By I.Soussis, MD, Fertility Specialist 

A woman experiences her period for the whole of her reproductive life. Sometimes, she considers as normal symptoms that should not exist.

Ηow do you know if your period is causing problems that it shouldn’t?

In most cases you should not worry if you:

  • get cramps

  • have low back pain

  • feel fatigue or discomfort

You should talk to your doctor if:

  • the pain is so bad you miss days of work or school every month

  • have such heavy bleeding that is causing anemia

These are things that may need investigation.

Most women’s menstrual cycles range between 21 to 35 days, or up to 45 days for teens. A recent study of 600.000 cycles from Britain, showed that only 13% of women have what we consider a “normal” cycle of 28 days. Bleeding usually lasts between three to seven days. What’s normal for one woman may not be for another.

The most common menstrual irregularities are:

  • not having a period at all

  • irregular periods

  • prolonged of shord periods

  • severely painful cramps

These problems can have many different causes, including:

  • scarring, caused by endometriosis or previous operations

  • hormonal imbalances (polycystic ovarian syndrome)

  • certain diseases or conditions (eg coagulation disorders)

  • medications (eg regular use of aspirin)

Uterine fibroids and endometriosis are two common causes.


Fibroids are benign tumors, made of muscle or connective tissue cells that grow inside or outside of the wall of the womb. Although the majority of women have at least one fibroid during their lives, most of them don’t have symptoms.

Very heavy bleeding during a woman’s period is the most common symptom of fibroids. Ultrasound is very good at diagnosing them.


Endometriosis is caused by the lining of the uterus (endometrium) when it grows outside it, on other organs. The cardinal symptoms of endometriosis are period pain, pain during sex and infertility. Endometriosis probably accounts for at least a third of infertility in women.

Endometriosis diagnosis is very difficult. Currently, there is no blood test or imaging technique that can diagnose endometriosis. The only way to diagnose endometriosis is laparoscopy. This can lead to a delay in diagnosis, in part because no one wants to be quick to do surgery.

Both fibroids and endometriosis have familiar tendencies. Women may not know that severe pain or heavy bleeding aren’t normal. Sometimes the mother would advise the daughter to “put up with it, it’s normal for a woman”.

However, there are treatments that can improve your health and quality of life.

It is the duty of the doctor to advise appropriately and to offer the right treatment.