Menstrual Issues

From pain to infertility, periods can create a raft of issues for women. Fortunately, there is much a gynaecologist can do to help.

Menstruation, also known as having a period, involves bleeding from the vagina for about five days, once a month. It starts between the ages of 10 and 16 and continues until menopause occurs.

Each month a woman’s body prepares itself for pregnancy. If no pregnancy occurs, the uterine (womb) lining is shed. This is what a period is – partly tissue from the uterus and partly blood. There are a number of issues that can accompany menstruation and they are more common than most people think.

Heavy periods

Standard blood loss for most women during one period is 30 – 40ml which usually happens over 3 – 7 days. If you experience long or heavy periods, characterised by any of the following, our gynaecologists can help.

  • Blood loss of more than 5–6 tablespoons of blood (80mls)
  • Clots that are larger than a 50 cent coin
    Bleeding to the extent that you have to change your pad/tampon every hour
  • Bleeding through clothing or bedding when you sleep
  • Bleeding that lasts more than 8 days (prolonged bleeding)
  • Anaemia and/or low iron levels

Your gynaecologist will run tests to investigate the causes and advise on the best course of treatment or management.

Some common causes are:

  • Endometrial polyps or uterine fibroids – benign growths in the uterus
  • Endometriosis – endometrial tissue, which should only be found in the uterus also grows outside the uterus, eg, on the ovaries or fallopian tubes. Read more about endometriosis
  • Pelvic inflammatory disease (PID) – an infection in the pelvic area of your body
  • Polycystic ovarian syndrome (PCOS) – a hormonal condition that affects the functioning of the ovaries Read more about PCOS
  • Endometrial hyperplasia – when the endometrium is thicker than usual

The doctors at COGA have broad experience in treating heavy periods or the underlying conditions and can offer the following medical and surgical treatments:

  • Surgical removal of fibroids or polyps (myomectomy)
  • Endometrial ablation
  • Hormone therapy i.e. The Pill, injection or IUD
  • Endometrial ablation
  • Hysterectomy

Abnormal bleeding

Bleeding between periods or after sexual intercourse is unusual.

Possible causes are:
  • Hormonal changes (such as starting menopause or polycystic ovary syndrome)
  • Contraception such as the pill, injection, implant or IUD (intrauterine device)
  • Infection in your vagina or uterus
  • Endometrial polyps or uterine fibroids – benign growths in the uterus
  • Trauma to your vagina
  • Some medications such as anticoagulants
  • Cancer in the lining of your uterus, your cervix or vagina (rare)

The doctors at COGA have broad experience in treating heavy periods or the underlying conditions and can offer the following medical and surgical treatments:

  • Surgical removal of fibroids, polyps or cancers
    Hormone therapy i.e. The Pill, injection, implant or IUD
  • Prescribing anti-inflammatory drugs or antibiotics
  • Anti-bleeding agents such as tranexamic acid
  • Treatment for any underlying health problem

There are times in a woman’s life where periods stop, including before puberty, during pregnancy and breastfeeding and after menopause. If your period stops outside of these times, it should also be investigated by a gynaecologist.

Painful periods

While most women experience some discomfort each month, for some a period causes significant interruption to daily life. If your periods are becoming more painful over time, our gynaecologists can help.

In addition to severe pain and cramps in the lower abdomen, you may also experience:

  • Lower back pain
  • Nausea
  • Vomiting
  • Constipation or diarrhoea
  • Headaches

Causes of painful periods can include fibroids, inflammation of your fallopian tubes and some IUDs. Your gynaecologist will rule these out as part of the investigation. The most common cause of painful periods is endometriosis.

COGA’s specialists have broad experience in treating painful periods as well as underlying conditions, and can offer the following medical and surgical treatments:

  • IUD (intrauterine device) fitting such as Mirena
  • Hormone therapy i.e. The Pill, injection or implant
  • Prescribing anti-inflammatory drugs and pain relief
  • Self-care suggestions
  • Investigation and treatment for any underlying health problems


Symptoms of endometriosis include:

  • pain with periods
  • bowel problems, such as bloating, diarrhoea, constipation,
  • pain with bowel movements
  • painful intercourse
  • sub-fertility or infertility
  • tiredness and low energy
  • pain in other places such as the lower back or leg
  • pain at other times, eg, with ovulation
  • premenstrual syndrome (PMS)
  • abnormal menstrual bleeding
  • pain before or with urination, recurrent urinary tract infections (UTIs), or interstitial cystitis (inflammation of the bladder causing painful urination).

This disorder is caused by tissue similar to uterine lining growing in places it shouldn’t, such as the abdomen, womb and bladder. Like the lining of the uterus, this tissue bleeds each month causing severe and chronic pain.

Endometriosis can be complex to diagnose and treat. Read more →

The only sure way to diagnose endometriosis is through a laparoscopy, which is a keyhole surgical procedure. COGA is fortunate to have some of the most experienced endometriosis surgeons in Canterbury and we have had good success in managing endo with a personalised treatment plan.

Polycystic ovarian syndrome (PCOS)

Common symptoms of PCOS include:

  • weight gain
  • irregular periods
  • cysts on the ovaries that show up during ultrasound scans
  • facial hair on areas such as the chin or upper lip
  • difficulty conceiving

PCOS is a hormonal disorder that affects many facets of a woman’s health, including disrupted menstrual cycles and infertility. Sufferers will usually experience an impact on their reproductive, metabolic and cardiovascular health, and symptoms can vary greatly over time and from person to person.

Management of polycystic ovarian syndrome must be tailored to individuals as the disorder affects each person so differently. There are many commonly prescribed medications that can help. Additionally, lifestyle changes around diet and exercise can alleviate PCOS symptoms. Your gynaecologist can work with other healthcare providers to establish a holistic management plan.

Our gynaecologists are some of the most experienced menstruation specialists in Christchurch.

For further reading about menstruation and associated issues, see our Knowledge Hub

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