Menstrual cycle dysfunction

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Know your menstrual cycle dysfunction
Endometriosis, Adenomyosis, PCOS, Fibroids, RED-s and PMDD

There is still a lack of awareness about issues and conditions associated with the menstrual cycle, even in medical circles. Health professionals may dismiss your excruciating period pains and symptoms as part-and-parcel of the cycle, when there could be something serious at play.

If you suspect your period symptoms aren’t normal don’t be brushed off. Menstrual cycle dysfunction is common and, left unchecked, could lead to significant health problems.

Endometriosis

What is it?

It’s when cells of the endometrium (the uterus lining) grow outside the uterus, instead of inside, and bleed regularly – causing an inflammatory reaction.

Is it common?

Yes, it’s the second most common gynaecological condition after fibroids; affecting one in ten women under 50.

What are the symptoms?

There are many but commonly it’s pain, irregular vaginal bleeding and reduced fertility. The pain typically recurs at the onset of your period and pain may be aggravated by sex, pooing and peeing.

How do I know for sure if I have it?

Symptoms and a medical examination can raise red flags, but the definitive diagnosis comes via a surgical procedure where a sample is taken to confirm whether endometrial cells are, in fact, outside the uterus.

Notes

The first guidelines to diagnose and manage endometriosis were published only in 2017 so there’s a lack of research. In the UK it takes an average of eight years from symptoms to diagnosis due to the lack of awareness, knowledge and because symptoms appear to mimic other conditions, such as irritable bowel syndrome.

Treatment

There’s no cure for endometriosis, so it’s more about management and pain relief. If you’re trying to conceive that adds another variable as to what treatments are best.

Pain relief is possible through over-the-counter anti-inflammatories and paracetamol. Hormonal contraception can help, as can surgery to remove the external cells but, again, this isn’t curative and may need to be repeated.

Period silence

What is it?

We’d all like to say that the stigma surrounding periods is weakening, but for some communities it is still deeply and damagingly entrenched.

For example, Black women are more likely than the general population to suffer complications such as fibroids than other demographics, and they’re just as likely to suffer endometriosis as the general population.

But for complicated historical and social reasons there’s a legacy of non-diagnosis among black women. Black women are much less likely to be diagnosed with reproductive conditions than other groups, leading to the misconception that black women are less prone to menstrual cycle dysfunction when, in fact, the opposite is true. They’re just more likely to suffer in silence.

Treatment

It sounds like a cliche, but the treatment is awareness. It’s making sure conversations about menstrual cycle conditions are honest, real, loud and normalised. Education and awareness around the menstrual cycle needs to be far more prominent so girls and women of all backgrounds can join the dots and see themselves in the picture.

Adenomyosis

What is it?

It’s when the lining of the uterus (endometrial tissue) grows into the muscular wall of the uterus. At menstruation, the displaced tissue continues to do what it’s supposed to do (break down and bleed) … which can cause additional pain and more extreme bleeding.

Is it common?

Because it can be asymptomatic — and easily missed or misdiagnosed — data differs on how common it is. We do know that it’s more likely in women over 40.

What are the symptoms?

The most common symptoms are recurring period pain and heavy, irregular bleeding. It can also include pelvic pain and pain during sex, but in some cases it is asymptomatic.

How do I know for sure if I have it?

Symptoms as above (heavy bleeding, recurring period pain) are a sign, but again it can also be asymptomatic. A pelvic exam may raise suspicion of adenomyosis and diagnosis may be via an MRI, ultrasound or biopsy of the uterus. Sometimes it can be almost impossible to be 100% certain and the diagnosis is not clear until a uterus has been surgically removed and examined under the microscope.

Treatment

Symptoms / pain can be improved with hormone suppression or the Mirena Coil, and adenomyosis can be cured by hysterectomy.

Polycystic Ovary Syndrome (PCOS)

What is it?

The main issue in PCOS is that an excess of androgen (a so-called ‘male’ hormone, but don’t read too much into that) in the ovary upsets the female’s hormonal balance and affects her ability to ovulate.

Is it common?

Yes. PCOS is the most common endocrine (hormone or hormone gland-related) disorder, affecting some 7% of women of reproductive age.

What are the symptoms?

The three main are irregular or infrequent periods, and symptoms of too much androgen, such as acne, excessive hair growth and weight gain. Polycystic ovaries can be detected via an ultrasound scan.

Treatment

The combined oral contraceptive pill could help to regulate vaginal bleeding and symptoms may need to be managed individually: cream for spots and hair loss products/laser treatment to counter excessive hair growth.

Lifestyle and exercise are fundamental in the management of PCOS. Up to half of women with the condition are obese and, although it can be harder than the norm, weight loss may help to improve period regularity and fertility.

In severe cases, or where there is a significant fertility issue, it’s recommended you see a specialist.

Fibroids

What is it?

Fibroids are benign (non-cancerous) tumours in the muscle of the uterus. There may be one or many, and they may be tiny or more significant in size – sometimes 30cm or more.

Is it common?

Very. By the age of 50, as many as four in every five women (80%) will have at least one. Fibroids often run in families and are more common in women who are obese, who never had children, or who started periods early on in life.

As you read earlier, research tells us that fibroids are more common in black women (at all ages) versus the general population, and increasingly so the older she gets. Black women are also more likely to experience severe fibroid symptoms than the general population.

What are the symptoms?

The presence of fibroids may cause difficulties in getting pregnant, while symptoms include heavy, long or painful periods. Bloating, pelvic pain, backache and leg pain.  Frequent peeing and difficulty peeing. And bowel issues – both constipation and incontinence.

Any one of the above would impact a player’s netball game, but fibroid symptoms often tend to come two or more at a time and, as stated, black women are more likely to experience pain and discomfort at the severe end of the spectrum.

How do I know for sure if I have it?

The above symptoms are an indicator but, surprisingly enough, fibroids don’t always cause issues. Some women go for months or even years without realising.

The best way to confirm whether (or not) you have fibroids is with via an ultrasound scan.

Treatment

Treatments, which are only necessary if your fibroids are symptomatic, include hormones, the Mirena Coil, tranexamic acid (to reduce bleeding) and / or non-steroidal anti-inflammatories. Surgery is possible via a gynaecologist referral.

Relative Energy Deficiency in Sport (RED-S)

What is it?

It is impaired physiological functioning caused by chronic underfuelling.

In simple terms, if you consistently burn more calories (through exercise and daily functioning) than you consume (through what you eat and drink), your body doesn’t have enough energy to continue normal functioning. Commonly, the body shuts down the reproductive system as a first line defence to save energy, meaning periods can become irregular, or stop altogether.

RED-S can occur in people who are consciously restricting their food intake, and also in people who just aren’t getting enough of the right food, and the right time, even though they think their diet is OK. It’s not just overall calories, but the timing of these (eating regularly so the body doesn’t spend long periods of time in a low energy state) and the types of food (the female body is particularly sensitive to carbohydrate restriction) which can contribute to RED-S.

Is it common?

In active women up to professional athletes it is common, across all sports, from cricket to cheerleading, not just endurance sports. However, the prevalence of athletes experiencing RED-S does seem to be related to whether the sport involves high volumes of training, where there are weight categories, and/or where there is a large subjective aesthetic element to the sport. Studies have found that 80% of players in team sports exhibit one symptom of RED-S and about 40% exhibit up to three symptoms.

What are the symptoms?

Disturbance of the immune system, menstrual cycle, gastrointestinal system and bone health are common in people suffering from RED-S, as well as an increased likelihood of mental health issues. Symptoms may include weight loss, fatigue, heightened injury risk, longer recovery times, poor adaptation to training, impaired aerobic fitness, obsessive behaviour, low mood, poor sleep, anxiety, and many more besides.

Erratic or absent periods are a key symptom, too. If an active woman’s period changes — or vanishes completely (it’s more common than you’d think) — they could be suffering from RED-S.

If it’s not spotted, RED-S can, because it affects bone health, lead to long term problems of bone weakness and even osteoporosis.

How do I know for sure if I have it?

The presence of one or more of the above symptoms may be a sufficient red flag, and screening tools are available to identify players who are at greater risk of RED-S. However, RED-S may be identified only after medical tests rule other conditions out.

Treatment

Everyone is different so the approach is specific to the individual’s symptoms and circumstances. But the core solution is to address the energy mismatch in order to stabilise health. This might include support from a sports medicine consultant, a nutritionist, a psychologist or psychiatrist. You can find a list of sports practitioners who specialise in supporting athletes with RED-S here.

If spotted early enough, most symptoms / consequences of RED-S are reversible.

If you, or someone you support in netball is affected by an eating disorder, contributing to their RED-S then seek support from organisations such as Beat.

Premenstrual Dysphoric Disorder (PMDD)

What is it?

It is a severe, debilitating form of Premenstrual Syndrome where symptoms worsen through the luteal phase (some 14 days before the period) and improve in the follicular phase (when the period starts).

Is it common?

It is. Despite being a fairly new diagnosis, it’s said to impact between 3 and 8% of women of reproductive age.

What are the symptoms?

In the week or so before the period, women may notice a mixture of physical and psychological symptoms.

Physical symptoms include headache, breast tenderness, bloating and weight gain.

Psychological symptoms include anxiety, anger and suicidal thoughts. Low mood, poor concentration, disturbed sleep, inactivity and food cravings.

How do I know for sure if I have it?

Keep a diary of symptoms over two or three consecutive cycles to show the trend of your symptoms. Once other medical conditions are excluded (via examination and tests) you may get a diagnosis.

Treatment

Like other menstrual cycle conditions, treatment is personal to the individual based on symptoms and their severity. Medication may include hormones and vitamins, but antidepressants and therapies could be recommended, as could a consultation with a dietician.

In severe cases, a referral to a gynaecologist and/or psychiatrist may be a way forward. The more this condition is recognised and diagnosed, the more specialised clinics, treatment options and support should become available.