There are a variety of menstrual problems. The most common problem is excessive blood loss during your period. This selection table can help you choose your treatment.

 

But there can be other reasons why you have menstrual problems summarized as follows: 

 

• A heavy and/or painful menstruation can be caused by a polyp, a fibroid, an abnormality in the uterine muscle, or because you have an IUD. Sometimes no cause can be found for it.

 

• Very irregular menstruation or (almost) no menstruation is usually a hormonal problem. PCOS may be the most common cause and we refer you to that page.

 

• Premenstrual syndrome depends on how your body and mind respond to hormonal fluctuations. 

At Gynaecologie Amsterdam we first listen to your problems and do tests (e.g., a pregnancy test, a transvaginal (internal) ultrasound, and if necessary other tests). You will receive a menstrual calendar and after the tests, we will discuss the diagnosis and treatment options. Below are a few menstrual problems described in more detail.

 

Painful menstruation

Painful menstruation is usually due to the contractions of your uterus. Your uterus makes certain substances (prostaglandins) that cause your uterus to contract. Some medications counteract the action of prostaglandins, which reduces the menstrual cramp. These drugs are called NSAIDs, and you can often buy these drugs at the drugstore. Well-known examples are Ibuprofen and Naprosyn.

What research is being done? 

To start with, the doctor wants to know more about your period – how often do you have your period? When did your pain start and how much pain do you have? Then she wants to know which medicines you have used and when you have taken these medicines. 

After that, the doctor makes a vaginal ultrasound and if needed other examinations (e.g., a saline infusion sonography) to see if there are any abnormalities such as fibroids or polyps. And based on this, the treatment options are discussed. 

What treatment is possible? 

If you suffer from pain during your period, you can try the following things:

• Placing a warm jug against your sore belly or back
• Regular exercise. This appears to help with menstrual cramps
• Using painkillers that you can buy yourself in the drugstore

Using painkillers

Medicines such as Ibuprofen and Naprosyn (NSAIDs) work best for cramps. The instructions for use (package leaflet) of the medicine state how often you can use these medicines. It is important to take the medicationS BEFORE the cramp is severe. As soon as the cramp starts, certain substances in the blood start to rise (prostaglandins), and then the medication is less effective. You can even take the medications just before your period and cramping will begin. You should always take the medications (NSAIDs) with food, to prevent irritation to your stomach. 

If regular medication does not work, there are other options available. The most common option is hormonal treatment (for example, the birth control pill or an IUD with hormones). These hormones are usually used to ensure that you do not get pregnant (contraception) but these hormones also often help well against the menstrual cramp. These hormones are an appropriate alternative way to treat menstrual cramps. 

Heavy periods with clots 

Excessive blood loss during your period can be very annoying. Your pads or tampons are always full or might even leak. You can also lose large lumps of blood (clots). On a calendar, you can write down how much blood you lose. Some treatments help if you lose a lot of blood during your period.

Which treatment suits you best depends on the cause of the loss of blood.

Medications that can help are:

• an NSAID (a strong painkiller), such as Ibuprofen, Diclofenac or Naprosyne
• a hormonal IUD
• pills (‘the pill’ or a pill with only progestogen) 
• tranexamine acid 

Treatment with medications if your blood loss is due to a copper IUD

If you have a copper IUD, you can take an NSAID or tranexamic acid, only on the days that you lose the most blood.

It is also possible to have the copper IUD removed. You can then opt for another contraceptive in consultation with your doctor at Gynecologie Amsterdam. Many women opt for a hormonal IUD.

Treatment with medications if you have a fibroid

If a fibroid (myoma) may be the cause, you can choose between:

• an NSAID
• pills with tranexamic acid
• the contraceptive pill (‘the pill’)
• a hormonal IUD

Sometimes surgery is needed and then you will be referred by Gynecologie Amsterdam.

Treatment if you have a polyp (benign tumor of the endometrium)

This can sometimes be removed on an outpatient basis and if not then you will be referred by us.

Endometriosis 

On the inside of the uterus is a mucous membrane layer, this is called the endometrium. Normally, this mucous membrane is only in the uterus. In endometriosis, there is tissue that resembles endometrium outside the uterus. For example, on the ovaries, the Fallopian tubes, the bands that support the uterus, the peritoneum, the bladder, and the last part of the intestine.

These pieces of tissue respond to hormones made by the ovary. Most women do not notice this, but some women get pain during or before their menstruation due to endometriosis. Other women have abdominal pain even when they are not on their period. It is estimated that 1 in 5 girls who have their period suffers from endometriosis. Endometriosis is more common in certain families.

Over time, the spots can cause bleeding, accumulation of blood, scarring in your abdomen, and causing pain.

What are the characteristics of endometriosis? 

Endometriosis can cause complaints, but that is not always the case. Sometimes it is discovered by chance. The complaints differ between women and per period. Which complaints you have, depends on the places where the spots are located. There is no relationship between the extent of the disease and how bad the pain is. Some women have a lot of endometrioses and have very little pain, while others have little endometriosis and suffer from very bad pain.

Other symptoms:

• Pain in the lower abdomen before and during menstruation. The pain can be convulsive, nagging, sharp, and stabbing and can radiate to your back or your legs. 
• Pain during sex
• Getting pregnant less easily

How is the diagnosis made? 

It is important to tell when the pain is present in relation to your period. A physical examination is usually done. This means an examination of the abdomen and sometimes an examination of the vagina and uterus and rectum. A vaginal ultrasound is made to see if there are any abnormalities. Blood tests and cultures can be done to make sure there is no other cause for the pain in your lower abdomen.

What treatment is possible at Gynecologie Amsterdam? 

The hormones used as contraception can also be used to diminish the effects of endometriosis or pain. The first choice of treatment is hormonal treatment such as ‘the pill’, the patch, the ring, a rod, or an IUD. Sometimes medication (gonadotropin-releasing hormone agonists (GnRH)) is prescribed to lower the production of hormones by the ovaries and reduce the pain from endometriosis. This is usually not the first choice when treating young girls, due to the possible effect on the bones (bone density) at that age.

More information about endometriosis can be found on the website of the patient association the Endometriosis Foundation. Here you can also read stories from patients and you can get in touch with other women with endometriosis.

Women are often asked to keep a detailed diary of their pain, periods, diet and defecation, and urination. The diagnosis is usually made based on the complaints you have. If there is no improvement after 3 to 6 months of treatment with medication, an MRI or a laparoscopy might be performed to see if there is endometriosis in the abdomen. You will be referred by Gynecologie Amsterdam.