Menstrual problems are common, and about 1 in 4 women have periods heavy enough to affect everyday life. A change in your bleeding does not always mean something is wrong, but it is worth having it checked, because many causes are straightforward to treat.

A menstrual cycle is counted from the first day of one period to the first day of the next. For most women a cycle lasts between 21 and 35 days, and bleeding lasts about 2 to 7 days. Cycles are often less regular in the first few years after periods begin, and again in the years leading up to menopause. What is normal varies from person to person, so the most useful comparison is with your own usual pattern.

It is a good idea to see a doctor if your periods change from your usual pattern. Reasons to check include periods that are heavier, more painful, or more irregular than usual, bleeding between periods or after sex, or periods that stop for a while when you are not pregnant. Any vaginal bleeding after menopause should always be checked. Dr Mahadik can look into the cause and discuss what can help.

Heavy periods, also called heavy menstrual bleeding, means losing enough blood that it gets in the way of your daily life. It is common and can usually be helped, so it is worth raising even if you have managed it for years.

Your periods may be heavy if you:

• Soak through one or more pads or tampons every 1 to 2 hours
• Need to use two types of protection at once, or change protection during the night
• Pass blood clots larger than a 20-cent coin (small clots can be normal)
• Bleed for longer than 8 days
• Feel very tired, dizzy, breathless, or look pale, which can be signs of low iron (anaemia)

Sometimes no single cause is found. When there is a cause, it may include:

• Fibroids, which are non-cancerous growths in the muscle wall of the uterus
• Polyps in the lining of the uterus
• Adenomyosis, where tissue like the lining grows into the muscle wall
• Endometriosis
• Hormone changes, including thyroid problems and conditions such as polyendocrine metabolic ovarian syndrome
• Bleeding disorders that affect how the blood clots
• Some medicines, including blood thinners
• In rare cases, changes in the lining of the uterus that need further checks

To find the cause, Dr Mahadik takes a full history and examination and may arrange some or all of the following:

• Blood tests, including iron studies to check for anaemia
• A pregnancy test
• An ultrasound of the pelvis to look at the uterus and ovaries
• A cervical screening test if one is due
• In some cases, a look at the lining of the uterus

Treatment depends on the cause, how much the bleeding affects you, and whether you would like to have children in the future. Care usually starts with medicine and moves to other options only if needed.

• A hormonal intrauterine device (Mirena) is often the first treatment offered for ongoing heavy bleeding, as it can reduce bleeding a lot over time
• Non-hormonal tablets taken during your period, such as tranexamic acid or anti-inflammatory medicines, can reduce bleeding and pain
• The combined pill or other hormonal options can help regulate and lighten periods
• If medicine is not enough, procedures such as endometrial ablation (treating the lining of the uterus) or, in some cases, surgery to remove fibroids or the uterus may be discussed

Period pain is very common, and most people have it at some point. Pain that stops you doing everyday things, or that is getting worse over time, is worth checking, because it can sometimes point to a treatable cause.

There are two broad types. Primary period pain is caused by the muscle of the uterus tightening to shed its lining, and it is not linked to another condition. It is the most common type. Secondary period pain is caused by an underlying condition, such as endometriosis, adenomyosis, fibroids, or a past pelvic infection. Pain that starts later in life, or that is getting worse, is more likely to be secondary. It is worth checking.

Anti-inflammatory pain medicines taken at the start of your period often help, and a heat pack and gentle activity can ease cramping. Some hormonal options, including the combined pill or a hormonal intrauterine device, can reduce pain by making periods lighter. If a condition such as endometriosis is found, treating that condition is part of managing the pain. Do not stop a prescribed medicine without medical advice.

Periods are irregular when the gap between them keeps changing, and infrequent when they come more than 35 days apart. Some variation is normal, especially in the first few years of having periods and in the lead-up to menopause. A lasting change is worth checking.

Common causes include:

• Hormone conditions such as polyendocrine metabolic ovarian syndrome or thyroid problems
• Natural stages of life, including the years after periods first start and the approach to menopause
• Significant weight gain or loss, or very high levels of exercise
• Stress
• An eating disorder
• Some medicines
• Primary ovarian insufficiency, when the ovaries stop working normally before age 40. This is not the same as early menopause. Some periods, and pregnancy, may still be possible.

Periods often settle again once the underlying cause is treated.

When periods stop for several months and you are not pregnant, breastfeeding, or past menopause, this is called amenorrhoea and it is worth checking. It can be linked to hormone changes, weight, high levels of exercise, or conditions such as polyendocrine metabolic ovarian syndrome. Finding the cause helps guide what will bring your periods back.

Bleeding or spotting when you are not due a period, or bleeding after sex, is called intermenstrual bleeding. It is often harmless and easy to treat, but it should always be checked so anything more serious can be ruled out. Any bleeding after menopause needs to be checked promptly.

Possible causes include:

• Ovulation, which can cause light spotting mid-cycle
• Starting or changing a hormonal contraceptive
• Infections, including some sexually transmitted infections such as chlamydia
• A polyp on the cervix or in the lining of the uterus
• Hormone changes
• Some medicines, including blood thinners
• Less commonly, changes in the cells of the cervix or the lining of the uterus. This is why bleeding between periods should always be checked.

Dr Mahadik may arrange:

• A test for infection
• A pregnancy test
• An ultrasound of the pelvis
• A cervical screening test if one is due