Salud menstrual

What is menstruation?
Can tracking my period help me plan for or prevent a pregnancy?
What is “normal” during my period? What is not “normal”?
Menstrual Disorders
Endometriosis
Heavy menstrual bleeding (HMB)
Premenstrual dysphoric disorder (PMDD)

Polycystic ovarian syndrome (PCOS)
Uterine Fibroids
Why can it take so long for menstrual disorders to be diagnosed?
What do I do if I think I have a menstrual disorder or problem?
Menstrual Health Resources
Resources for Providers
Share Your Thoughts With VDH!

Menstrual health matters. Our periods are a key indicator of our reproductive health and overall health. Learning more about our cycles helps us understand our bodies and fertility.

What is menstruation?

Menstruation, often referred to as a person’s period or menses, occurs when the lining of the uterus (endometrium) sheds. Periods occur about once every 28 days. People often start their periods between the ages of 8 and 15. Periods stop during menopause. The average age of menopause is 51.

Can tracking my period help me plan for or prevent a pregnancy?

Yes. When practiced correctly, natural family planning methods like tracking your period can help someone predict when they are most likely to be fertile. Virginia’s family planning clinics offer information and guidance about natural family planning methods.

What is “normal” during my period? What is not “normal”?

Everyone’s body is different, and bodies can change in different stages of life; what is “normal” can vary from one person to another. That said, some common period symptoms include headaches, bloating, mood changes, breast tenderness, acne, and trouble sleeping. Sometimes periods are irregular or cause significant discomfort. A person’s period may not follow a regular pattern, feel very painful, or make it hard to do everyday activities. These may be signs of a menstrual disorder.

(Source: Cleveland Clinic)

Menstrual Disorders

Uncommon symptoms, like those listed above, may be the sign of an underlying menstrual problem. Below is more information about some common menstrual disorders. It is possible to have more than one menstrual health disorder.

You know your body best. Talk to your healthcare provider if something does not feel right, you are in pain, or if you think you might have a menstrual disorder.

Endometriosis

Endometriosis is a condition where the tissue that forms the lining of the uterus (endometrium) is found outside the uterus. Up to 10% of people who menstruate have endometriosis. The cause of endometriosis is not well understood.

Common signs and symptoms of endometriosis include:

• Consistent pelvic pain, especially just before and during periods.
• Pain during sex
• Heavy bleeding

Endometriosis resources

• ACOG’s FAQs about Endometriosis
• Below the Belt, a PBS documentary that discusses the challenges many people face in diagnosing and treating this condition.
• Endometriosis Foundation of America, a national organization focused on research, advocacy, education, and awareness
• My Endometriosis Team, a free social network for people with endometriosis
• Virginia HOPE, a Virginia-specific resource for information and education about endometriosis

Heavy menstrual bleeding (HMB)

Approximately one-third of people who menstruate seek treatment for heavy menstrual bleeding. Bleeding is considered “heavy” if it:

• Lasts more than 7 days
• Soaks through one or more tampons or pads every hour for several hours in a row
• Requires wearing more than one pad at a time
• Requires changing pads or tampons during the night
• Includes blood clots that are as big as a quarter or larger

Heavy menstrual bleeding is sometimes caused by a menstrual disorder like endometriosis or polycystic ovarian syndrome (PCOS), but it can be caused by a variety of other conditions.

Heavy menstrual bleeding resources

• ACOG’s FAQs about heavy menstrual bleeding

Premenstrual dysphoric disorder (PMDD)

Premenstrual syndrome (PMS) is normal and affects nearly everyone who menstruates. Common PMS symptoms include irritability, cramping, bloating, and breast tenderness in the 1-2 weeks before menstruation. PMS symptoms can largely be treated with over-the-counter pain medication, heating pads/warm baths, and exercise.

Premenstrual dysphoric disorder (PMDD) is when these symptoms disrupt someone’s social, academic, personal, professional, and sexual life. Approximately 5% of people who menstruate have PMDD.

Symptoms of PMDD include:

• Depresión
• Tearfulness
• Loss of interest in usual activities

• Feeling overwhelmed and out of control
• Low energy
• Big changes in appetite and sleep

PMDD resources

• ACOG’s expert post about PMDD
• IAPMD: Support, information, and resources for those affected by Premenstrual Dysphoric Disorder and Premenstrual Exacerbation

Polycystic ovarian syndrome (PCOS)

PCOS is a condition where the ovaries produce excess hormones called androgens. High androgen levels can interfere with ovulation and cause the ovaries to release an egg sporadically or not at all. High androgen levels can also affect ovarian follicles (the sacs where eggs grow), increase hair growth, and cause acne. Up to 15% of people who menstruate have PCOS. The causes of PCOS are not fully understood, but research suggests that PCOS is caused in wholly or in part by a hormonal imbalance.

Common signs and symptoms of PCOS include:

• Irregular periods
• Esterilidad
• Obesidad
• Excess hair growth
• Severe acne
• Oily skin
• Patches of thickened, velvety, darkened skin (acanthosis nigricans)
• Ovarian cysts

PCOS resources

• ACOG’s FAQs about PCOS
• The National Institute of Health’s webpage about PCOS
• The PCOS Awareness Association, an organization that offers information and support about this condition.

Uterine Fibroids

Uterine fibroids are benign (non-cancerous) growths that form on the uterus. These growths can form inside the uterus or on the outer wall. They can be as small as a pea to more than 6 inches wide. Fibroids can grow slowly over a period of years or grow rapidly. Uterine fibroids are very common; up to half of all people with uteruses have fibroids by age 50. The cause of uterine fibroids is not well understood, but research suggests they may be related to a person’s hormones or genetics.

Common symptoms of uterine fibroids include:

• Changes in menstruation
• Pain or cramps in the abdomen or lower back
• Pain during sex
• Pressure or pain that makes you urinate frequently or makes it difficult to urinate or have a bowel movement
• Enlarged uterus or abdomen
• Miscarriages or infertility

Uterine fibroids resources

• ACOG’s FAQs about uterine fibroids
• The Fibroid Foundation

• MedlinePlus's page about uterine fibroids
• The White Dress Project

Why can it take so long for menstrual disorders to be diagnosed?

Unfortunately, menstrual disorders can take several years to be diagnosed. For endometriosis, the average time for diagnosis is 5-12 years. For PCOS, a diagnosis often takes over two years and requires visits with three or more health providers.

The reasons for this are complex. People may wait years after they first experience symptoms before they seek help. They may be unaware of the symptoms, used to the symptoms, or think the symptoms are normal. They may suspect something is wrong but feel scared to be diagnosed. They may lack access to healthcare or have cultural beliefs that make them hesitant to engage with healthcare systems. Once receiving care, for many reasons, it can still take years to reach an accurate diagnosis. Folks may mistake their symptoms for something else, or they may think symptoms are normal. Some providers may not have the medical tools, training, or expertise to identify and treat menstrual disorders. Gaps in the healthcare system can also contribute to someone waiting for a diagnosis; for example, patients may visit multiple providers to address their symptoms, but those providers may not communicate or work together.

If you are experiencing the symptoms of concern, seek help from a provider. Your provider should take your pain and your experiences seriously. If your provider does not take your pain and your experiences seriously, you deserve a provider that does. Do not be afraid to look for another provider or to get a second medical opinion if you are not satisfied.

Waiting to find out why you are not feeling well can be hard and going to several doctor’s visits can feel exhausting. Your mental health is just as important as your physical health, particularly when waiting for a diagnosis. It is natural to experience uncertainty or stress during this time. Prioritizing emotional care and seeking support when needed are important steps in supporting yourself while awaiting further information.

(Sources: Time to Diagnose Endometriosis: Current Status, Challenges and Regional Characteristics—A Systematic Literature Review, Delayed Diagnosis and a Lack of Information Associated With Dissatisfaction in Women With Polycystic Ovary Syndrome)

What do I do if I think I have a menstrual disorder or problem?

If your periods are making you very uncomfortable or you think you may have a menstrual disorder, make an appointment with a gynecologist or women’s health provider. Your provider may recommend a series of tests and treatments, including but not limited to:

• Physical exam to better understand symptoms
• Ultrasound to visualize cysts
• Lab work to measure hormonal level

• Hormonal contraception to manage symptoms
• Pain medication to manage pain
• Cirugía