Question: When I get my periods, they go on too long. Sometimes I bleed for 15 days each month. I am 25 years old. I have seen different doctors, but they don’t seem to help. I’m going crazy. What do you suggest?
Prolonged irregular periods in a young woman require detailed investigation to exclude any cause for the obvious hormonal imbalance you are suffering. These investigations could include blood tests, a laparoscopy (looking into your pelvis with a microscope tube), and a curette (cleaning out of the uterus). If all these are negative, and the problem continues, a number of different hormones and medications can be used to regulate your cycle.
The most commonly used treatment is the oral contraceptive pill, but a relatively high dose may be necessary to totally suppress your own hormone production. After some experimentation with dosage, most women find that this will give them regular, light, pain-free periods. Other alternatives include other types of hormones taken for the ten to fourteen days before an expected period, and hormone-blocking drugs. You should continue to pester the doctor in whom you have the most confidence, for a successful form of control. Continued doctor shopping will only lead to confusion in your mind, and between the different doctors.

Question: I have terrible period pain, but every two weeks when I am both menstruating and ovulating! It seems to be more pronounced on the right side. What can I do?
You are extraordinarily unlucky to be suffering from both forms of regular gynecological pain—uterine cramps and mittelschmerz.
When your periods come every month, the thick muscle of the uterus contracts to squeeze out the old uterine lining as blood mixed with cells. In some women, the uterus contracts too much, goes into spasm and causes severe pain, in much the same way that a leg muscle can go into cramp and cause pain.
In the middle of each month, a small cyst that contains a microscopic egg reaches the surface of a woman’s ovary, ruptures, and releases the egg and a small amount of fluid. If the woman produces eggs in a large cyst instead of a small one, excessive amounts of fluid will be released at ovulation when the cyst ruptures. The fluid is irritant to the lining of the pelvis, and so pain (called mittelschmerz) results. Often one ovary is more active than the other, and in your case the right ovary is producing more eggs than the left. Most women experience uterine cramps with periods, or mittelschmerz with ovulation at some time of their life, but when it occurs regularly, the problem becomes distressing. If you are not trying to fall pregnant, the simple way to treat your two problems is to take the contraceptive pill, which has the double benefit of stopping ovulation (and thus mittelschmerz), and of significantly reducing the loss at period times, thus reducing uterine cramps.
Period cramps can also be reduced by taking medication such as Ponstan or ibuprofen, but there is no other easy way to stop ovulation pain.

Question: My daughter is 15 but has not started her periods. Is this reason for concern?
In the seventeenth century, it was unusual for girls to start their periods until they were 16 or 17. Today, they may start at 12 or earlier, the change being due to the better diet, health and hygiene in the twentieth century, more rapid growth, and therefore faster maturation of the body. The onset of periods in a girl can be estimated by the experience of her mother, sisters or cousins, but there may still be significant variations. The trend is continuing for periods to start earlier every generation.
By 15, you would expect breast buds to have developed and some early wisps of pubic hair to be present. If this is not the case your daughter should be checked by a doctor. There are some medical conditions that can lead to a delay in the onset of periods. These include any severe illness earlier in life that may have slowed maturation, diseases of the ovaries or other glands, and some rare congenital disorders.

Question: Can you explain endometriosis for me? I have been told that this is the cause of my painful periods.
Your uterus (womb) is lined with special cells, which during the second half of your monthly cycle, are prepared to accept any fertilized egg and allow it to grow into a baby. If no pregnancy occurs, these cells degenerate, break away from the inside of the uterus, and with the resultant bleeding, pass out of the body in a woman’s period.
From the top of the uterus, the two Fallopian tubes lead out to the two ovaries. In a very small number of unlucky women, the cells that normally go out during a period, may go in and through these Fallopian tubes. The cells are then in an abnormal position around the ovary, on the outside of the uterus or in the pelvic cavity, and they can attach to these tissues and start growing and spreading further. They will still respond to the hormonal cycle every month, as these hormones pass through the bloodstream to every cell in the body. As a result, these cells in abnormal positions will bleed every month, releasing blood in places where it can cause pain and other symptoms. The cells may also block the Fallopian tubes causing infertility, or settle on the outside of the intestine to cause irritation and diarrhea.
The condition can only be diagnosed by examining a woman’s pelvis by means of an operation or a laparoscopy. A laparoscopy involves a small tube being put through the belly button into the abdomen, and through this a doctor can see the spots of endometriosis in its abnormal positions.