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Everything you've ever known about your period is probably wrong.

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Watch: Speaking of pelvic health, here are three men trying a period pain stimulator to see if they can handle women's pain. Post continues below.


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Listen: In Mamamia's brand new podcast Well, co-hosts Claire Murphy and Dr Mariam discuss everything you need to know about periods and bust a few myths along the way. Post continues below.

This month, we're diving deep into pelvic health and period myths with Dr Rebecca Goadby MD FRACGP. From endometriosis and adenomyosis to PCOS and beyond, we're exploring the conditions that affect millions of women but remain shrouded in misconceptions and taboo. For more, head to our Well hub here.

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FACT SHEET: Period myths.

What does a normal period look like?

Our menstrual cycles are as unique as we are. This means we are all different in terms of how many days between our periods, as well as their duration. Our menstrual cycles also change over time. For example, our cycle length may be longer in adolescence, then may shorten or become irregular in perimenopause.

The average length of a menstrual cycle is 28 days. However, anywhere between 21 to 35 days (post adolescence) is considered normal. Generally, menses will come regularly, but there may be variation of a day or two, so don't feel anxious if it's not exactly the same every month. However, if it doesn't appear after 35 days, then you should see your GP for a check-up.

An average period will last 3 to 7 days. If your period lasts longer than 7 days, this is also time to make a GP appointment as further investigation may be needed.

Common period myths and facts.

MYTH: If you have irregular periods, it's because you have polycystic ovarian syndrome (PCOS).

FACT: There are many causes for a period that is irregular or skips months at a time. PCOS is one of the causes of irregular periods, but your doctor will also rule out many other causes, including hormone imbalances with thyroxine and prolactin, medication side effects and any anatomical issues. Irregular periods can also be caused by stress, increased exercise or nutritional deficiency. And of course, we do need to rule out pregnancy if your normally regular period suddenly stops.

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MYTH: Painful, heavy periods are normal.

FACT: No, painful and heavy periods are not normal. If you are finding your periods are impacting on your ability to work, study, exercise or do the things you need to do, it is time to see your doctor to discuss causes and treatment options to improve your quality of life.

MYTH: Everyone gets pre-menstrual syndrome.

FACT: I think most of us definitely notice the changes to our hormones throughout our monthly cycle in some way, whether with physical symptoms or mood. However, some women are more sensitive to these hormonal fluctuations and experience more severe symptoms, including low mood, increased anxiety and anger, and in some instances, suicidal ideation. There are many options for treating these symptoms, so it's important to discuss this with your doctor to find a regime that works best for you.

MYTH: You can't get pregnant during your period.

FACT: You have a much lower risk of pregnancy during your period, as ovulation generally occurs on average two weeks after your period. However, sperm can live in the female reproductive for three to five days, so if ovulation occurs early, then there is a risk of pregnancy. Contraception is recommended throughout the entire menstrual cycle just to be sure!

MYTH: Using hormonal medication for period management will affect my fertility.

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FACT: There have been large studies about fertility and contraception use, including long-term contraception use, and they have been reassuring that fertility is not affected. If you have specific concerns, always discuss these with your doctor to ensure your family planning is supported.

Endometriosis and adenomyosis.

What is endometriosis?

Endometriosis is a common condition affecting one in seven females and those assigned female at birth. It is when cells similar to those that form the lining of the uterus are found in other locations within the pelvic and abdominal cavities, such as the bowel, bladder, fallopian tubes, and ovaries. The exact cause of endometriosis is not known and needs further research. Some risk factors include family history and retrograde (backwards) menstruation.

What are the symptoms of endometriosis?

The cells outside the uterus form tissue deposits on the affected organs and respond to the hormones of the menstrual cycle. This means that during a period, they can bleed and become inflamed, leading to the formation of scar tissue. Due to this, the most common symptom of endometriosis is pelvic pain, which is worse during a period and can spread to the back and legs.

Other symptoms of endometriosis vary between individual patients depending on which organs are affected and can include:

  • Constipation or diarrhoea, as well as pain with bowel movements, which worsens during a period.

  • Bladder irritation including frequent urination and pain passing urine.

  • Pain during sex.

  • Abdominal bloating, worse in the days before and during your period.

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  • Heavy bleeding during your period.

  • Difficulty getting pregnant.

As endometriosis is an inflammatory condition, it can also cause more generalised symptoms such as persistent fatigue, mood changes and joint pain.

How is endometriosis treated?

More options are becoming available to treat endometriosis and, in Australia, many of them are now listed on the Pharmaceutical Benefit Scheme (PBS). There is no one-size-fits-all treatment, and your doctor should discuss various options and find the one that works best for you.

Evidence-based options include:

  • Pain-relief medication, including anti-inflammatories.

  • Medication to reduce heavy bleeding during your period.

  • Pelvic health physiotherapy.

  • Acupuncture, yoga, regular exercise and sleep.

  • Psychological support to assist with managing chronic pain.

  • Dietitian support to assist with gut health and irritable bowel symptoms.

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  • Use of hormonal medication to improve pain and reduce heavy bleeding during your period, such as the oral contraceptive pill, oral progesterone or progesterone intrauterine device.

  • Hormone-blocking medication.

  • Surgical options, including removal of endometrial tissue and hysterectomy.

What is adenomyosis?

Adenomyosis is where the tissue that normally lines the inside of the uterus grows within the muscular layer of the uterus. Many people with endometriosis also have adenomyosis. The exact cause of adenomyosis is not known. Some risk factors include previous uterine surgery, co-existing endometriosis and post-birth uterine inflammation.

What are the symptoms of adenomyosis?

The symptoms of adenomyosis are:

  • Pelvic pain.

  • Painful and heavy periods.

  • Pain during intercourse.

  • Difficulty getting pregnant.

How is it treated?

The treatment options for adenomyosis are similar to endometriosis (see above).

The main differences are:

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  • The progesterone intrauterine device is considered the most effective treatment for symptoms long-term.

  • The option for uterine artery embolisation is a procedure that blocks the blood supply to the uterus which can reduce pain and bleeding.

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS is a complex syndrome that affects one in 10 females and those assigned female at birth. PCOS affects the way the body produces two hormones — insulin and androgens (for example, testosterone). The exact cause is not known but those with a family history of PCOS are at a higher risk, although no single gene has been found and it is thought that multiple genes may be responsible.

What are the symptoms?

Symptoms of PCOS are caused by a combination of impaired ovulation, increased insulin levels and increased androgen (for example, testosterone) production.

Symptoms include:

  • Irregular or absent periods.

  • Hirsuitism (excess hair growth).

  • Male pattern baldness.

  • Acne and skin tags.

  • Weight gain.

  • Changes to mood and anxiety levels.

  • Difficulty getting pregnant.

To be diagnosed with PCOS, two out of the three below criteria must be met:

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  • Evidence of impaired ovulation with irregular or absent periods.

  • Evidence of increased androgen production either through symptoms such as excessive hair growth or male pattern hair loss, or with increased androgens seen in blood tests.

  • Polycystic ovaries seen on ultrasound testing.

How is it treated?

Treatment of PCOS is individualised for each patient and their symptoms. The treatment aims to regulate ovulation and periods, reduce any symptoms of PCOS, reduce complications including the risk of diabetes, as well as optimising fertility if desired.

 Treatment options include:

  • Access to nutrition support and exercise physiology to assist in reducing insulin levels and restoring ovulation.

  • Hormonal therapies such as the oral contraceptive pill or the progesterone only pill which can help regulate the menstrual cycle.

  • The progesterone intrauterine device which prevents the lining of the uterus from thickening.

  • A non-hormonal medication to reduce insulin and androgen levels.

  • Treating symptoms such as hirsuitsim and acne with medication or with topical therapies such as laser therapy or retinols.

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  • Psychology support to assist with mood and anxiety symptoms.

  • The use of complementary therapies is an emerging area in PCOS management and as yet there are no recommendations in best practice guidelines.

Stay tuned for future editions of Mamamia's Well Fact Sheets, where we'll continue to bring you expert guidance on the health topics that matter most to women. For more, head to our Well hub here.

Feature image: Getty.

Well by Mamamia. Australian women, welcome to your full-body health check. At Well, our goal is to improve the health of one million Aussie women by delivering the game-changing health info they actually need. This initiative is made possible through the support of our presenting partner, Chemist Warehouse, and our pelvic health topic sponsors, Metagenics and Chemist Warehouse.

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