Best Treatments for Painful or Irregular Periods

The menstrual cycle is the monthly hormonal sequence a female’s body experiences in preparation of pregnancy. Menstruation typically consists of shedding the lining of the uterus. Periods, menses, and menstrual periods are different terms used to describe the menstrual cycle.

The menstrual cycle, often called “the period,” may vary between individuals, and it can change from month to month due to stress, natural hormonal changes, or starting on hormonal birth control. However, sometimes, irregular menstrual cycles can be signs of certain underlying problem.

As mentioned, natural hormonal changes are often the reasons behind irregular periods. Specifically, irregular periods often occur more frequently during puberty, when you first begin menstruating (typically between ages 9 and 14), or when you start approaching menopause, called perimenopause (around age 50 or just before menopause).

Irregular periods are also common after childbirth and breastfeeding. Breastfeeding suppresses ovulation, causing periods to stop.

Menstrual cycle and its variations

The menstruation cycle is usually 28 days from the first day of monthly periods (start of bleeding) and goes until the next period cycle. It differs (21-35 days) depending upon different factors. The reproductive age typically starts between the ages of 8 and 12 for most girls and ends between the ages of 45 to 55.

Menstruation or menstrual bleeding remains between 3 to 7 days. During the menstrual cycle, hormones are released from different organs, including the pituitary and reproductive system (ovaries). Various hormones lead to 4 distinct phases of the menstrual cycle.

Menses phase

The first phase of the menstruation cycle is when infertility of the egg planted in the uterus is confirmed. The lining of the uterus starts to shed, resulting in menstrual bleeding. The blood flow lasts between 3 to 7 days.

Follicular phase

Estrogen hormone thickens the walls of the uterus. This phase lasts from day 6 to day 14. The eggs mature during this phase.

Ovulation

The ovulation process, where the egg is released from the ovaries, results on the 14th day.

Luteal phase

This is the last phase of the cycle. The egg travels from the fallopian tube to the uterus from day 15 to day 28. A hormone called progesterone is released to prepare the uterus for pregnancy. If the egg doesn’t receive sperm to be fertile, the progesterone level drops, and the menstrual periods start.

The duration of the menstrual cycle varies from person to person. Age plays a significant role in the variation of the menstrual cycles. Earlier in a woman’s life, she may experience a more extended period with less blood flow. With age, menstruation may become more regular with heavy menstrual bleeding. Near menopause (end of menstrual cycles), increased bleeding and shorter, irregular cycle intervals can occur.

What are irregular or painful periods?

An irregular period can be any change experienced during a menstrual period or any characteristic that is not typical for a normal menstrual period. It can be anything from the duration to the amount of bleeding during that cycle. These irregular periods can even be painful at times. Examples of irregular menstrual cycles (or irregular menstruation) are:

Periods longer than seven days
Much heavier or lighter menstrual bleeding than usual
More severe abdominal pain than usual
Irregular bleeding or spotting happening between periods
Not having a period for more than three months (unless pregnant)
The time between periods is less than 21 days or more than 35 days

Causes of irregular periods

The irregular period can influence your overall health and life satisfaction. Communicating with your healthcare provider about your reproductive health whenever you undergo notable shifts in your menstrual pattern is essential. Many causes of period irregularity can be managed or corrected with assistance from your doctor.

Hormonal imbalance

Physiological changes in the body can also lead to hormonal imbalance, which can affect your menstruation. The main hormones responsible for the regular cycle are estrogen and progesterone. Variations in the levels of these hormones can cause irregular periods.

Polycystic ovary syndrome (PCOS)

PCOS disturbs regular ovulation (egg release from ovaries), releasing either none or more than one egg. This condition usually affects your body's metabolism. Therefore, weight gain is a significant problem. PCOS is considered one of the main causes of irregular periods.

Thyroid problems

Thyroid hormones directly interfere with ovaries, resulting in changes in the ovulation phase. Thyroid problems can change the menstruation cycle and cause irregular periods.

Reproductive medical conditions

Endometriosis, pelvic inflammatory disease, uterine fibroids, and adenomyosis affect ovaries and disturb the hormonal balance, causing heavy periods or abnormal bleeding.

Uterine or ovarian cancer

Some cancers can potentially impact an individual's menstrual period, causing unusually heavy bleeding or the absence of periods.

Other medical conditions

Medical conditions, stress, eating disorders, blood disorders, and hormonal birth control pills, can contribute to irregular periods.

Blood thinners

Aspirin, warfarin (Jantovan), rivaroxaban (Xarelto), apixaban (eliquis) are some examples of blood thinners. These medications work to prevent blood clots. However, they can also cause heavy bleeding during menstrual cycles.

Symptoms

Symptoms of irregular periods include:

Abnormal uterine bleeding
Heavy menstrual bleeding
Menstrual cramps
Prolonged menstrual bleeding
Irregular bleeding
Missed periods
Menstrual pain
Emotional symptoms, such as mood swings, stress, or depression

Diagnostic techniques

Physical examination

A comprehensive physical examination is crucial to investigate painful and irregular periods.

A general assessment of the individual's medical history, medications, surgeries, lifestyle, and stress factors are considered. A breast examination is conducted to identify any irregularities or breast tenderness.

The patient's menstrual history is reviewed, including onset, regularity, flow, and clotting. Vital signs and Body Mass Index are measured to understand overall health.

A pelvic examination is performed, which involves assessing the vaginal area for abnormalities using a speculum.

Blood tests

These tests are valuable tools to identify the root cause of menstrual irregularities. Below are the standard tests used to diagnose a menstrual irregularity:

Hormone levels

Progesterone, thyroid-stimulating hormone (TSH), thyroid Hormones (T3, T4), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, and prolactin are detected through blood tests.

Complete Blood Count (CBC)

A complete blood profile showing red blood cells, white blood cells, and platelet levels.

Blood glucose and insulin levels
Androgen and cortisol levels
Inflammatory markers

C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) levels are also included in tests to diagnose irregular periods.

Diagnostic tools

Ultrasound

Ultrasounds are non-invasive and provide real-time imaging without radiation. There are two primary types of ultrasounds used for this purpose:

Transabdominal ultrasound: A gel is applied to the patient's abdomen, and the transducer is moved over the gel to emit sound waves to show the size, shape, and position of the uterus or ovaries. They detect abnormalities such as fibroids, thickening of the uterine lining (endometrium), ovarian cysts, or abscesses.
Transvaginal ultrasound: A thin lubricated transducer is inserted into the vagina. It allows for a more detailed and precise examination. It is primarily used in polycystic ovary syndrome (PCOS), which can lead to irregular and painful periods.

Endometrial biopsy

This is a diagnostic procedure used to collect a small sample of organ tissue from the uterus lining, called endometrium, for analysis. A speculum is inserted into the vagina to view the cervix. A thin, flexible tube, called a catheter, is used with an attached device to collect small endometrial tissue samples, which are then sent to a laboratory for complete analysis.

Best treatments for painful or irregular periods

Lifestyle Changes

Diet and exercise: Regular exercise or physical activity promotes hormonal balance, reduces stress levels, and helps you lose weight or maintain a healthy weight. People with sedentary lifestyles can lead to health issues. Engaging in activities like walking, swimming, yoga, and aerobic exercises can play a vital role in helping to regulate menstrual cycles.

While reaching a healthy weight is good, extreme weight loss or weight gain can disrupt the hormonal balance and lead to irregular periods. A balanced diet with regular exercise is a good combination for a healthy lifestyle. A balanced diet should be rich in whole grains, lean proteins, healthy fats, fruits, and vegetables.

Stress management: Yoga, meditation, and deep breathing exercises can help manage stress and promote hormonal balance. Engaging in activities and hobbies can lower stress and potentially treat irregular periods.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Uterine contractions are the culprits of painful periods and cramps. In these cases, over-the-counter pain medications like ibuprofen (Advil) and naproxen (Aleve) are often used to alleviate the symptoms of painful periods. Ibuprofen and naproxen are some examples of a drug class called non-steroidal anti-inflammatory drugs (NSAIDs).

In addition to pain relief, NSAIDs may also be helpful if you also have heavy periods. Nonsteroidal anti-inflammatory medications reduce the production of prostaglandins, the chemicals that trigger uterine shedding. Therefore, NSAIDs not only help reduce period cramps, but these medications also are helpful for those with heavy periods.

One thing to keep in mind is that aspirin, one of the NSAIDs, is not a suitable option for heavy periods. Aspirin, with its anti-clotting effect, may increase the bleeding amount.

Hormone medications and therapy

Irregular periods can occur due to the hormonal imbalance of estrogen and progesterone. Hormone therapy aims to restore hormonal balance in the body. This is particularly helpful for menopausal women with irregular periods.

Hormonal birth control

Estrogen or progestin are synthetic birth control pills used to prevent pregnancy. However, they can also work to regulate menstrual periods and reduce symptoms of painful periods caused by uterine fibroids, polycystic ovary syndrome (PCOS), and endometriosis. Hormonal birth control with progestin-only or the combination of estrogen and progestin are available as oral birth control pills, injections, and an intrauterine device (IUD). Some examples include:

Intrauterine devices (IUDs): these devices release a controlled amount of progestin hormone in your body. It thins the uterus lining, causing less tissue to shed during your period to lighten the flow of blood. They can also relax uterine muscles and reduce menstrual cramps.

Hormone-releasing contraceptives: these include birth control pills, patches, injections, vaginal rings, and hormones regulating menstrual cycles. They keep hormone levels steady and more predictable to regulate menstrual cycles, making your periods lighter and less heavy, with fewer painful cramps.

Surgical Procedures

Uterine artery embolization

Increased blood flow to the uterus can cause heavy bleeding. Uterine artery embolization blocks blood vessels, shrinks fibroids, cuts blood supply, and helps to reduce menstrual bleeding.

Endometrial ablation

Using various methods, such as heat and cold, the doctor gently removes the lining of the uterus, called the endometrium, to make periods lighter. Endometrial resection (removal) is done for patients who haven't found any relief through medications.

Surgical removal of endometrial tissue

The surgical removal of endometrial tissue is done through an incision in the abdomen with the help of a thin tool called a hysteroscope. It is done to help treat conditions like heavy bleeding or abnormal growth.

Treatments for Specific Conditions

Uterine fibroids

Treatment approaches for uterine fibroids are medication, non-invasive procedures, or surgical removal of the fibroids, depending on the size and symptoms.

Pelvic inflammatory disease (PID)

PID is typically treated with antibiotics to clear the infection and prevent complications.

Pelvic pain

Treating pelvic pain involves identifying the underlying cause and addressing it. It might include medications, physical therapy, or lifestyle changes.

Hormonal imbalances

Hormonal imbalances can be managed with hormone therapy or medications to restore proper balance.

Thyroid problems

Thyroid problems are found to be a cause of irregular periods. Treating thyroid issues involves medications or other therapies to regulate thyroid hormone levels.

Primary dysmenorrhea

Dysmenorrhea is the term used to describe painful periods and cramps. Primary dysmenorrhea can be life-long due to abnormal uterine contraction. Secondary dysmenorrhea is typically caused by a medical condition. Pain relievers, hormonal birth control, or lifestyle adjustments can alleviate menstrual cramps caused by primary dysmenorrhea.

Premature menopause

Hormone therapy and lifestyle adjustments can help manage symptoms of premature menopause.

Missed period

Treatment for missed periods depends on the underlying cause, ranging from lifestyle changes to medical interventions.

How to manage pain and symptoms

Heat therapy to the lower abdomen can help relax muscles and alleviate pain. OTC pain relief medications, staying hydrated, adopting regular exercise, eating a healthy diet, managing stress, getting adequate sleep, and tracking your periods, symptoms, and triggers can help treat irregular menstrual cycles.

When to see a healthcare provider?

You are advised to seek medical attention if you have severe pain, excessive bleeding requiring frequent changes of pads and tampons, or observe large clots during a menstrual period. These irregular cycles last less than 21 days or more than 35 days, or periods may be completely absent. It is necessary to get evaluated and treated in cases of severe pelvic pain or unusual vaginal discharge.

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