Periods are extraordinary events, and it’s okay to skip them (Period blog #2)

Professor Sonia Grover’s first post on period pain has already been one of the most-read posts for 2017. In this next post of her popular and important series, Professor Grover shares her experience in some of the more unusual experiences that can occur with periods, such as nausea, vomiting, diarrhoea, headaches, or dizziness, and the medical approaches to dealing with these. Our thanks again to Professor Grover.

Learning from the unexpected

One of the things about working for some of the week at the Royal Children’s Hospital in Melbourne is that I get to see some pretty unusual problems. But it is these unusual problems that often teach us a whole lot of unexpected things. There are a few stories that I have collected over many years that have really influenced how I think about periods, their hormones and special substances. Also, along the way I have had a chance to do some research looking at the stories of many young women with period pain and been able to put all of that together.

Did you know that 40% of young women with period pain get nausea, 30% have vomiting, 30% get diarrhoea, 20% experience headaches, and other things like dizziness and fainting occuring in around 10%? And that we see some of these problems in young women starting before their very first period? Now, that does make it harder to work out when we first see these young women – but it all becomes pretty clear when the same problem occurs with, or just before, their first period. So if we were suspicious that the problem might be ‘period related’, then when that first period happens and the problem occurs, we can then say, ‘Ahhh! So it was due to period hormones and chemicals just beginning to start doing their pattern – but before the uterus had actually got itself completely ready to do the kill, peel, crumble, and bleed bit to its lining’. (See my previous blog for an explanation of these!).

Even stranger things

On top of that, we get to see some of the really unusual things, like the young teenager who had a history of mild asthma during her childhood. When she was about 12 she had a really, really bad episode of asthma that landed her in the intensive care unit (yes, that is bad asthma). Well, she ended up in the intensive care unit a second time, just over a month after that, with her second period. Her first admission to the intensive care unit had been with her first period…

Then there are the young women who get seizures occurring in a pattern with their period cycle – and this also often begins to happen when their puberty hormones are just switching on, that is, before their first period. And then there are the young women who have anaphylaxis happening only when they have a period (yes, I did use the plural there – we have seen this several times), or the ones who get a blood nose – regularly, but only on the day before a period. Fascinating stuff, isn’t it?

Hormones and chemicals – potent substances

But the important message to me here was that these apparently unrelated problems, asthma, vomiting, fainting, dizziness, diarrhoea, worsening asthma, nose bleeds, seizures, and anaphylaxis were all being caused by the hormones and chemicals related to making periods happen. That tells me that those chemicals are pretty potent substances, and if they can make all these things happen, then making some fantastic, ghastly uterus cramps doesn’t sound so extraordinary.

What can we do about it?

So, now you want to know how we fix all these whacky problems? Well, sometimes just knowing the explanation is enough to help young women manage the problem and prepare themselves, so that they don’t need to worry quite as much. But, if you are ending up in the intensive care unit then you might need to do something more. Equally, if you are missing school/uni/work due to severe vomiting every month, or having seizures every month, then just knowing isn’t enough.

If your body doesn’t produce all those chemicals to make that kill-crumble-peel-bleed job happen and if your hormones aren’t going up and down, then these things won’t occur. So the answer is often aiming for stable or constant hormones. But that also means no periods or skipping lots of periods.

Now, I can just hear you saying, ‘What?? No periods? Skipping periods? That’s not natural!’

Well, as I explain to my younger patients, often with their mothers present, ‘Can you just check with your mum how many periods she had when she was pregnant? None of course – for 9 months. Nothing wrong with that, it’s natural’.

So next, ‘Can you check with your mum how many periods your mum had when she was breastfeeding you?’ Well, most women have none, and depending on how much, how often and for how long women breastfeed, this can last for two, three or more years. So what about your great-great- grandmother, who had 15 kids and breastfed them all – how many periods do you think she had in her lifetime? Well we know that our great great grandmothers and those women in the world who are still having many children and breastfeeding them all have only 40 periods in their lifetime. Now – is not having periods such an unnatural thing to do? Nature actually meant us to be pregnant and to be breastfeeding, and certainly didn’t plan for us to have careers and only 1 or 2 children!!

Not in the textbooks

I always say that a lot of what I know has come from actually listening to my patients – they have taught me so much, and I have just been lucky to work in a place that has allowed me to hear these stories… Most of this stuff is not in the textbooks and not taught in medical school, so it is no surprise if your doctor doesn’t know about these things.

There are some more things that I have learnt from my patients who have uncommon conditions – but I’ll save them for another time, if you are interested.

– Sonia Grover

Professor Sonia Grover has extensive experience in paediatric and adolescent gynaecology having worked in this field for over 20 years. She has been instrumental in establishing this subspecialty in Australia as well as in Asia and internationally. Professor Grover’s clinical interests include all aspects of young women’s reproductive health – including menstrual problems (excessive bleeding and/or pain), amenorrhoea, ovarian problems, congenital anomalies affecting the reproductive tract and reproductive hormones and the cyclic exacerbation of ‘non-gynaecological symptoms’ including cyclic seizures, asthma, and chronic fatigue. Professor Grover’s ResearchGate profile here.

Sonia’s five-blog series:

#1: Period Pain
#2: Periods are extraordinary events, and it’s ok to skip them
#3: Heavy periods and retrograde bleeding
#4: Understanding the common by learning from the rare
#5: Ovulation Pain

Feature image adapted from Freepik.