It’s not unusual for your periods to change over time. Bleeding can get heavier or lighter, and cramps can come and go. But sometimes, changes in your menstruation can be the sign of a problem. Endometriosis, fibroids, pelvic inflammatory disease (PID) and sexually transmitted infections (STIs) can all cause menstrual problems. Find out what’s normal when it comes to periods, and when you should seek help. Are my periods normal? Most women have a period every 28 days, although anywhere between 21 and 40 days is normal. Generally, a period will last about five days. Your bleeding will be heaviest in the first few days. At this stage it’s usual for the blood will be very red. After that it will change to pink and then brown or black as the bleeding gets lighter. Most women lose around 2 or 3 tablespoons of blood during their period. It’s very common to get cramps that start just before you get your period and last for up to three days. If you’re experiencing period pain, there are some things you can do to help. While exercise may be the last thing on your mind, just going for a walk can relieve your cramps. You can also try over-the-counter painkillers. If you’re finding it hard to cope with the bleeding or the pain, it could be a sign of a problem. What counts as a heavy period? You may already suspect you have heavy periods but it can be hard to be sure. One way to tell if your periods are heavier than they should be is if you’re getting through a sanitary pad every hour or two or have to get up in the night to change your pad. Another sign is if you have clots of blood that are bigger than a ten pence piece<localise>. When should I get help for my heavy and painful periods? If you’re bleeding so much that it’s making your life difficult, it’s time to get it checked out. Even if nothing serious is causing your heavy periods, losing extra blood each month can lead to an illness called anaemia. Anaemia can make you feel unwell and very tired. Get checked out too if: What’s causing the changes to my periods? If you’ve just started taking the pill or another hormonal contraceptive, you’ll probably notice your periods changing. They should settle into a regular pattern again after a few months. Intrauterine devices (IUDs) can cause your periods to get heavier but they shouldn’t be so heavy you can’t cope. If you don’t think either of these are to blame, you could have one of these conditions. They are all treatable, so talk to MSI about getting help. Fibroids Fibroids are lumps which grow in or around the womb. They’re not cancerous. As well as painful, heavy periods and bleeding between periods they can cause: They can vary in size from a pea to a melon. The bigger they are, or the more fibroids you have, the more likely it is you’ll get symptoms. Depending on how badly affected you are, they can also be to blame if you’re finding it hard to get pregnant. Pelvic inflammatory disorder or disease Pelvic Inflammatory disease (PID) can be caused by sexually transmitted infections (STIs) like chlamydia and gonorrhoea that aren’t treated properly. PID can cause pain in your lower tummy and bleeding between periods or when you have sex. Your vaginal discharge may change and you can sometimes have a fever too. Ovarian cysts These sacs filled with fluid grow on your ovaries and are very common. They usually go away on their own without you even noticing them. But if they get very big, they can cause heavy periods and pain in your lower tummy. Endometriosis Endometriosis can cause very heavy, painful or irregular periods that are very difficult to manage. Endometriosis can also lead to infertility. Endometriosis pain is usually worse during your period, but it can last throughout the month. It can also be worse when you wee or poo. You might also have pain during or after sex and feel sick, have constipation or diarrhoea. Ectopic pregnancy An ectopic pregnancy is when a baby starts to grow outside your womb. You’ll usually miss your period but if it does arrive, it will look watery and dark brown. You may also have pain in your lower tummy down one side. An ectopic pregnancy can’t be saved. It can become life-threatening if it gets big enough so it needs urgent treatment. Where can I get help for painful, heavy or irregular periods? If your periods have changed or you think you may have one of these conditions, get in contact with one of our MSI providers. While you wait for your appointment, start keeping a diary of symptoms. It may help us work out the best treatment for you so that you can soon be on the way to recovery. Sources [All accessed November 2020]: CDC. 2017. Heavy menstrual bleeding. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html CDC. 2018. Common reproductive health concerns for women. Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/womensrh/healthconcerns.html CDC. 2020. Pelvic inflammatory disease (PID). Centers for Disease Control and Prevention. https://www.cdc.gov/std/pid/stdfact-pid.htm Kaunitz AM. 2020. Heavy of prolonged menstrual bleeding (Beyond the basics). UpToDate. https://www.uptodate.com/contents/heavy-or-prolonged-menstrual-bleeding-menorrhagia-beyond-the-basics Muto MG. 2020. Ovarian cysts: beyond the basics. UpToDate. https://www.uptodate.com/contents/ovarian-cysts-beyond-the-basics NHS 2018. Ectopic pregnancy. NHS, Health A-Z. https://www.nhs.uk/conditions/ectopic-pregnancy/symptoms/ NHS. 2019b. Period problems. NHS, Health A-Z. https://www.nhs.uk/conditions/periods/period-problems/ NHS. 2019a. Periods: overview. NHS, Health A-Z. https://www.nhs.uk/conditions/periods/ NHS. 2019c. Ovarian cyst. NHS, Health A-Z. https://www.nhs.uk/conditions/ovarian-cyst/ NICE. 2018a. Dysmenorrhoea. NICE Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/dysmenorrhoea NICE. 2018b. Menorrhagia. NICE Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/menorrhagia NICE. 2018c. Fibroids. NICE Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/fibroids/ NICE. 2018d. Ectopic pregnancy. NICE Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/ectopic-pregnancy NICE. 2019. Pelvic inflammatory disease. NICE Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/pelvic-inflammatory-disease/diagnosis/assessment/ NICE. 2020. Endometriosis. NICE Clinical Knowledge Summaries. https://cks.nice.org.uk/topics/endometriosis
How can I have a healthy pregnancy?
Now that you’re pregnant, it’s more important than ever to take care of yourself both physically and emotionally. From check-ups at the clinic to planning your baby’s birth, the right antenatal care (ANC) will help you to have a safe and healthy pregnancy. Here’s what you need to know. What kind of antenatal care do I need? Antenatal care (ANC) is the healthcare and support you have while you’re pregnant. It will help to make sure you and your baby are well throughout your pregnancy. Getting ANC is the most important step you can take to having a healthy pregnancy. So as soon as you know you’re pregnant, start your ANC by contacting our friendly and supportive MSI providers. Your care will include regular check-ups. These change as your pregnancy progresses. At the start you may have blood tests to check for any health issues that could affect your pregnancy or your baby. Later on, you’ll have your blood pressure measured and you may be asked to do urine tests to check for signs of a pregnancy condition called pre-eclampsia. Pre-eclampsia can cause serious problems for you and your baby if it isn’t monitored and treated. About halfway through your pregnancy you’ll be offered a scan to see how your baby is developing. Although the scan is done for medical reasons, it’s very exciting to see your baby for the first time. At your antenatal appointments you can ask your provider any questions you have. Write them down so you don’t forget. You can also speak with someone in confidence if you need extra support. Use this opportunity to get help if you’re experiencing domestic violence or emotional abuse. Which foods should I eat for a healthy pregnancy? The more varied your diet is, the more likely you are to get the nutrients you and your growing baby need. Try to eat some of these foods every day: Should I take a vitamin supplement? When you’re pregnant, there are some nutrients that are hard to get from food alone. So all pregnant women should take a folic acid tablet for the first 12 weeks of pregnancy. Folic acid is a vitamin that prevents a problem with your baby’s spine. You may also need extra vitamin D and iron to help your baby grow. Your MSI provider can give you more information about supplements. What’s not safe to eat in pregnancy? Some foods aren’t safe while you’re pregnant. They include: It’s not just what you’re eating but also how you store and prepare food that is important. During pregnancy your immune system doesn’t work as well as usual, so you need to be extra careful about food hygiene. These tips will help you stay safe: Is it safe to exercise in pregnancy? Yes. Just be careful to avoid activities that may cause you to fall over or strain your joints. Keeping active during pregnancy boosts your chance of a shorter labour. Regular exercise will also help you maintain a healthy weight and can prevent low back pain and pelvic pain. Aim for a mixture of activities that raise your heart rate, such as brisk walking, swimming or running, and strength-building exercise, such as using light weights and yoga. You don’t need any special equipment. There are lots of free exercise videos online that can give you ideas for safe workouts at home. How should I plan for my baby’s birth? You’ll feel more confident about giving birth to your baby if you know what to expect. There may also be aspects of your labour and delivery where you have some choices, so thinking about what you want will help you feel prepared. Your MSI provider can talk to you about your options for: You can write your choices down in a birth plan which you can share with the team who look after you during your labour. Remember you’ll need to be flexible; labour doesn’t always go to plan. How can I get support during my pregnancy? Many women feel like they’re on an emotional rollercoaster during pregnancy. One moment you’re excited about becoming a mum, the next overwhelmed. One of the best ways to reduce stress is simply by talking. Find someone you trust and tell them how you’re feeling. It could be your husband, a friend or a family member. Or an online community for mums-to-be can be a great place to vent. You may find you that you need more practical support, particularly at the start and end of your pregnancy, when tiredness is a problem. If you’re struggling at work, talk to your employer to see if any adjustments can be made to your role. If it’s household chores that are getting you down, ask your husband or another family member to help you. Or you may want to pay for help during your pregnancy and after your baby arrives. It can be a very busy time. Sources [All accessed November 2020]: Agampodi TC, Agampodi SB, Glozier N, et al. 2019. Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH). BMJ Open 9(7):e027781. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31289074/ CDC. 2020. During pregnancy: preventing problems. Centers for Disease Control and Prevention. https://www.cdc.gov/pregnancy/during.html Haakstad LAH, Bø K. 2020. The marathon of labour-Does regular exercise training influence course of labour and mode of delivery?: Secondary analysis from a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 251:8-13. https://pubmed.ncbi.nlm.nih.gov/32460116/ Hashmi AH, Paw MK, Nosten S, et al. 2018. ‘Because the baby asks for it’: a mixed-methods study on local perceptions toward nutrition during pregnancy among marginalised migrant women along the Myanmar-Thailand border. Glob Health Action. 2018;11(1):1473104. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/29785874/ Hunter-Adams J, Rother H-A. 2016. Pregnant in a foreign city: A qualitative analysis of diet and nutrition for cross-border migrant women in Cape Town, South Africa. Appetite 103:403-410. https://pubmed.ncbi.nlm.nih.gov/27166078/ Lander RL, Hambidge KM, Westcott JE, et al 2019. Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That
