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Don’t Suffer in Silence: Painful Periods & Bleeding

April 26, 2018 4:00 PM with Dr. Sangeeta Senapati

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Painful periods, referred to as dysmenorrhea, are experienced by a large population of women during various points of their menstrual cycle. For so long, young girls and women believed they simply needed to suffer in silence, but in many cases, the pain, along with abnormal bleeding, can be an indication of something more going on. Many women experience chronic issues due to conditions like endometriosis, PCOS, fibroids and more. If you have questions, start with Dr. Sangeeta Senapati, Endoscopic Surgeon, Advanced Gynecologic Care at NorthShore. She will provide her expertise and useful information about the causes of painful periods, abnormal pain and bleeding, how conditions can be diagnosed and the available treatment options.

Kathryn (Moderator) - 4:00 PM:
Our chat is now open. You can submit questions at any time.

Dr. Sangeeta Senapati (NorthShore) - 4:02 PM:
Hello everyone. I'm Dr. Senapati, part of the team here at NorthShore. I'm ready to take your questions.

  Katie (Chicago, IL) - 4:02 PM:
My period seems much worse (more bleeding and cramping) now that I'm on blood thinners. Why might that be?
Dr. Sangeeta Senapati (NorthShore)

When a woman is on blood thinners, any process that causes bleeding can be exacerbated - such as getting a cut on your skin or getting your menstrual period.

And often, when the bleeding is heavier, women may experience more cramping and discomfort.


  Vanessa (Evanston, IL) - 4:05 PM:

Hi doc! What is the best treatment approach for primary dysmenorrhea? OCP's are currently not an option and OTC NSAIDS seem to provide only minimal relief. I'm concerned that continuous NSAID use will be harmful for both my stomach and kidneys.

Thank you!

Dr. Sangeeta Senapati (NorthShore)

Thank you for your question. First line therapy for dysmenorrhea is over the counter NSAIDs or hormonal suppression. If a combined oral contraceptive pill is not an option, other hormonal therapies may be an option. IF those are not working (or you are unable to tolerate them), other sources of pain should be investigated.

Non- medication options can be helpful as well, such as heating pads, exercise and hydration (especially at the time of menses).


  Kevina (Chicago, IL) - 4:10 PM:
Are you running any clinical or research trials for period pain?
Dr. Sangeeta Senapati (NorthShore)

Our division is involved in several research trials for menstrual period pain - for more information on them please refer to the following sites:


  Tameka (Evanston, IL) - 4:13 PM:
Hello, I had surgery done to remove 7 pounds of fibroids; the doctor did a C-section to remove them. I have had 2 grow back since then and the pain has increased, and so has the bleeding. Is there anything that can help with the pain beside pills?
Dr. Sangeeta Senapati (NorthShore)
It is important to have a thorough evaluation done after having surgery for fibroids as there may be other sources of pain outside of just the fibroids. In order to treat the pain appropriately, the sources of the pain must first be determined (and there may be more than one).

  Kylis (Zion, IL) - 4:15 PM:
I have been to see various OB/GYNs for my chronic pelvic pain. I've had irregular periods and heavy cycles since I got my tubes tied after my second time giving birth. The recommendation for me was to have a partial hysterectomy, but I am not interested in having such an invasive surgery. What are my other options?
Dr. Sangeeta Senapati (NorthShore)
It sounds like there may be two separate issues involved - the heavy bleeding/irregular periods and the pelvic pain. For the bleeding - options can include hormonal suppression or more conservative surgery that addresses just the lining of the uterus. A discussion with your physician about risks and benefits of those options in your case can be helpful in making the decision. These options may help the pain symptoms as well, or those may have to be addressed separately with other treatment options .

  Traci (Grayslake, IL) - 4:21 PM:
I had a uterine ablation in 2017; it worked wonderfully and almost stopped the bleeding and painful menstruation. I do however, still suffer from awful-terrible PMS and migraine headaches that have gotten worse since the surgery. I will be 42 this August. I was wondering if I had a total hysterectomy and my tubes and ovaries removed if that would help me? (My aunt on my mother's side died of ovarian cancer so I want ALL of the female stuff removed if possible)
Dr. Sangeeta Senapati (NorthShore)
Endometrial ablation can be very helpful in addressing bleeding symptoms, but typically will not change any PMS symptoms. PMS symptoms are related to hormonal function. The hormones are produced by the ovaries. Removal of the ovaries may help the PMS symptoms but that benefit must be weighed again the risk of early menopause - many women develop significant mood disturbances, hot flashes, night sweats etc. There are also increased cardiovascular and bone health risks associated with early menopause.

  Jen (Kenosha, WI) - 4:27 PM:
Ever since I had my children (both C-sections) my periods have become extremely heavy and painful. I also have pelvic pain before and after my period, as well as odd pains when I urinate. I even have sciatic pain occasionally. Why might this happening? Should I be concerned? My OB suggested an MRI and possibly a hysterectomy. And is there any correlation with not being able to lose weight?
Dr. Sangeeta Senapati (NorthShore)
The symptoms that you are describing - may all be related to the uterus or could be coming for several different sources. A careful examination and evaluation by your physician can help determine whether a hysterectomy would help or if there are other issues present such as specific bladder or musculoskeletal conditions

  Urmila (Skokie, IL) - 4:31 PM:
Is there anything that I could do to avoid getting PCOS or endometriosis? Like a change in diet, more exercise, etc.?
Dr. Sangeeta Senapati (NorthShore)
There are no definitive recommendations for preventing endometriosis or PCOS. We do receommend leading a healthy lifestyle with attention to diet and exercise and regular visits to your gynecologist to address issues that may arise sooner rather than later.

  Sibgha (Skokie, IL) - 4:34 PM:
Whenever I get my periods it hurts so bad. Even if ai take pain killers, it doesn't really help, especially in the back. When I get my periods during sleep hours as soon as i get up and go to the bathroom, I faint and am not able to walk. I asked my doctor she said it is normal, but it is affecting my work life. Any ideas?
Dr. Sangeeta Senapati (NorthShore)
Painful periods that interfere with daily life do need to be evaluated further. When over the counter pain medications such as NSAIDs do not work, hormonal supression can be helpful. But women may respond differently to different treatment options and not all treatment options are appropriate for everyone so discussing this further with either your physician or obtaining another opinion/evaluation can be helpful to find a safe and successful treatment for you.

  Abbie (Evanston, IL) - 4:40 PM:
I've heard that stimulation (like sex) can actually make periods less heavily and reduce pain. Is that true?
Dr. Sangeeta Senapati (NorthShore)
Yes. For some women, stimulation and orgasm can reduce menstrual pain and cramping.

  Sara (Glenbrook, IL) - 4:41 PM:
I have experienced painful periods for years and will be having a baby soon, is there any research/information on if you periods change after a pregnancy?
Dr. Sangeeta Senapati (NorthShore)
Yes - menstrual periods can change after pregnancy and delivery. Often women with painful menses will notice an improvement in their symptoms after a pregnancy. This is variable though and dependant on the individual.

  Michele (Chicago, IL) - 4:43 PM:
Hi Dr. Sangeeta. Ever since I got the Mirena IUD (about a year and a half ago), I've had persistent breakthrough bleeding essentially 3 weeks out of every month. Recently, within the past month, I've been having really bad cramps, bloating and bleeding/clotting. I know It's probably because I started my period, but I don't understand why the PMS symptoms are persisting. Pain medication doesn't help. I've gotten an Intra-uterine ultrasound, but nothing was found to be wrong. What could I do next to figure this out?
Dr. Sangeeta Senapati (NorthShore)
For some women, the Mirena IUD does not supress them completely so they do have menses and irregular bleeding. Ultrasound can be helpful for evaluting the uterus and ovaries. It is also important to evaluate for vaginal infections that can cause bleeding. If those are normal, some women need additional hormonal supression with a low dose birth control pill or estrogen. If the bleeding/cramping persists, I recommend that you see your gynecologist for further evaluation and discussion of other treatment options.

  Tea (Glenbrook, IL) - 4:47 PM:
Am I too old for fibroid surgery? I am 45 years old. What's the criteria for surgery?
Dr. Sangeeta Senapati (NorthShore)
There is no specific age criteria for fibroid surgery. The recommendation for surgery is based on symptoms, size, number, and location of the fibroids.

  Pearl (Evanston, IL) - 4:49 PM:
I have always had painful periods and every doctor I’ve spoken to has told me to take birth control. I am on birth control and it does help, but should I be doing more?
Dr. Sangeeta Senapati (NorthShore)
Birth control pills are a good treatment option for painful periods. Whether or not you should be doing more depends on how you are feeling on the pills. If you are still in pain and it is disrupting your quality of life, then you may need to try additional or alternative treatments.

  Kari (Grayslake, IL) - 4:52 PM:
I’m 49 years old, have very regular cycles, plus very heavy bleeding and cramping for at least an entire day each period. I’m told I have fibroids, and the pain will stop once I’m in menopause. My mother and grandmother didn’t go through menopause until their mid-to- late 50s and I’m told I’ll likley follow that path. I’m so tired of living with painful periods and want to know my options outside of the pill, IUD and ablation. Thank you in advance. Kari
Dr. Sangeeta Senapati (NorthShore)
Other options for treatments for fibroids can include uterine fibroid embolization, MR guided focused ultrasound treatment of the fibroids and surgical removal of the fibroids. But fibroids themselves do not always cause pain so it is important to have an evaluation to determine the cause of your pain in order to suggest treatment options.

  Meilanie (Chicago, IL) - 4:57 PM:
What are treatments for dysmenorrhea and heavy menstrual bleeding? Including surgical and non-surgical options.
Dr. Sangeeta Senapati (NorthShore)
Treatments for heavy menstrual bleeding depend on what the source of the bleeding is. They can include antifibrinolytic medications such as tranexamic acid or hormonal supression (birth control pills, iud, implant, injection). Surgical treatments can include endometrial ablation or ultimately hysterectomy. The treatments for dysmenorrhea include NSAIDS, hormonal supression ( similar to above), magnesium, and muscle relaxants/medications targeted towards relieving muscle contractions. Surgical treatments may start with a diagnostic laparoscopy to investigate other sources of pain such as endometriosis.

  Pearl (Evanston, IL) - 5:04 PM:
I have found what looks like thick, bloody, tissue, either on my tampon, or in my underwear after my period. It’s only happened a few times but it really scared me. What might that be, could it be a symptom/sign of a problem, and if so, what?
Dr. Sangeeta Senapati (NorthShore)
Some women do pass tissue or blood clots during their menses and it can be normal. If this is happens on a continued basis, I would discuss this further with your gynecologist as it sometimes can be an indicator of a thickened endometrial lining or growth in the uterus.

  Lynn (Waukegan, IL) - 5:09 PM:
I’m 52; I get migraines during my period. What causes that? I also have heavy bleeding and cramps. I take 3 ibuprofen, but it doesn't really help.
Dr. Sangeeta Senapati (NorthShore)
Some women do get migraines at various time during their menstrual cycle. They may be more sensitive to changes (rise and fall) in their hormones (which happens normally during a menstrual cycle). This can trigger a migraine.

Kathryn (Moderator) - 5:12 PM:

This will be the end of our chat - thank you for all of your questions, and thanks to Dr. Senapati for taking extra time out to make sure all of today's questions were answered.

For more information on painful periods and abnormalities, contact the Department of Women's Health.

If you are interested in participating in a study, you can view the current listings on our clinical trials page or on http://www.thegyrl.org/.

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