement that contains a substance called PEA may also help with pain and inflammation. Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xvii), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xviii) with no known side effects (xvii).
Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xvii). When this happens, PEA supplements may be helpful. In fact a review of 16 clinical trials and meta-analysis of PEA suggests it does have analgesic actions – in other words it helps to relieve pain (xix).
Experiencing troubles with your period can be difficult at the best of times – but this guide should help to ease some of the symptoms. For more helpful articles on a range of health conditions, feel free to visit our health library.
Available online: https://www.nhs.uk/conditions/periods/fertility-in-the-menstrual-cycle/
McClintock MK. et al., Menstrual Synchrony and Suppression. Nature 229. 1971;244-245. Available online: https://www.nature.com/articles/229244a0
Beebeejaun . Y., Varma R., Heavy Menstrual Flow: Current and Future Trends in Management. Rev Obstet Gynecol. 2013;6(3-4):155-164. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002192/
Available online: https://www.nhs.uk/conditions/period-pain/
Speed C. et al., Exercise and menstrual function. BMJ. 2007 Jan 27;334(7586):165. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781987/
Taymor. ML, Sturgis. SH, Yahia. C. The etiological role of chronic iron deficiency in production of menorrhagia. JAMA. 1964;187:323-327. Available online: https://jamanetwork.com/journals/jama/article-abstract/1161803
Seifert. B, Wagler. P, Dartsch. S, et al. Magnesium—a new therapeutic alternative in primary dysmenorrhea. Zentralbl Gynakol. 1989;111:755-760. Available online: https://pubmed.ncbi.nlm.nih.gov/2675496/
Fontana-Klaiber. H, Hogg. B. The therapeutic effects of magnesium in dysmenorrhea. Schweiz Rundsch Med Prax. 1990;79:491-494. Available online: https://europepmc.org/article/med/2349410
Parazzini . F, Di Martino. M, Pellegrino. P. Magnesium in the gynecological practice: a literature review. Magnes Res. 2017 Feb 1;30(1):1-7.Available online: Available online: https://pubmed.ncbi.nlm.nih.gov/28392498/
Harel. Z, Biro. FM, Kottenhahn. RK, et al. Supplementation with omega-3 polyunsaturated fatty acids in the management of dysmenorrhea in adolescents. Am J Obstet Gynecol. 1996;174:1335-1338. Available online: https://pubmed.ncbi.nlm.nih.gov/8623866/
Rahbar. N, Asgharzadeh. Nm, Ghorbani. R. Effect of omega-3 fatty acids on intensity of primary dysmenorrhea. Int J Gynaecol Obtet. 2012 Apr;117(1):45-7.Available online: https://pubmed.ncbi.nlm.nih.gov/22261128/
Available online: https://www.asthma.org.uk/advice/triggers/hormones/
Clayton P. et al., Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021 May;22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/
Clayton P. et al., Palmitoylethanolamide: A Potential Alternative to Cannabidiol. J Diet Suppl. 2021 Nov;28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733
Gabrielsson . L, Mattsson. S, Fowler. CJ. Palmitoylethanolamide for the treatment of pain: pharmacokinetics, safety and efficacy. Br J Clin Pharmacol. 2003;110:359-362.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094513/
Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.