Menstrual Disorders and Period Problems at Tees Valley Hospital in Middlesbrough

Menstrual disorders and period problems are extremely common. Yet many people are told their symptoms are “normal” or something they simply have to put up with. In reality, period symptoms that interfere with your daily life, work, relationships, or wellbeing deserve proper assessment and treatment.

At Ramsay Health Care, our gynaecology specialists diagnose and treat the full range of menstrual disorders, from heavy or irregular periods to severe period pain, Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD). This page explains the different types of menstrual disorders, common symptoms, causes, diagnosis, and the treatment options available.

What are menstrual disorders?

A menstrual disorder is any condition that disrupts your normal menstrual cycle, including changes in:

• Frequency

• Duration

• Flow

• Associated symptoms (pain, mood changes, bleeding between periods)

A normal menstrual cycle typically lasts between 21 and 35 days, with periods lasting 2 to 7 days. The average cycle is 28 days. Variation is common, but when symptoms become severe, unpredictable, or disruptive, it’s important to seek medical advice.

Menstrual disorders include heavy periods, painful periods, irregular periods, absent periods, PMS, PMDD, and bleeding between periods.

Types of abnormal menstruation

Below are the eight main types of abnormal menstruation, each with distinct symptoms and causes.

1. Heavy Periods (Menorrhagia)

Heavy periods involve:

• Soaking through pads or tampons every 1 to 2 hours

• Passing large clots

• Periods lasting longer than 7 days

Heavy bleeding can lead to fatigue, iron-deficiency anaemia, dizziness, and reduced quality of life.
Ramsay offers assessment and treatments including medication, hormonal therapy, and procedures such as endometrial ablation. You can access NICE guidance on heavy periods here.

2. Painful Periods (Dysmenorrhoea)

Period pain is common, but severe period pain is not normal.

There are two types:

• Primary dysmenorrhoea: painful periods with no underlying condition

• Secondary dysmenorrhoea: caused by conditions such as endometriosis, fibroids, or adenomyosis

Pain that affects work, school, sleep, or daily activities should be assessed by a specialist.

3. Irregular Periods (Oligomenorrhoea)

Irregular periods include:

• Cycles shorter than 21 days or longer than 35 days

• Unpredictable timing

• Missed or widely spaced periods

Common causes include PCOS, thyroid disorders, perimenopause, stress, and significant weight changes.

4. Absent Periods (Amenorrhoea)

Amenorrhoea may be:

• Primary: periods have not started by age 16

• Secondary: periods stop for 3+ months (not due to pregnancy)

Causes include low body weight, over-exercise, stress, hormonal imbalance, and menopause.

5. Light or Infrequent Periods (Hypomenorrhoea)

This involves:

• Very light bleeding

• Shorter periods than usual

It may be normal for some people, but can also be linked to hormonal imbalance, contraception, or structural issues.

6. Premenstrual Syndrome (PMS)

PMS causes physical and emotional symptoms in the 1 to 2 weeks before a period, such as:

• Mood swings

• Bloating

• Breast tenderness

• Headaches

• Fatigue

Symptoms usually improve once the period begins.

7. Premenstrual Dysphoric Disorder (PMDD)

PMDD is a severe, debilitating form of PMS and is classified as a mood disorder.

Symptoms include:

• Severe depression or low mood

• Anxiety or panic

• Irritability or anger

• Difficulty concentrating

• Feeling overwhelmed or unable to function

PMDD affects 5 to 8% of people who menstruate. Symptoms appear 1 to 2 weeks before a period and resolve shortly after bleeding begins.

Diagnosis requires tracking the symptoms across at least two cycles. Treatment may include antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors), hormonal therapy, CBT, lifestyle changes, and specialist support, all available through Ramsay. 

You can access more information on PMS and PMDD on the NHS website 

PMDD is a severe, debilitating form of PMS and is classified as a mood disorder.

Symptoms include:

• Severe depression or low mood

• Anxiety or panic

• Irritability or anger

• Difficulty concentrating

• Feeling overwhelmed or unable to function

PMDD affects 5 to 8% of people who menstruate. Symptoms appear 1 to 2 weeks before a period and resolve shortly after bleeding begins.

Diagnosis requires tracking the symptoms across at least two cycles. Treatment may include antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors), hormonal therapy, CBT, lifestyle changes, and specialist support, all available through Ramsay. 

You can access more information on PMS and PMDD on the NHS website here.

8. Intermenstrual or Post-Coital Bleeding

Bleeding between periods or after sex always warrants medical investigation.

Possible causes include:

• Cervical ectropion

• Polyps

• Infection

• Hormonal imbalance

• (Rarely) cervical or endometrial cancer

You should seek prompt assessment.

Common period symptoms to look out for

Knowing what is “normal for you” is important. If you experience any of the following symptoms you should speak with a specialist.

Physical period symptoms 

• Severe cramping or pelvic pain (before or during your period)

• Heavy or prolonged bleeding

• Passing large clots

• Spotting between periods or after sex

• Bloating or breast tenderness

• Fatigue or dizziness (possible anaemia)

• Lower back or thigh pain

• Nausea or vomiting during periods

Emotional and psychological period symptoms

• Mood swings, irritability, low mood or depression in the days before a period

• Anxiety or feeling overwhelmed

• Brain fog or difficulty concentrating

• Severe psychological symptoms (possible PMDD)

Psychological symptoms are real, recognised, and treatable. They are not “just hormones”.

What causes period problems?

Menstrual disorders often have multiple contributing factors, often related to underlying conditions. 

Hormonal causes

• Polycystic ovary syndrome (PCOS) 

• Thyroid disorders (over or underactive)

• Hyperprolactinaemia (high prolactin)

• Perimenopause / menopause transition

Physical causes

• Endometriosis 

• Uterine fibroids

• Endometrial or cervical polyps

• Adenomyosis

Lifestyle causes

• Significant weight loss or gain

• Excessive exercise (common in athletes)

• High levels of stress

• Changes in contraception

Other causes

• Certain medications (e.g. blood thinners, antipsychotics)

• Bleeding disorders

• Pelvic inflammatory disease (PID)

• Sometimes no clear underlying cause is identified (e.g. primary dysmenorrhoea / primary amenorrhoea)

How are menstrual disorders diagnosed?

Early, accurate diagnosis is the key to effective treatment. At Ramsay Health Care you have rapid access to private GP appointments, specialist gynaecologists and a full range of diagnostic tools. Because menstrual disorders can have hormonal, structural, or lifestyle-related causes, a thorough assessment helps identify exactly what’s happening and ensures you receive the right treatment from the start.

Diagnosis usually begins with a detailed consultation, where your specialist will discuss your period symptoms, menstrual history, medical background, and any previous treatments. Many patients choose to begin this process through our Private GP Service, which offers fast appointments, same-day referrals, and immediate access to investigations if needed. From there, your GP or gynaecologist may recommend one or more tests to understand the underlying cause of your period problems.

Diagnostic tests may include:

Blood tests - help identify hormonal or medical conditions that may be affecting your cycle. These may include:

• A full hormone panel (FSH, LH, oestrogen, progesterone)

• Thyroid function tests

• Prolactin levels (high prolactin can stop or disrupt periods)

• Full blood count to check for anaemia caused by heavy bleeding

• Tests for androgens if PCOS is suspected

These results help pinpoint whether your symptoms are linked to hormonal imbalance, thyroid issues, PCOS, or other medical conditions.

Pelvic ultrasound - is a key first-line investigation. It can identify:

• Uterine fibroids

• Ovarian cysts

• Endometrial or cervical polyps

• Signs of adenomyosis

• Ovarian appearance consistent with PCOS

Ultrasound is non-invasive and provides valuable information about the structure of the uterus and ovaries.

Hysteroscopy - allows your specialist to examine the inside of your womb using a thin camera. It can:

• Identify polyps, fibroids, or abnormal tissue

• Assess the endometrial lining

• Allow removal of small polyps during the same procedure

This is particularly useful for investigating heavy bleeding or bleeding between periods.

Laparoscopy - is the gold-standard test for diagnosing endometriosis. It involves a small keyhole incision to view the pelvic organs directly. It can:

• Confirm or rule out endometriosis

• Assess the severity of disease

• Allow treatment of endometriosis during the same procedure

This is recommended when symptoms strongly suggest endometriosis or when other tests are inconclusive.

Endometrial biopsy - involves taking a small sample of the womb lining. It is used to:

• Rule out endometrial cancer

• Investigate abnormal or heavy bleeding

• Assess the endometrium in perimenopausal or postmenopausal patients

This test is especially important for people over 40 with new or persistent abnormal bleeding.

Many Ramsay hospitals offer same-day or fast-track diagnostic pathways, meaning you can often have your consultation and investigations completed quickly, without long waiting times. This allows your specialist to provide a clear diagnosis and personalised treatment plan as soon as possible.

Treatment for period problems

Treatment for menstrual disorders depends on the underlying cause, the severity of symptoms, and how much they affect your daily life. 

At Ramsay Health Care, your gynaecologist will work with you to create a personalised treatment plan. Options range from medication and hormonal therapy to minimally invasive procedures and, where necessary, surgery.

Medication and hormonal treatments

Medication is often the first step in managing heavy, painful, or irregular periods. These treatments can regulate your menstrual cycle, reduce bleeding, ease pain, and help stabilise hormones.

• Combined oral contraceptive pill - helps regulate your menstrual cycle, reduce heavy bleeding, and ease period pain. It can also improve PMS symptoms.

• Progestogen tablets or injections - useful for regulating periods, reducing bleeding, and managing symptoms linked to hormonal imbalance.

• Hormonal coil (IUS / Mirena) - one of the most effective treatments for heavy periods. The coil releases a small amount of hormone directly into your womb, reducing bleeding and pain for many patients.

• GnRH analogues - are used for conditions such as endometriosis or fibroids. These medications temporarily switch off ovarian hormone production, creating a short-term “menopause-like” state to reduce symptoms.

• Tranexamic acid - is a non-hormonal medication that reduces heavy bleeding by helping blood to clot more effectively.

• NSAIDs (e.g., mefenamic acid) - reduce period pain and can also lessen blood loss during menstruation.

• SSRIs / SNRIs - are used specifically for PMDD, helping to stabilise mood and reduce severe psychological symptoms.

• Thyroid medication - is prescribed when irregular or absent periods are caused by an underactive or overactive thyroid.

Minimally invasive procedures

If medication is not effective or suitable, minimally invasive procedures can provide long-lasting relief with shorter recovery times.

• Endometrial ablation - a procedure that destroys the lining of the womb to reduce or stop heavy bleeding. It is suitable for people who do not wish to become pregnant in the future and offers a quick recovery. Find out about Microwave Endometrial Ablation 

• Hysteroscopic surgery - a thin camera (hysteroscope) is used to remove polyps or small fibroids from inside the womb. This can significantly improve heavy bleeding and irregular periods.

• Laparoscopic surgery - keyhole surgery used to diagnose and treat conditions such as endometriosis or adenomyosis. It allows surgeons to remove endometriosis lesions or treat structural problems with minimal downtime.

Surgical options

Surgery is usually considered when other treatments have not worked or when period symptoms are severe.

• Myomectomy - is the surgical removal of fibroids while preserving the womb. This option is often recommended for people who wish to maintain fertility.

• Hysterectomy - is the removal of your uterus. This is typically reserved for severe cases of heavy bleeding, fibroids, or adenomyosis when other treatments have been unsuccessful. Your specialist will discuss all alternatives before considering this option.

Ramsay specialists will always explore the least invasive and most conservative treatments first, ensuring you receive safe, effective care tailored to your needs.

Menstrual disorder treatment at Ramsay Health Care

At Ramsay, you’ll receive:

• Fast access to experienced gynaecologists

• Consultant-led care from your first appointment

• Comprehensive diagnostic testing in one place

• A full range of treatment options tailored to your needs

• Private, discreet appointments

• Hospitals nationwide

• Self-pay, payment plans, and private medical insurance options

Our specialists take the time to understand your period symptoms, your cycle, and your concerns and work with you to create a personalised treatment plan.

Book a consultation with a Ramsay gynaecology specialist to discuss your treatment options.

Period Problems FAQs