First and foremost, I have to remind you that I am not a medical professional. I feel okay writing about menstruation because it is not a disease, it is in fact a sign of good health, and something generally dealt with privately, in the home, and not in a medical setting. However, problems with your period can be symptoms of more serious problems that you need to see your doctor about. These guidelines are based on the suggestions that my HMO makes in its handbook, and I figure they are a good place to start. But you know your body best, and if you think something is wrong, call your doctor immediately. Never, never be hesitant or ashamed to ask questions about your period. If you don't have health insurance, go to a women's clinic, such as Planned Parenthood, where they have reasonable fees and/or sliding scale payments where you pay as much as you can afford.
Cramps can be painful. They are caused by an overproduction of a hormone called prostogladin which overstimulates the uterus into heavy cramping. Check out the section on cramps in "Anwers" for general advice for dealing with cramps. Heavy cramps are also one symptom of endometriosis. The following are some reasons to see your doctor about heavy cramps:
1) If your bleeding is extreme: more than one maxi pad or super tampon per hour for more than 6 hours, or if you bleed longer than 10 days.
2)If your cramps do not repond to home treatment
3) If your periods are closer than 21 days apart.
4) If you suspect your IUD of causing the cramps.
5) If your period is accompanied by sudden high fever, diarrhea or skin rash.
6) If your heavy cramping is a new thing after years of mild periods
7) If your cramping begins long before your period, and does not stop after your period stops.
If you miss a period and you are sexually active, pregnancy is the first obvious thing to check, but many other things can send your cycle a little off-kilter, including: stress; weight loss or gain; travel; heavy atheletic training; various medications including steroids, tranquilizers and diet pills. Birth control pills, and Norplant etc. can cause irregular or missed periods as well. If you are not pregnant, a missed period is really nothing to worry about, and chances are you will get regular again next month.
Also, the first years of menstruation (menarche) as well as the last (menopause) are marked by irregular periods. If you are just starting your period, you can expect irregularity for a while, if you are over 45, you may being starting menopause.
The following are reasons to see the doctor over missed periods:
1) If pregnancy seems possible.
2) If you have missed two regular periods and you are not pregnant, not in menopause, not dieting or exercising a lot, or under more than usual stress.
3) If you are an endurance athelete who cannot cut back on training. You may need supplemental calcium or hormones.
4) If you miss two or three periods while on birth control pills, and you have not skipped any pills .
Please see my section in "Answers" on PMS for general advice on dealing with PMS. Remember, you know it is PMS if it starts 7 to 10 days before your period, and gets better when your period starts.
Call your doctor if your PMS symptoms(physical or emotional) are severe or make you feel out of control. Also, call the doctor if your symptoms do not stop when the bleeding starts.