There is no definitive rule with regards to how often you should see a doctor if you have [endometriosis](https://nabtahealth.com/glossary/endometriosis/). The main thing is to find a _sympathetic doctor_ who will take the time to listen to any concerns you might have. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) can be [difficult to diagnose](https://nabtahealth.com/how-is-endometriosis-diagnosed/) and often the [symptoms](../the-symptoms-of-endometriosis) will closely resemble those of other conditions, such as [irritable bowel syndrome](https://nabtahealth.com/glossary/irritable-bowel-syndrome/) ([IBS](https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome)). For this reason you may initially be referred to a [gastroenterologist](https://nabtahealth.com/glossary/gastroenterologist/) rather than a [](https://nabtahealth.com/articles/top-10-gynaecologists/)[gynaecologist](https://nabtahealth.com/glossary/gynaecologist/). In fact, even once diagnosed, the best approach may well be to consult a multidisciplinary team of experts, depending on the specific symptoms you are experiencing. #### Looking after your emotional health It is also important to consider that [endometriosis](https://nabtahealth.com/glossary/endometriosis/) can have a large impact on your emotional wellbeing, and thus you need to manage more than just the physical symptoms of the condition. Chronic pain can be psychologically draining, as can putting on a ‘brave face’ in front of friends and family. It is not unusual for [](https://nabtahealth.com/articles/what-medications-are-recommended-for-endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) patients to report feeling isolated and alone and the condition has a strong association with depression. It is important to consult your doctor before these feelings start to overwhelm you. Your doctor should also be able to put you in contact with local support groups, where you will have the opportunity to talk to other women who are in the same position. #### Personalised treatment approach The wide ranging clinical presentation of [](https://nabtahealth.com/articles/how-is-endometriosis-diagnosed/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/) means that every patient ideally needs to have a [personalised treatment plan](https://nabtahealth.com/), tailored to their own requirements. This can take time to optimise, so in the early days after diagnosis, it might be necessary to see the doctor on a regular basis. As symptoms improve, the frequency of visits should subside. Nabta is reshaping [women’s healthcare](https://nabtahealth.com). We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Try Nabta’s [Cycle Monitoring with OvuSense](https://nabtahealth.com/product/cycle-monitoring-with-ovusense/) and understand your cycle and health. Get in [touch](/cdn-cgi/l/email-protection#dca5bdb0b0bd9cb2bdbea8bdb4b9bdb0a8b4f2bfb3b1) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * _[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) FAQs_. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [https://www.](https://www.endometriosis-uk.org/endometriosis-faqs)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-faqs. * _Overview: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/. Page last reviewed: 18/01/2019.
Medication for [endometriosis](https://nabtahealth.com/glossary/endometriosis/), the most common [symptom](https://nabtahealth.com/the-symptoms-of-endometriosis/) of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is pain, with up to 80% of patients complaining of period pain and up to 50% experiencing chronic pelvic pain. Aside from the physical discomfort and day-to-day limitations that long-term, chronic pain causes, it can also massively impact a patient’s quality of life, potentially leading to psychological conditions including anxiety and depression. The anxiety can be exacerbated in those patients who experience heavy periods every month, which causes additional discomfort and worry. #### Painkillers The first line approach for managing the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) are over-the-counter painkillers. Non-steroidal anti-inflammatories ([NSAIDs](https://my.clevelandclinic.org/health/drugs/11086-non-steroidal-anti-inflammatory-medicines-nsaids)), such as ibuprofen, partly function by inhibiting the production of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/). [Prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) cause the [uterus](https://nabtahealth.com/glossary/uterus/) to contract during [menstruation](https://nabtahealth.com/articles/menopause-the-symptoms-nobody-talks-about/) and this contributes to the [period pain](https://nabtahealth.com/articles/what-is-period-pain/) experienced by patients with _[endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Reducing the levels of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) will reduce the painful [contractions](https://nabtahealth.com/glossary/contraction/). Codeine-based medications and paracetamol-containing products are other options for pain relief. #### Hormone treatment If painkillers do not provide sufficient relief from the symptoms of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) there is the option of hormonal treatment. This is not a suitable option for those who are seeking help for [infertility](https://nabtahealth.com/glossary/infertility/). The endometrial deposits that develop outside the [uterus](https://nabtahealth.com/glossary/uterus/), and are characteristic of the condition, form in response to the hormone [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Hormonal therapy aims to block or reduce the production of [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Frequently prescribed hormonal therapies include the [combined contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/), [progesterone](https://nabtahealth.com/glossary/progesterone/) pills and gonadotrophin releasing hormone (GnRH) analogues: * The combined pill contains [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/); it prevents [](https://nabtahealth.com/articles/is-oligo-ovulation-anovulation-a-symptom-of-pcos/)[ovulation](https://nabtahealth.com/glossary/ovulation/) and makes periods lighter and less painful. * [Progesterone](https://nabtahealth.com/glossary/progesterone/) suppresses the growth of endometrial tissue, reducing [inflammation](https://nabtahealth.com/glossary/inflammation/) and pain. * GnRH analogues block [oestrogen](https://nabtahealth.com/glossary/oestrogen/) production, causing the endometrial tissue to shrink and become inactive. These drugs place the body into a temporary [menopausal](https://nabtahealth.com/i-am-post-menopause/) state, and long term use may require further medication to combat [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/)\-associated symptoms, such as [hot flushes](https://nabtahealth.com/glossary/hot-flushes/) and bone density loss. #### Alternative options Medication is just one option for the treatment of [endometriosis](https://nabtahealth.com/glossary/endometriosis/). If symptoms persist, another option to consider is [surgery](https://nabtahealth.com/should-i-have-surgery-for-endometriosis/). A fully personalised treatment approach is recommended for each patient, taking into account their age, symptoms, [fertility](https://nabtahealth.com/product/fertility-selfcare/) status and family situation. Nabta is reshaping [women’s healthcare](https://nabtahealth.com/). We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, [pregnancy](https://nabtahealth.com/articles/pregnancy-symptoms/), and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#225b434e4e43624c434056434a47434e564a0c414d4f) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bulletti, C, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [Infertility](https://nabtahealth.com/glossary/infertility/).” Journal of Assisted Reproduction and Genetics, vol. 27, no. 8, 25 June 2010, pp. 441–447., doi: 10.1007/s10815-010-9436-1. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Treatment. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [www.](http://www.endometriosis-uk.org/endometriosis-treatment)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-treatment. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). Mayo Clinic, 24 July 2018, [https://www.mayoclinic.org/diseases-conditions/](https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/diagnosis-treatment/drc-20354661. * Treatment: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/treatment/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/treatment/. Page last reviewed: 18/01/2019.
[](https://nabtahealth.com/what-is-endometriosis/)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Diagnosis can be challenging because the [symptoms](../the-symptoms-of-endometriosis) are often difficult to distinguish from [irritable bowel syndrome](https://nabtahealth.com/glossary/irritable-bowel-syndrome/); symptoms such as diarrhea, [constipation](https://nabtahealth.com/glossary/constipation/) and abdominal cramping are frequently seen with either or both conditions. Other symptoms, such as heavy and painful periods, and migraines, may be dismissed as normal ‘[monthly women problems](https://nabtahealth.com/articles/how-can-i-regulate-my-periods/)’. As well as regularly presenting with symptoms that are indistinguishable from other conditions, there is also a great deal of variability from patient to patient, further complicating diagnosis. 20-25% of _women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/)_ are [asymptomatic](https://nabtahealth.com/glossary/asymptomatic/), suggesting that the cited incidence rate of 6-10% of the female population having [endometriosis](https://nabtahealth.com/glossary/endometriosis/), is probably an under-estimation. Due to the inefficiency of the diagnostic tools currently in place, it very often takes years to diagnose a woman with [endometriosis](https://nabtahealth.com/glossary/endometriosis/). Diagnostic techniques --------------------- If you suspect you have [endometriosis](https://nabtahealth.com/glossary/endometriosis/), the first thing your doctor will do is examine your tummy and pelvis. They will feel for any abnormalities, such as cysts around your [](https://nabtahealth.com/articles/do-polycystic-ovaries-equal-pcos/)[ovaries](https://nabtahealth.com/glossary/ovaries/). Of course there are other conditions that cause [cysts](../are-ovarian-cysts-the-same-thing-as-pcos) to form on the [ovaries](https://nabtahealth.com/glossary/ovaries/), so this alone is not sufficient to diagnose [endometriosis](https://nabtahealth.com/glossary/endometriosis/). The current ‘[gold](https://nabtahealth.com/glossary/gold/) standard’ test for [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is to perform a [](../what-is-a-laparoscopy)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/). This is a procedure performed under general anaesthetic, where a small tube is passed through a cut in your abdomen. The surgeon will use a camera to view any abnormal tissue. Ideally, at least a single [biopsy](https://nabtahealth.com/glossary/biopsy/) will be taken at the same time, for further histological analysis. Histological diagnosis is usually accurate and, if this supports a positive diagnosis, an appropriate treatment plan can be implemented. Alternative, non-invasive tests, such as [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) and MRI scans have been shown to have very good accuracy at diagnosing deep [endometriosis](https://nabtahealth.com/glossary/endometriosis/), particularly when used in combination. Accuracy of diagnosis can be as high as 95%, which matches the level seen with [](https://nabtahealth.com/articles/what-is-a-laparoscopy/)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/). Deep [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is thought to affect up to 20% of patients. The main advantage to these imaging techniques is that they are less invasive than the current tests of choice and their popularity in the clinical setting is likely to continue to grow. The future for [endometriosis](https://nabtahealth.com/glossary/endometriosis/) diagnosis ----------------------------------------------------------------------------------------- An understudied area of research for the diagnosis of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is the identification of serum biomarkers of the condition. Levels of a protein, CA-125, are often raised in patients with [endometriosis](https://nabtahealth.com/glossary/endometriosis/). However, as a general marker of [](https://nabtahealth.com/product/vitamin-d-and-inflammation-test/)[inflammation](https://nabtahealth.com/glossary/inflammation/), it is not specific to [endometriosis](https://nabtahealth.com/glossary/endometriosis/) and can be indicative of an alternative inflammatory condition such as appendicitis, [pelvic infection](https://nabtahealth.com/articles/pelvic-inflammatory-disease-a-simple-guide/) or ovarian cysts. Ideally an [endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-specific marker, or panel of markers, will be found, enabling accurate diagnosis using a simple blood test, negating the need for more invasive treatment. Nabta is reshaping [women’s healthcare.](https://nabtahealth.com) We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#a1d8c0cdcdc0e1cfc0c3d5c0c9c4c0cdd5c98fc2cecc) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bazot, M, and E Daraï. “Diagnosis of Deep [Endometriosis](https://nabtahealth.com/glossary/endometriosis/): Clinical Examination, Ultrasonography, Magnetic Resonance Imaging, and Other Techniques.” _Fertility and Sterility_, vol. 108, no. 6, Dec. 2017, pp. 886–894., doi:10.1016/j.fertnstert.2017.10.026. * Hickey, M, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/).” _BMJ_, vol. 348, 19 Mar. 2014, p. g1752., doi:10.1136/bmj.g1752. * Kennedy, S, et al. “ESHRE Guideline for the Diagnosis and Treatment of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/).” _Human Reproduction_, vol. 20, no. 10, Oct. 2005, pp. 2698–2704., doi:10.1093/humrep/dei135. * May, K E, et al. “Peripheral Biomarkers of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/): a Systematic Review .” _Human Reproduction Update_, vol. 16, no. 6, 2010, pp. 651–674., doi:10.1093/humupd/dmq009. * _Overview: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/. Page last reviewed: 18/01/2019. * _[Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Mayo Clinic, 24 July 2018, [www.mayoclinic.org/diseases-conditions/](http://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/symptoms-causes/syc-20354656.
A normal menstrual cycle lasts between 21 and 35 days. Day one of the cycle is always the first day of menstrual bleeding (also known as having your period). Menstrual bleeding typically lasts for between 2 and 7 days and is often incorrectly used as a sign that [ovulation](https://nabtahealth.com/glossary/ovulation/) has occurred. In fact, women can have apparently normal periods without ovulating, click [here](https://nabtahealth.com/i-have-regular-periods-could-i-still-have-pcos/) to find out more. Normal [ovulation](https://nabtahealth.com/glossary/ovulation/) is essential for maintaining healthy levels of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/). Whilst these two hormones play a pivotal role during pregnancy, their beneficial effects are not limited to this; they are also vital for maintaining general health and help to protect against [osteoporosis](https://nabtahealth.com/glossary/osteoporosis/), breast cancer and heart disease. #### What defines abnormal uterine bleeding? Abnormal uterine bleeding affects 2-5% of women of reproductive age. It occurs when the cycle length and period duration differ from the normal values. It is a broad term that also encompasses bleeding or spotting between periods. Unfortunately this wide categorisation means that there are many potential causes of abnormal uterine bleeding and, often, diagnosis becomes a process of elimination. When abnormal uterine bleeding takes the form of prolonged, or heavy bleeding it is termed [menorrhagia](https://nabtahealth.com/glossary/menorrhagia/). Medically a ‘heavy’ period is defined as losing more than 80ml blood and/or it having a duration of over 7 days. Young teenagers and women experiencing the [perimenopause](https://nabtahealth.com/glossary/perimenopause/) are most at risk. For young teenagers it is usually just a case of their bodies settling into a regular cycle. Women who are perimenopausal are nearing the end of their reproductive years and will probably find the bleeding becomes more irregular and sporadic, before stopping altogether. Treatment options range from non-steroidal anti-inflammatory drugs, which block [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) (easing painful period cramps) and reduce menstrual flow; to hormonal treatment, such as the combined [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/%MCEPASTEBIN%), which stabilises the endometrial lining and ensures controlled monthly bleeds. In the most severe cases a female may need to undergo a [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/). Broadly speaking, abnormal uterine bleeding occurs because of structural abnormalities, lifestyle disruptions or [ovulation](https://nabtahealth.com/glossary/ovulation/) disorders. #### Structural abnormalities These can include [benign](https://nabtahealth.com/glossary/benign/) lesions such as [](../a-simple-guide-to-fibroids)[fibroids](https://nabtahealth.com/glossary/fibroids/), [](../what-are-uterine-polyps)[polyps](https://nabtahealth.com/glossary/polyps/) and [](../what-is-adenomyosis)[adenomyosis](https://nabtahealth.com/glossary/adenomyosis/), as well as lesions of the [cervix](https://nabtahealth.com/glossary/cervix/) and the [vagina](https://nabtahealth.com/glossary/vagina/). [](../what-is-endometriosis)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) is a well characterised condition that results from a build-up of endometrial-like tissue elsewhere in the body; chronic period pain and heavy periods are two of the main symptoms. Complications during the early stages of pregnancy, such as [miscarriage](https://nabtahealth.com/glossary/miscarriage/) and [](../what-is-an-ectopic-pregnancy)[ectopic pregnancy](https://nabtahealth.com/glossary/ectopic-pregnancy/) can also result in abnormal bleeding. Sometimes women who have an intrauterine device ([IUD](https://nabtahealth.com/glossary/iud/)) fitted for contraception will experience abnormal bleeding. Most structural abnormalities can be identified with ultrasound; for lesions deep within the pelvic region, a high resolution [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) is a very useful diagnostic aid. Occasionally surgery will be required; [hysteroscopies](../what-is-a-hysteroscopy) (within the uterine cavity) and [laparoscopies](../what-is-a-laparoscopy) (outside the [uterus](https://nabtahealth.com/glossary/uterus/)) can be used for both diagnosis and ablation of unwanted lesions. #### Lifestyle disruptions Certain medications and medical conditions can disrupt the menstrual cycle. Diabetes is one example. There appears to be some association between [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/) and a thickening of the uterine lining, the latter of which results in heavy periods. Emotional and physical stress can cause the menstrual cycle to become irregular, as can [obesity](https://nabtahealth.com/what-is-body-mass-index-bmi/%MCEPASTEBIN%) ([BMI](https://nabtahealth.com/glossary/bmi/) >30) and smoking. These are known as modifiable risk factors because through making behavioural adjustments, the risk of experiencing menstrual irregularities is reduced. #### [Ovulation](https://nabtahealth.com/glossary/ovulation/) disorders If no other cause can be established for abnormal uterine bleeding then an [ovulation](https://nabtahealth.com/glossary/ovulation/) disorder will probably be considered. These are classed as dysfunctional uterine bleeding and the most common examples are [polycystic ovary syndrome](../treating-the-associated-symptoms-of-pcos) ([PCOS](https://nabtahealth.com/glossary/pcos/)), thyroid disease and premature ovarian insufficiency ([POI](https://nabtahealth.com/glossary/poi/)). Thyroid disease is frequently misdiagnosed as [PCOS](https://nabtahealth.com/glossary/pcos/) because it shares a number of common symptoms, including [anovulation](https://nabtahealth.com/glossary/anovulation/) and [hair loss](../coping-with-pcos-hair-loss). However, thyroid disease itself has a strong association with irregular menstrual cycles. One study found that 44% of people with menstrual disorders had an underlying thyroid issue. The predominant thyroid issue is [hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/), which suppresses [ovulation](https://nabtahealth.com/glossary/ovulation/), impairs insulin sensitivity and reduces the availability of cellular energy (ATP). Normal ovarian function requires significant energy. The advantage to finding out you have an [ovulation](https://nabtahealth.com/glossary/ovulation/) disorder is that often it is [reversible](https://nabtahealth.com/is-it-possible-to-reverse-pcos/) with changes to the diet and lifestyle. For example, losing weight can improve the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). [POI](https://nabtahealth.com/glossary/poi/) is one case where lifestyle modifications will unfortunately not help. It happens when the [ovaries](https://nabtahealth.com/glossary/ovaries/) stop producing eggs and can come on gradually or occur suddenly. The first sign of the condition will usually be irregular menstrual cycles. In 50% of cases the cause is unknown, although there is thought to be a familial component. This condition can also occur in women who have undergone [](https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/radiotherapy/about)[radiotherapy](https://nabtahealth.com/glossary/radiotherapy/) or [](https://nabtahealth.com/articles/skin-changes-after-chemotherapy/)[chemotherapy](https://nabtahealth.com/glossary/chemotherapy/). Symptoms can be alleviated with hormone replacement therapy, but to date there is no cure. Unfortunately doctors are often unsure how best to manage _abnormal uterine bleeding_ and treatment is, at best, random and speculative, and at worst, ineffective. It is of fundamental importance to identify the reasons for your [irregular cycles](https://nabtahealth.com/articles/why-are-my-periods-irregular/) and abnormal bleeding because only that way will you be able to find a solution that provides complete symptomatic relief. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/articles/effects-of-menopause-on-the-body/)[menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#0a736b66666b4a646b687e6b626f6b667e6224696567) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Abnormal Uterine Bleeding (Booklet).” ReproductiveFacts.org, The American Society for Reproductive Medicine, www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/abnormal-uterine-bleeding/. Revised 2012. * Ajmani, N S, et al. “Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of Walled City of Delhi.” Journal of Obstetrics and Gynaecology of India , vol. 66, no. 2, Apr. 2016, pp. 115–119., doi:10.1007/s13224-014-0650-0. * Bae, J, et al. “Factors Associated with Menstrual Cycle Irregularity and [Menopause](https://nabtahealth.com/glossary/menopause/).” BMC Women’s Health, vol. 18, no. 1, 6 Feb. 2018, p. 36., doi:10.1186/s12905-018-0528-x. * Koutras, D A. “Disturbances of Menstruation in Thyroid Disease.” Annals of the New York Academy of Sciences, vol. 816, 17 June 1997, pp. 280–284. * “Overview: Heavy Periods.” NHS, [www.nhs.uk/conditions/heavy-periods/](http://www.nhs.uk/conditions/heavy-periods/). Page last reviewed: 07/06/2018. * “What Is Premature Ovarian Insufficiency (Also Called Premature Ovarian Failure)? .” ReproductiveFacts.org, The American Society for Reproductive Medicine, [www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/](http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/). Revised 2015.
\***_According to Patient Feedback_** “Who are the best gynaecologists in Dubai? Can anyone recommend an OBGYN?” You asked us and we turned the question back to you. We have compiled the top 10 gynaecologists in Dubai, based only on real patient recommendations, experience and feedback. No healthcare professionals were questioned. Gathered from exemplary recommendations across Dubai social media forums, these top 10 gynaecologists in Dubai not only have a wealth of clinical expertise in their field, they also stand out for the overwhelmingly positive comments from their patients. #### **Dr Salma Ballal, Consultant Obstetrics and Gynaecology, [Genesis Healthcare Center](https://www.genesis-dubai.com/our_doctors/dr-salma-ballal/)** Having delivered well over 1000 babies, Dr Salma Ballal has extensive experience in managing normal and complex pregnancies and deliveries. Dr Salma trained in obstetrics and gynaecology with the UK’s NHS where she developed a strong interest in maternal medicine, high-risk pregnancies, and labour care. She completed advanced maternal medicine and labour ward practice training with the Royal College of Obstetrics and Gynaecology (RCOG) before moving to Dubai in 2014. Dr Salma was most recently at Mediclinic Parkview hospital before joining the Genesis Healthcare Center team. Dr Salma believes in open communication with her patients and that “women should be kept informed through every step of what is the most amazing experience in any woman’s life.” She also offers pre-pregnancy counselling to patients with complicated or traumatic pregnancy history. Patients describe Dr Salma as “refreshingly honest”, and “very safe hands”, saying she “totally respected my wishes”. #### **Dr Esra Majid, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Kings’ College Hospital Dubai**](https://kingscollegehospitaldubai.com/dr/esra-mejid/) Based in Dubai since 2016, Dr Esra has built a reputation for her management of high-risk pregnancies and gynaecological conditions. She worked at Al Zahra Hospital Dubai, where she regularly received excellent feedback from her patients, before moving to King’s College Hospital Dubai. At Kings’ College Hospital Dubai Dr Esra “performs major surgical procedures, follow up of high-risk pregnancies and deliveries, along with natural and water births.” Dr Esra qualified in Baghdad and went on to complete her Board Certificate in Obstetrics and Gynaecology in Sweden. She worked at the teaching hospital Sundsvall County Hospital and as a specialist at Sodra Alv Bord Hospital in Gothenburg before moving to Dubai. Patients have praised Dr Esra for her expertise and skill, describing her as “straight to the point, warm and approachable.” #### **Dr Vibha Sharma, Specialist [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Prime Medical Center**](https://www.primehealth.ae/prime-medical-centers/medical-centers/prime-medical-center-sheikh-zayed-road/dr-vibha-sharma) Working in Dubai since 2004, Dr Vibha is known for her commitment to supporting women with a range of gynaecological and women’s health problems. In the UAE she worked at Ministry of Health and Tertiary Care hospitals prior to joining Prime Medical Center. Dr Vibha specialises in areas of women’s health requiring specialist gynaecological expertise. Qualified in India at Jammu Medical College, Dr Vibha went on to do her post-graduate at King George’s Medical College in Lucknow. She worked at Queen Mary’s Hospital Lucknow and Willingdon and Batra Hospitals and Research Centre in New Delhi before moving to the Middle East. Patients have described Dr Vibha as “consistent”, “approachable”, and “professional”. **Dr Aisha Alzouebi, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic Parkview Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/aisha-alzouebi-dr.html) Dr Aisha Alzouebi has more than 15 years of experience in obstetrics and gynaecology in the UK and the UAE, with specialist expertise in “early pregnancy, management of complications in early pregnancy, family planning and sexual health, [benign](https://nabtahealth.com/glossary/benign/) open and laparoscopic surgery and hysteroscopy.” A member of the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), Dr Aisha attended medical school at Sheffield University and completed her Masters in Surgical Education at Imperial College London. Patient social media feedback on Dr Aisha said, “she was brilliant”, “I would highly recommend her”, “Dr Aisha is great”. #### **Dr Reeja Mary Abraham, Specialist in Obstetrics and Gynaecology,** [**Medcare Women and Children Hospital**](https://www.medcare.ae/en/physician/view/reeja-mary-abraham.html) A specialist in high-risk pregnancies, Dr Reeja takes an “evidence-based” approach to complex and low risk gynaecological issues. Dr Reeja is based at Medcare Women and Children Hospital, where she also “performs and assists in major and minor gynaecological procedures”. A member of the Indian Medical Association (IMA) and the Kerala Federation of Obstetricians and Gynaecologists (KFOG), Dr Reeja began her medical career at Christian Fellowship Hospital in Oddanchatram, Tamil Nadu and worked in hospitals in Kerala and Tamil Nadu before moving to Dubai to work at Medcare Women and Children Hospital. Patients recommending Dr Reeja describe her as “kind and attentive”, “highly professional”, and “detail-oriented”. #### **Dr Nashwa Abulhassan, Head of Obstetrics and Gynaecology, Dr** [**Sulaiman Al Habib Hospital Healthcare City**](https://www.hmguae.com/doctor/dr-nashwa-abul-hassan/) Dr Nashwa is a specialist in normal and complex pregnancies and deliveries, as well as “acute gynaecology and early pregnancy complications management” based at Dr Sulaiman Al Habib Hospital Healthcare City. A member of the Royal College of Obstetricians and Gynaecologists (RCOG) and an accredited member of the British society of colposcopists and cervical pathologists, Dr Nashwa has more than 15 years of experience in the UK and the UAE. Dr Nashwa has been featured in the UAE media discussing pregnancy complications and was most recently in [Gulf News](https://gulfnews.com/uae/health/step-by-step-guide-to-dealing-with-covid-19-during-pregnancy-1.80112211), offering advice for pregnant women who have tested positive for Covid-19. Dr Nashwa’s patients describe her as “kind and caring”. #### **Dr Samina Dornan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/) and sub specialist in Maternal Fetal Medicine, [Al Zahra Hospital](https://azhd.ae/doctors/dr-samina-dornan/#:~:text=Consultant%20Maternal%20and%20Fetal%20Medicine,London%20to%20come%20to%20Dubai.)** An established international voice on maternal and fetal health issues, Dr Samina Dornan has extensive experience in fetal medicine. At Al Zahra Hospital she works as a consultant [obstetrician](https://nabtahealth.com/glossary/obstetrician/) and gynecologist with a sub-specialty in Maternal Fetal Medicine. Dr Samina qualified at Queen’s University Belfast. She received a fellowship from the Royal College of Obstetricians and Gynaecologists (RCOG) in 2017 and is the “first female Maternal Fetal Medicine sub-specialist \[at RCOG\]” to work with patients in Dubai. Frequently quoted in the media, Dr Samina is “extensively published in complex twin pregnancies”. Patient feedback on Dr Samina is overwhelmingly positive, describing her as “wonderful”, “absolutely fantastic”, “caring” and “amazing”. #### **Dr Sarah Francis, Consultant Obstetrics and Gynaecology,** [**American Hospital Dubai and American Hospital Al Khawaneej Clinic**](https://www.ahdubai.com/doctors-profile/sarah-francis) With clinical expertise in general and [benign](https://nabtahealth.com/glossary/benign/) gynaecology, adolescent gynaecological issues, polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), and low and high-risk pregnancies, Dr Sarah supports patients at American Hospital Dubai and American Hospital Al Khawaneej Clinic. A member of the Royal College of Obstetricians and Gynaecologists (RCOG), Dr Sarah qualified in Sierra Leone and practised in NHS hospitals and trusts across the UK before moving to the UAE. She worked with patients at Drs Nicholas and Asp clinics before joining the team at American Hospital. Patients say that Dr Sarah is “wonderful” and “exceptionally supportive”. #### **Dr Dragana Pavlovic-Acimovic, Specialist Obstetrics and Gynaecology,** [**Mediclinic Meadows**](https://www.mediclinic.ae/en/corporate/doctors/8/dragana-pavlovic-acimovic.html) Dr Dragana has “a special interest in obstetrics” and consults on “adolescent gynaecology, [menopause](https://nabtahealth.com/glossary/menopause/), family planning” and various gynaecological conditions. Dr Dragana qualified in Serbia and started her career at University Hospital Narodni Front in Belgrade, “the largest specialised obstetrics and gynaecology centre in South-East Europe”. She moved to Dubai in 2015 and worked at Drs Nicholas and Asp before joining Mediclinic. Patients’ experience with Dr Dragana is “great”. #### **Dr Alessandra Pipan, Consultant [Obstetrician](https://nabtahealth.com/glossary/obstetrician/) and [Gynaecologist](https://nabtahealth.com/glossary/gynaecologist/),** [**Mediclinic City Hospital**](https://www.mediclinic.ae/en/corporate/doctors/1/alessandra-pipan.html) With more than 30 years’ experience in gynaecology and obstetrics Dr Alessandra treats a range of gynaecological conditions, is a specialist in [infertility](https://nabtahealth.com/glossary/infertility/) and oncology, and works with high-risk pregnancies at Mediclinic City Hospital. A member of the Royal College of Obstetrics and Gynaecology (RCOG), the European Society of Reproduction and Embryology, and the European Society of Gynaecological Endoscopy, Dr Alessandra qualified at Cattolica University of Rome, Italy and has developed extensive sector experience in positions across the Italian and UAE healthcare institutions. Patients of Dr Alessandra have described her as “great” and “amazing”. \_\_\_ Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [](https://nabtahealth.com/glossary)[menopause](https://nabtahealth.com/glossary/menopause/). You can track your menstrual cycle and get [personalised support by using the Nabta app.](https://nabtahealth.com/our-platform/nabta-app/) Get in [touch](/cdn-cgi/l/email-protection#fc859d90909dbc929d9e889d94999d908894d29f9391) if you have any questions about this article or any aspect of women’s health. We’re here for you.
 #### What is a menstrual cycle? A woman’s menstrual cycle is the time between the first day of each period. The average menstrual cycle is around 28 days, but cycles can range from 21 to 40 days. A woman’s period, also known as menstruation, is when she bleeds from her [vagina](https://nabtahealth.com/glossary/vagina/) and typically lasts 5 to 7 days. #### What is a period? During a woman’s monthly period her body discards the [uterus](https://nabtahealth.com/glossary/uterus/) (womb) lining thickened in preparation for a fertilised egg. When the egg isn’t fertilised this lining sheds from the [uterus](https://nabtahealth.com/glossary/uterus/), through the [cervix](https://nabtahealth.com/glossary/cervix/), and out of the body through the [vagina](https://nabtahealth.com/glossary/vagina/). A girl’s periods start at any time from age 10 to 15 years old, the average age is 12 years, but everyone is different. Her periods will continue until she is in her 40s to 50s, when her [ovaries](https://nabtahealth.com/glossary/ovaries/) will gradually stop producing female reproductive hormones, leading to [perimenopause](https://nabtahealth.com/glossary/perimenopause/) and then [menopause](https://nabtahealth.com/glossary/menopause/). #### Managing menstrual bleeding Discreet, easy-to-use sanitary products are designed to soak up or collect the menstrual blood released from the [vagina](https://nabtahealth.com/glossary/vagina/). * Sanitary pads: Disposable or washable absorbent padding attached to underwear and changed regularly. Designed in sizes to suit light, medium and heavy flows. * Tampons: Small disposable tubes of absorbent material designed to be inserted into the [vagina](https://nabtahealth.com/glossary/vagina/) to soak up menstrual blood. For hygiene and safety reasons tampons are single-use and should be changed and disposed of regularly. Women should follow labelled instructions for safe tampon use, use the right tampon absorbency, change each tampon every 4 to 8 hours, and never wear a single tampon for more than 8 hours at a time. * Menstrual cups: Washable, reusable medical-grade silicone cups designed to be inserted into the [vagina](https://nabtahealth.com/glossary/vagina/) to catch and collect blood. They should be emptied, washed, and reinserted regularly, and again good hygiene practices are important when using a menstrual cup. * Period underwear: Regular-looking panties designed with absorbent material and a moisture barrier to keep the wearer dry and leak-free. Period panties offer various levels of absorbency and can go in the washing-machine. Some brands also produce period swimwear with built-in leak protection. #### Period hygiene tips The [vagina](https://nabtahealth.com/glossary/vagina/) is a self-cleaning organ and period blood is not contaminated when it exits the body from the womb. However, during a woman’s period the presence of blood, warmth and moisture makes the [vagina](https://nabtahealth.com/glossary/vagina/) and vulva an environment more prone to yeast, fungal and bacterial infections, and bad odour. So keeping a menstrual hygiene routine is important. Healthcare professionals recommend a woman washes her genitals with warm water, not soap, at least twice a day while bleeding, always wiping from front to back. Female hygiene products (tampons, sanitary pads, menstrual cups, period pants) should be changed and disposed of regularly. Reusable and washable sanitary products, such as menstrual cups and period panties, must be rinsed and cleaned thoroughly. #### Tracking periods Everyone is different and every woman’s period and cycle will vary in length, frequency, and flow, sometimes from month to month. It’s useful to get into the habit of tracking periods, either using a period tracker app or a calendar. This helps a woman understand her body’s natural cycle and fertile days. And it’s important to discuss any ongoing changes in cycle length, flow, and frequency with a healthcare practitioner. _How to manage menstrual symptoms_ #### Managing painful periods Period pain (primary dysmenorrhea), cramping in the lower abdomen and back, varies in severity from woman to woman, and sometimes from month to month. Over the counter pain relief, paracetamol, or anti-inflammatory medications such as ibuprofen, will normally relieve painful period cramps. The pains usually last 1 to 3 days, and for some women the cramps might be strong enough to need a day or two in bed. Many women find relief from their period symptoms in gentle exercise, having a warm bath, or putting a hot water bottle, heat pack, or warm flannel on their stomach. Debilitating period pain, also known as secondary dysmenorrhea, is often caused by an underlying medical condition that affects the [uterus](https://nabtahealth.com/glossary/uterus/), such as uterine [fibroids](https://nabtahealth.com/glossary/fibroids/), polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), [endometriosis](https://nabtahealth.com/glossary/endometriosis/), or pelvic inflammatory disease. #### What is PMS? PMS ([premenstrual syndrome](https://nabtahealth.com/glossary/premenstrual-syndrome/)) or PMT (premenstrual tension) describes the physical and emotional changes caused by the change in estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/) levels in the [lead](https://nabtahealth.com/glossary/lead/)\-up to a woman’s period. Typical symptoms of PMS include: * Swollen and tender breasts * Mood swings and irritability * Bloating * Acne and greasy hair * Headaches * Low libido To manage PMS women should try to take it easy, eat a healthy diet, do some gently exercise and get plenty of rest. Some doctors may recommend hormonal birth control – the contraceptive pill or Mirena coil – to manage menstrual symptoms. #### What are abnormal periods? If period symptoms are so severe that they interfere with everyday life, or if periods suddenly change (flow is noticeably lighter, heavier or lasts longer, cycles change in length, periods are missed for 3 months or more) it is important to discuss with a healthcare professional. Lifestyle changes and emotional stress can affect a woman’s periods. Other reasons include birth control pills, and underlying conditions such as uterine [polyps](https://nabtahealth.com/glossary/polyps/) or [fibroids](https://nabtahealth.com/glossary/fibroids/), [endometriosis](https://nabtahealth.com/glossary/endometriosis/), polycystic ovarian syndrome ([PCOS](https://nabtahealth.com/glossary/pcos/)), and pelvic inflammatory disease. #### Is it possible to have sex or get pregnant during the period? In a word, yes. Although the risk of getting pregnant is lower while menstruating, it is still important to use birth control to avoid an unwanted pregnancy. #### Continuing with daily life Periods don’t have to get in the way of everyday life. Menstruation is regular part of a woman’s life from [puberty](https://nabtahealth.com/glossary/puberty/) to [menopause](https://nabtahealth.com/glossary/menopause/). Most women will get their period regularly for 30-40 years and managing periods becomes second nature.
There are a number of reasons why a female might experience [irregular periods](https://nabtahealth.com/what-is-abnormal-uterine-bleeding). Many factors can disrupt the delicate hormone balance that is required for a regular menstrual cycle. Whilst the length of a menstrual cycle can differ from woman to woman, most find that it is between 21 and 35 days long. Irregular cycles occur when the duration falls outside of this range and/or the length of the cycle varies month by month (the gap between periods keeps changing). The best way of regulating your periods is to identify the reason for the irregularity and rectify that. Some of the most common causes are listed below. #### **Age** Young girls and women who are approaching [menopause](https://nabtahealth.com/glossary/menopause/) often experience menstrual irregularities. For those who have only recently started their periods, it can take over two years for their cycles to become regular; time and patience are likely to be the best treatment. Women who are starting to experience symptoms of [menopause](https://nabtahealth.com/glossary/menopause/) can use hormonal treatment to regulate their cycles; this also protects against the damaging effects of low estrogen, which include reduced bone strength and increased risk of breast cancer. Natural estrogens and progesterones are the preferred option. #### **Hormonal Contraception** The intrauterine device ([IUD](https://nabtahealth.com/glossary/iud/)) and [oral contraceptive pill](../the-oral-contraceptive-pill) contain synthetic estrogen and [progesterone](https://nabtahealth.com/glossary/progesterone/) (progestin) analogs. They actually have widespread use as a means of regulating the menstrual cycle. Many women who are fitted with an [IUD](https://nabtahealth.com/glossary/iud/) will stop having periods altogether and those on the pill will have a withdrawal bleed once a month. However, sometimes it takes time to identify a form of hormonal treatment that is suitable and if irregular periods persist three months after commencing treatment, it is probably worth switching to an alternative. #### **Lifestyle changes** Excessive weight gain or loss, too much exercise, a poor or irregular diet, and stress can all have an impact on the menstrual cycle. Moderating these factors can help to regulate the cycle. If stress is starting to have an effect on your physical and emotional health seeing a trained counselor may help. Ensure that any changes in weight are controlled and not as a result of an extreme diet. #### **Medical conditions** Ovulatory disorders, such as [polycystic ovary syndrome](../what-is-pcos), and thyroid problems frequently [lead](https://nabtahealth.com/glossary/lead/) to fluctuations in the menstrual cycle. The best way of regulating the cycle in these instances is to treat the underlying condition. For example, [PCOS](https://nabtahealth.com/glossary/pcos/) is frequently associated with [insulin resistance](https://nabtahealth.com/glossary/insulin-resistance/), and thus, losing weight can drastically improve many of the associated symptoms. [Hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/) (an underactive [thyroid gland](https://nabtahealth.com/glossary/thyroid-gland/)) commonly causes irregular periods. Thyroid hormone replacement can be very effective at resolving this issue. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) occurs when endometrial tissue forms elsewhere in the body, potentially causing pain, heavy bleeding, and irregular periods. Treating [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is challenging; the medication can provide temporary relief by masking the symptoms and surgical removal of accessible endometrial deposits is sometimes successful, but unfortunately, relapse is common. Some patients find that the only way to completely resolve their symptoms is to undergo a radical surgical procedure, such as a [hysterectomy](https://nabtahealth.com/glossary/hysterectomy/). Some women find that after an infection or following a surgical procedure, they experience irregular periods. This can happen even if the [uterus](https://nabtahealth.com/glossary/uterus/) and reproductive organs are not the sources of the infection or the area being operated on. Essentially the body goes into a state of physiological stress, which then disrupts the menstrual cycle, in the same way, that psychological stress does. Provided you had a regular menstrual cycle before, with time your periods should become regular again. In rare cases, an irregular menstrual cycle can be a sign of something more serious, such as cervical or ovarian cancer. For this reason, it is essential that if you are experiencing any irregular bleeding you consult a doctor so that they can eliminate the more severe conditions, identify the underlying cause and find a treatment approach that works for you. #### Conclusion The options for regulating your periods will depend heavily on whether you wish to become pregnant. Many women only start exploring ways of regulating their cycle because they are hoping to conceive. With irregular cycles, it is hard to calculate if and when [ovulation](https://nabtahealth.com/glossary/ovulation/) is occurring and this can make getting pregnant challenging. The birth control pill is frequently prescribed to regulate periods, but will not be suitable for women trying to conceive. For these women, exploring the underlying reasons for their irregular cycles in more detail may be necessary. They may also have to resort to alternative hormone therapies, such as clomiphene citrate, or gonadotrophins to help stimulate [ovulation](https://nabtahealth.com/glossary/ovulation/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#f68f979a9a97b698979482979e93979a829ed895999b) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Pasquali, R, et al. “The Impact of Obesity on Reproduction in Women with Polycystic Ovary Syndrome.” _BJOG_, vol. 113, no. 10, Oct. 2006, pp. 1148–1159., doi:10.1111/j.1471-0528.2006.00990.x. * “Irregular Periods.” _NHS_, [www.nhs.uk/conditions/irregular-periods/](http://www.nhs.uk/conditions/irregular-periods/). Page last reviewed: 09/04/2018. * Briden, L. “Irregular Periods? It Could Be Your Thyroid.” _Lara Briden – The Period Revolutionary_, 31 Oct. 2014, [www.larabriden.com/irregular-periods-think-about-thyroid/](http://www.larabriden.com/irregular-periods-think-about-thyroid/).
Causes of [infertility](https://nabtahealth.com/glossary/infertility/) when a couple does not fall pregnant, despite actively trying for at least a year. The challenge of [infertility](https://nabtahealth.com/glossary/infertility/) should be one faced by a couple together. Until testing is carried out, it may not be possible to discern where the problem lies. Where a cause for the [infertility](https://nabtahealth.com/glossary/infertility/) is identified, testing will usually reveal that in one-third of cases the problem lies with the female, in one-third of cases it lies with the male and in one-third of cases it is due to a combination of factors. Female [infertility](https://nabtahealth.com/glossary/infertility/) ------------------------------------------------------------------- Some of the most common [female](https://nabtahealth.com/causes-of-female-infertility-an-overview/) [infertility](https://nabtahealth.com/glossary/infertility/) issues include: * [](../what-is-endometriosis)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) * [Polycystic ovary syndrome](../what-is-pcos) ([PCOS](https://nabtahealth.com/glossary/pcos/)) * Hormonal disorders, including [hyperthyroidism](https://nabtahealth.com/glossary/hyperthyroidism/) and [hypothyroidism](https://nabtahealth.com/glossary/hypothyroidism/) * [Fallopian tube blockages](https://nabtahealth.com/assessing-fallopian-tube-patency-in-females-who-are-struggling-to-conceive/) * Anti-[sperm](https://nabtahealth.com/glossary/sperm/) antibodies in the follicular fluid and in the blood * Early [menopause](https://nabtahealth.com/glossary/menopause/)/ovarian insufficiency. Male [infertility](https://nabtahealth.com/glossary/infertility/) ----------------------------------------------------------------- Some of the most common [male](https://nabtahealth.com/causes-of-male-infertility/) [infertility](https://nabtahealth.com/glossary/infertility/) issues include: * Abnormal [sperm](https://nabtahealth.com/glossary/sperm/) production (a low [sperm](https://nabtahealth.com/glossary/sperm/) count, [](../low-sperm-motility-asthenozoospermia)[sperm](https://nabtahealth.com/glossary/sperm/) that does not move well, or [sperm](https://nabtahealth.com/glossary/sperm/) that is an irregular shape) * [](../what-are-varicoceles)[Varicoceles](https://nabtahealth.com/glossary/varicoceles/) (abnormal veins in the testes) * Premature or retrograde ejaculation * Anti-[sperm](https://nabtahealth.com/glossary/sperm/) antibodies. * Exposure to [environmental factors](https://nabtahealth.com/environmental-factors-that-contribute-to-male-infertility/), including pesticides, drugs and other chemicals. * Cancers, particularly those that affect the male and female reproductive systems, can also massively impair fertility, as can the most commonly used radiation and [chemotherapy](https://nabtahealth.com/glossary/chemotherapy/) treatments. Seeking help for [infertility](https://nabtahealth.com/glossary/infertility/) ----------------------------------------------------------------------------- When seeking guidance and advice for [infertility](https://nabtahealth.com/glossary/infertility/), it is recommended that both partners attend the sessions, particularly as it is a good opportunity to learn more about the normal process of conception as well as natural ways to increase fertility. In up to 25% of cases, even after comprehensive testing, the doctor will diagnose ‘idiopathic [infertility](https://nabtahealth.com/glossary/infertility/)’, meaning there is no obvious cause. The good news, however, is that most couples that seek medical advice will eventually conceive. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#5c253d30303d1c323d3e283d34393d302834723f3331) if you have any questions about this article or any aspect of women’s health. We’re here for you. #### **Sources:** Gunn, D D, and G W Bates. “Evidence-Based Approach to Unexplained [Infertility](https://nabtahealth.com/glossary/infertility/): a Systematic Review.” _Fertility and Sterility_, vol. 105, no. 6, June 2016, pp. 1566–1574., doi:10.1016/j.fertnstert.2016.02.001. Nip, M M, et al. “[Autoantibodies](https://nabtahealth.com/glossary/autoantibodies/) and Antisperm Antibodies in Sera and Follicular Fluids of Infertile Patients; Relation to Reproductive Outcome after in-Vitro Fertilization.” _Human Reproduction_, vol. 10, no. 10, Oct. 1995, pp. 2564–2569. “Causes: [Infertility](https://nabtahealth.com/glossary/infertility/).” NHS, 14 Feb. 2017, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/infertility/causes/)[infertility](https://nabtahealth.com/glossary/infertility/)/causes/. “[Infertility](https://nabtahealth.com/glossary/infertility/).” Mayo Clinic, [www.mayoclinic.org/diseases-conditions/](http://www.mayoclinic.org/diseases-conditions/infertility/symptoms-causes/syc-20354317)[infertility](https://nabtahealth.com/glossary/infertility/)/symptoms-causes/syc-20354317.
* [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) is a condition where endometrial tissue grows outside the [uterus](https://nabtahealth.com/glossary/uterus/). * Endometrial tissue is tissue that is similar to the lining of the [uterus](https://nabtahealth.com/glossary/uterus/) or womb. * With [endometriosis](https://nabtahealth.com/glossary/endometriosis/), the endometrial tissue usually occurs in the [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) or [ovaries](https://nabtahealth.com/glossary/ovaries/). * This can cause swelling and chronic pain, an accumulation of blood and the formation of cysts. * [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) can be treated with medication and, in severe cases, the tissue can be removed surgically. Endometrial tissue growing elsewhere still behaves in the same way as normal endometrial tissue, meaning that every month it thickens, breaks down and bleeds. Unlike normal endometrial tissue, which is released from the body during a woman’s monthly menstrual period, tissue that is located elsewhere in the body has nowhere to go. Thus, it accumulates; causing swelling, followed by [inflammation](https://nabtahealth.com/glossary/inflammation/) and pain. Scar tissue can cause irritation to the surrounding tissue and, if the [ovaries](https://nabtahealth.com/glossary/ovaries/) are affected, blood can accumulate forming cysts called endometriomas. #### Symptoms of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) Whilst 20-25% of patients with [endometriosis](https://nabtahealth.com/glossary/endometriosis/) are [asymptomatic](https://nabtahealth.com/glossary/asymptomatic/), of the 75-80% who are affected, the [symptoms](https://nabtahealth.com/the-symptoms-of-endometriosis/) can be quite debilitating. Symptoms may include chronic pelvic pain, which occurs around the same time as menstruation, bowel and bladder problems and heavy periods. One of the main complications of the condition is [problems with fertility](https://nabtahealth.com/can-endometriosis-make-it-harder-to-get-pregnant/), which affects up to 40% of women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/). In severe cases, the endometrial tissue will have to be [surgically removed](https://nabtahealth.com/what-is-a-laparoscopy/). [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) is a long-term condition that typically affects women in their 30s and 40s. The chronic nature of the symptoms means that patients will often experience concurrent depression and fatigue. It is also sometimes confused with [irritable bowel syndrome](https://nabtahealth.com/glossary/irritable-bowel-syndrome/), as the symptoms can be very similar. #### **Treatment of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/)** [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) treatment often include medication, pain killers and possible surgery to remove the endometrial tissue. Medications can include: * **Hormonal contraceptives.** Hormonal contraceptive pills can control the amount of endometrial tissue that thickens and bleeds each month. Many have lighter and shorter menstrual flow when they’re using a hormonal contraceptive and therefore it is possible to reduce pain by taking the pill. * **Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists.** These help endometrial tissue to shrink by blocking [oestrogen](https://nabtahealth.com/glossary/oestrogen/) hormones, creating an artificial [menopause](https://nabtahealth.com/glossary/menopause/). * **Progestin.** Taking progestin supplements or using a progestin implant can stop women from experiencing periods meaning there is no build up of endometrial tissue each month. These are often taken with aromatase inhibitors that decrease the amount of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) in your body. #### What causes [Endometriosis](https://nabtahealth.com/glossary/endometriosis/)? The exact [cause of](https://nabtahealth.com/what-causes-endometriosis/) [endometriosis](https://nabtahealth.com/glossary/endometriosis/) remains unknown. It is thought to be due to a combination of genetic susceptibility, hormonal imbalance and immune system dysfunction. [Retrograde menstruation](https://nabtahealth.com/glossary/retrograde-menstruation/) is also believed to play a role. [Retrograde menstruation](https://nabtahealth.com/glossary/retrograde-menstruation/) occurs when menstrual blood containing endometrial cells enters the fallopian tube instead of leaving the body. This is known as the [transplantation theory](https://nabtahealth.com/glossary/transplantation-theory/) and can also occur when the endometrial cells travel elsewhere in the body via the bloodstream. Living with [endometriosis](https://nabtahealth.com/glossary/endometriosis/) can be challenging, both emotionally and physically. If you are affected and it is having an impact on your quality of life, the first step is to seek medical advice and support. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#e79e868b8b86a789868593868f82868b938fc984888a) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bulletti, C, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [Infertility](https://nabtahealth.com/glossary/infertility/).” _Journal of Assisted Reproduction and Genetics_, vol. 27, no. 8, Aug. 2010, pp. 441–447., doi:10.1007/s10815-010-9436-1. * Koninckx, P R, et al. “Pathogenesis of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/): the Genetic/Epigenetic Theory.” _Fertility and Sterility_, vol. 111, no. 2, Feb. 2019, pp. 327–340., doi:10.1016/j.fertnstert.2018.10.013. * _Overview: [Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. NHS, [www.nhs.uk/conditions/](http://www.nhs.uk/conditions/endometriosis/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/. Page last reviewed: 18/01/2019. * _Understanding Endrometriosis_. [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) UK, [www.](http://www.endometriosis-uk.org/understanding-endometriosis)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-uk.org/understanding-[endometriosis](https://nabtahealth.com/glossary/endometriosis/). * _[Endometriosis](https://nabtahealth.com/glossary/endometriosis/)_. Mayo Clinic, 24 July 2018, [www.mayoclinic.org/diseases-conditions/](http://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)/symptoms-causes/syc-20354656.
Hormonal contraceptives are used to prevent pregnancy. When taken correctly, they are a highly effective form of birth control and have given women the opportunity to manage their family planning in a way they never could before. However, in today’s world, hormonally-driven contraceptives, such as the [oral contraceptive pill](https://nabtahealth.com/the-oral-contraceptive-pill/), are used to ‘treat’ a myriad of female health concerns, from irregular or heavy periods, to [acne](https://nabtahealth.com/why-do-i-get-acne-breakouts-before-my-period/) and [](https://nabtahealth.com/coping-with-pms/)[premenstrual syndrome](https://nabtahealth.com/glossary/premenstrual-syndrome/) (PMS). The question is how effective are they and should we be happy with a solution that merely masks the symptoms, rather than solving the underlying problem? #### **What are some of the conditions the pill is regularly prescribed for?** * [](https://nabtahealth.com/what-is-endometriosis/)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/). [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) occurs when the tissue that normally forms the lining of the [uterus](https://nabtahealth.com/glossary/uterus/) (the endometrium) grows elsewhere in the body. The two main [symptoms](https://nabtahealth.com/the-symptoms-of-endometriosis/) of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) are pain and [infertility](https://nabtahealth.com/glossary/infertility/). Whilst the pill is never going to help resolve any difficulties women may be having conceiving; it does have widespread use in managing the [pain associated](https://nabtahealth.com/three-signs-you-might-have-endometriosis/) with the condition. In this case, the pill works by reducing the growth of endometrial tissue both within and outside the [uterus](https://nabtahealth.com/glossary/uterus/), which usually results in less pain. * [Polycystic Ovary Syndrome](https://nabtahealth.com/what-is-pcos/) ([PCOS](https://nabtahealth.com/glossary/pcos/)). [PCOS](https://nabtahealth.com/glossary/pcos/) is one of the most common conditions affecting women of reproductive age. It can prove challenging to both [diagnose](https://nabtahealth.com/problems-with-traditional-diagnosis-of-pcos/) and treat as it usually presents as a set of symptoms that can vary woman to woman, and even month to month in the same woman. The three defining features of the condition are [anovulation](https://nabtahealth.com/glossary/anovulation/), signs of [androgen excess](https://nabtahealth.com/male-hormones-in-women/) ([hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/)) and [polycystic](https://nabtahealth.com/do-polycystic-ovaries-equal-pcos/) [ovaries](https://nabtahealth.com/glossary/ovaries/); and two of these three need to be present for a diagnosis to be made. The pill is frequently prescribed to women struggling with the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/): * [Anovulation](https://nabtahealth.com/glossary/anovulation/)/irregular periods. The pill is often claimed to regulate abnormal menstrual cycles. However, the menstrual cycle is not actually being regulated because the monthly bleeds experienced are pill withdrawal bleeds, not normal menstruation, so regular, cyclical [ovulation](https://nabtahealth.com/glossary/ovulation/) is still not occurring. * Acne/[](https://nabtahealth.com/how-to-manage-facial-hair/)[hirsutism](https://nabtahealth.com/glossary/hirsutism/)/[](https://nabtahealth.com/coping-with-pcos-hair-loss/)[alopecia](https://nabtahealth.com/glossary/alopecia/) ([hyperandrogenism](https://nabtahealth.com/glossary/hyperandrogenism/)). The pill reduces the levels of [androgens](https://nabtahealth.com/glossary/androgen/) produced by the [ovaries](https://nabtahealth.com/glossary/ovaries/), which subsequently alleviates the physical signs of an androgen excess. * [](https://nabtahealth.com/a-simple-guide-to-fibroids/)[Fibroids](https://nabtahealth.com/glossary/fibroids/). [Fibroids](https://nabtahealth.com/glossary/fibroids/) are non-cancerous growths that can cause heavy periods and cramping. * [Menorrhagia](https://nabtahealth.com/glossary/menorrhagia/) (heavy periods). The synthetic version of the hormone [progesterone](https://nabtahealth.com/glossary/progesterone/), progestin, which is in the pill, thins the lining of the [uterus](https://nabtahealth.com/glossary/uterus/), resulting in lighter periods. Menstrual fluid volume is also reduced. * [Dysmenorrhoea](https://nabtahealth.com/glossary/dysmenorrhoea/) ([period pain](https://nabtahealth.com/natural-methods-to-alleviate-period-pain/)). The pill prevents [ovulation](https://nabtahealth.com/glossary/ovulation/), which normally triggers the release of [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/). [Prostaglandins](https://nabtahealth.com/glossary/prostaglandins/) cause the [uterus](https://nabtahealth.com/glossary/uterus/) to contract during menstruation, causing cramps and discomfort. Without [prostaglandins](https://nabtahealth.com/glossary/prostaglandins/), period pain is significantly reduced. * PMS. Using the pill prevents [ovulation](https://nabtahealth.com/glossary/ovulation/) and inhibits the normal menstrual cycle. Although it might appear you are still having a monthly period, this is not the case and without the normal hormonal fluctuations seen during a typical cycle, the unwanted symptoms of PMS and [PMDD](https://nabtahealth.com/what-is-premenstrual-dysphoric-disorder/) can be significantly reduced. #### **What are the advantages to using hormonal contraceptives?** For those women not looking to conceive, taking hormonal contraceptives can bring welcome relief from otherwise relentless pain and discomfort. Heavy and/or chronically irregular periods are more than just an inconvenience; they can impede day-to-day life, impact mental health and even increase your risk of suffering from other medical complications, such as [anaemia](https://nabtahealth.com/glossary/anaemia/). Preventing [ovulation](https://nabtahealth.com/glossary/ovulation/) also reduces the risk of experiencing [pelvic inflammatory disease](https://nabtahealth.com/pelvic-inflammatory-disease-a-simple-guide/) and [ovarian cysts](https://nabtahealth.com/are-ovarian-cysts-the-same-thing-as-pcos/), which can be serious if they [rupture](https://nabtahealth.com/what-happens-when-an-ovarian-cyst-ruptures/). Women with unmanaged [PCOS](https://nabtahealth.com/glossary/pcos/) are at increased risk of developing [endometrial cancer](https://nabtahealth.com/a-guide-to-endometrial-cancer/) due to unopposed exposure of the [uterus](https://nabtahealth.com/glossary/uterus/) to [oestrogen](https://nabtahealth.com/glossary/oestrogen/). The pill can lower this risk. #### **What are the problems with using hormonal contraceptives to treat female-related healthcare issues?** The major problem with the pill having such widespread use in modern gynaecological medicine is that it does not rectify any of the underlying healthcare issues. It is a relatively ‘quick fix’ option that can give the illusion of symptom alleviation; when all it really does is mask the consequences of a condition. In all likelihood, once you stop taking the pill, your symptoms will return, in some cases more pronounced than before. Taking the pill for pain management, or to control the signs of androgen excess, is one thing and in these cases, perhaps it can provide some relief. However, for those women who are seeking help to manage their irregular cycles, perhaps with a view to improving fertility; hormonal contraceptives are not the optimal solution. The components of the pill are synthetic; artificial versions of the hormones they are attempting to replicate. Whilst it would be amazing if the pill contained some sort of stimulating agent that coaxed the body’s own endogenous hormones into behaving as they should; this simply does not happen. Menstrual cycles that appear regular with pill use are artificial and will not be maintained once treatment is ceased. #### **What is the alternative?** One alternative to symptom management is attempting to understand the root cause of your issue. [Obesity and](https://nabtahealth.com/how-are-obesity-and-pcos-connected/) [PCOS](https://nabtahealth.com/glossary/pcos/) are closely associated and lowering [](https://nabtahealth.com/what-is-body-mass-index-bmi/)[BMI](https://nabtahealth.com/glossary/bmi/) has been shown to improve the symptoms of [PCOS](https://nabtahealth.com/glossary/pcos/). In fact, many women will find that making [simple lifestyle adjustments](https://nabtahealth.com/is-it-possible-to-reverse-pcos/), such as losing weight, can help to restore fertility. A number of the conditions described above are exacerbated by high levels of endogenous [oestrogen](https://nabtahealth.com/glossary/oestrogen/); for example, high [oestrogen](https://nabtahealth.com/glossary/oestrogen/) contributes to the heavy periods and pelvic pain experienced by women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/) and can trigger the growth of [fibroids](https://nabtahealth.com/glossary/fibroids/). By preventing [ovulation](https://nabtahealth.com/glossary/ovulation/), the pill reduces [oestrogen](https://nabtahealth.com/glossary/oestrogen/) production, but there are other more natural methods of reducing [oestrogen](https://nabtahealth.com/glossary/oestrogen/). Lowering body fat by exercising more, and limiting caffeine and alcohol intake can all help. Smoking can make period pain worse, so giving this up can also help significantly. A number of women rely on complementary medicine to manage their gynaecological health issues. Unfortunately, in most cases the data is limited on the effectiveness of such approaches. [Melatonin](https://nabtahealth.com/which-dietary-supplements-help-to-combat-insomnia/) might have some use in rectifying disrupted sleep; but other supplements, including fish oil, vitamins B1 and E, [zinc](https://nabtahealth.com/glossary/zinc/) sulphate, fenugreek and ginger have had negligible benefits in scientific studies. To conclude, the pill is an option for managing a number of gynaecological health issues. However, you should be wary about relying on it long-term and it might be worth speaking to your doctor about alternative solutions. Consider Nabta’s [Selfcare Essentials](https://nabtahealth.com/product/selfcare-essentials-for-him-and-her/) and try our [Women’s Health Test](https://nabtahealth.com/product/womens-health-test/). Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#6a130b06060b2a040b081e0b020f0b061e0244090507) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * “Noncontraceptive Benefits of Birth Control Pills.” _ReproductiveFacts.org_, American Society for Reproductive Medicine, [www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/noncontraceptive-benefits-of-birth-control-pills/](http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/noncontraceptive-benefits-of-birth-control-pills/). * Pattanittum, Porjai, et al. “Dietary Supplements for [Dysmenorrhoea](https://nabtahealth.com/glossary/dysmenorrhoea/).” _Cochrane Database of Systematic Reviews_, vol. 3, no. 3, 22 Mar. 2016, doi:10.1002/14651858.cd002124.pub2. * Sachedin, Aalia, and Nicole Todd. “Dysmenorrhea, [Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and Chronic Pelvic Pain in Adolescents.” _Journal of Clinical Research in Pediatric Endocrinology_, vol. 12, no. 1, 6 Feb. 2020, pp. 7–17., doi:10.4274/jcrpe.galenos.2019.2019.s0217. * “What Birth Control Method Is Right for You?” _Womenshealth.gov_, 14 Feb. 2019, [www.womenshealth.gov/a-z-topics/birth-control-methods](https://www.womenshealth.gov/a-z-topics/birth-control-methods). * “Which Birth Control Pills Can Help Reduce Acne?” _Institute for Quality and Efficiency in Health Care: Germany_, by Mona Nasser and Peter Sawicki, www.ncbi.nlm.nih.gov/books/NBK279209/.
Primary [dysmenorrhoea](https://nabtahealth.com/glossary/dysmenorrhoea/), known more commonly as period pain or menstrual cramps, is an uncomfortable pain in the lower abdominal region and is a common occurrence for women just before or during their period. #### **What is period pain?** Primary [dysmenorrhoea](https://nabtahealth.com/glossary/dysmenorrhoea/) is not due to disease, instead, it happens when the [uterus](https://nabtahealth.com/glossary/uterus/) contracts, i.e. when it squeezes and cramps, during menstruation. This contraction is normal and causes the lining of the [uterus](https://nabtahealth.com/glossary/uterus/) to shed and leave the body along with period blood through the [vagina](https://nabtahealth.com/glossary/vagina/). Unfortunately, it also causes muscle cramps in the tummy, which can spread to the back and thighs; and which, for a large number of women, makes life very uncomfortable around the time of their period. It is unknown why some women experience more pronounced period pain than others. It is also unknown why the type and intensity of pain can vary with each period; sometimes manifesting as a muscular spasm, other times as a dull, constant ache. What does seem to be fairly consistent is that the pain is usually worse when bleeding is at its heaviest and eases off after 48 to 72 hours. Women also tend to notice an improvement after childbirth and as they get older. #### **Secondary [dysmenorrhoea](https://nabtahealth.com/glossary/dysmenorrhoea/)** Secondary [dysmenorrhoea](https://nabtahealth.com/glossary/dysmenorrhoea/) typically lasts longer and starts earlier in the menstrual cycle. It is caused by a disorder of the female reproductive organs, such as [](https://nabtahealth.com/en/hints-and-tips/what-is-endometriosis)[endometriosis](https://nabtahealth.com/glossary/endometriosis/), [](https://nabtahealth.com/en/hints-and-tips/what-is-adenomyosis)[adenomyosis](https://nabtahealth.com/glossary/adenomyosis/), [uterine](https://nabtahealth.com/en/hints-and-tips/all-about-fibroids) [fibroids](https://nabtahealth.com/glossary/fibroids/), or [pelvic inflammatory disease](https://nabtahealth.com/pelvic-inflammatory-disease-a-simple-guide/). If you suffer from any of these conditions, you will usually need to be under the care of a specialised health care professional and they will be able to further advise you on symptom management. #### **Managing period pain** Period pain can often be managed at home without the need to consult a doctor. Whilst uncomfortable and inconvenient, it rarely warrants a trip to a specialist and there are certainly things you might want to try before seeking medical assistance. * **Over-the-counter pain relief.** Painkillers, such as ibuprofen and aspirin can be very effective at easing uncomfortable menstrual cramps. Paracetamol is less effective. If the pain is severe, your doctor should be able to prescribe something a little stronger. * **Exercise.** Whilst it might be the last thing you feel like doing, a gentle walk, swim or bike ride can help to distract you and relieve the pain. * **Heat.** Applying a heat pack or a hot water bottle to the affected region can reduce pain. Likewise, a warm bath or shower can also improve any discomfort. There is some evidence that heat can be as effective as pharmaceutical painkillers, without the side effects. * **Gentle massage** to the abdomen, using light circular movements can help. * **Reducing stress** can lessen the severity of period pain. You might find that relaxation techniques, such as [yoga](https://nabtahealth.com/hatha-vinyasa-ashtanga-what-is-the-best-type-of-yoga-for-me/) and pilates help with this. * **TENS** (Transcutaneous Electronic Nerve Stimulation) has also been recommended as a means of easing period pain. A mild electric current is delivered to the nerves, via electrodes attached to the skin of the abdomen. It is thought that this raises the threshold for pain sensitivity, as well as stimulating the release of [endorphins](https://nabtahealth.com/glossary/endorphins/). #### **What about dietary supplements?** There are some scientific publications advocating a role for dietary supplements in the management of period pain. However, the reality is that this is an under-researched area, and the studies that are available are typically of poor quality, with small sample sizes. There is also a shortage of safety data on dietary supplements. There is limited data supporting a beneficial role for fenugreek, ginger, [zinc](https://nabtahealth.com/glossary/zinc/) sulphate, fish oil, and vitamin B1 in the easing of period pain. However, other proposed ‘pain alleviators’ such as cinnamon, fennel seeds, dill, Damask rose and chamomile tea, have not, to date, been well validated. Despite this, it is probably worth noting that herbs such as chamomile have been used in traditional medicine for thousands of years. Chamomile has been used in various formulations, as a tea, as a lotion and as an essential oil, for a multitude of human ailments. Many people have derived comfort from it, dating as far back as the ancient times. So if having a daily cup of chamomile tea relaxes and soothes you, it is probably a habit worth continuing with, including during your period. Try Nabta’s [PMS pack](https://nabtahealth.com/product/pms-luxury-selfcare-pack/) and have a [women’s health test](https://nabtahealth.com/product/womens-health-test/) to understand what could be the cause. Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#d8a1b9b4b4b998b6b9baacb9b0bdb9b4acb0f6bbb7b5) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Bavil, Dina Abadi, et al. “Comparison of Lifestyles of Young Women with and without Primary Dysmenorrhea.” _Electronic Physician_, vol. 8, no. 3, 25 Mar. 2016, pp. 2107–2114., doi:10.19082/2107. * Guimarães, Inês, and Ana Margarida Póvoa. “Primary Dysmenorrhea: Assessment and Treatment.” _Revista Brasileira De Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics_, 19 June 2020, doi:10.1055/s-0040-1712131. * “Menstrual Cramps.” _Mayo Clinic_, Mayo Foundation for Medical Education and Research, 8 Apr. 2020, [www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944](http://www.mayoclinic.org/diseases-conditions/menstrual-cramps/diagnosis-treatment/drc-20374944). * Pattanittum, Porjai, et al. “Dietary Supplements for [Dysmenorrhoea](https://nabtahealth.com/glossary/dysmenorrhoea/).” _Cochrane Database of Systematic Reviews_, no. 3, 22 Mar. 2016, doi:10.1002/14651858.cd002124.pub2. * “Period Pain.” _NHS Choices_, NHS, [www.nhs.uk/conditions/period-pain/](http://www.nhs.uk/conditions/period-pain/). * Srivastava, J K, et al. “Chamomile: A Herbal Medicine of the Past with a Bright Future (Review).” _Molecular Medicine Reports_, vol. 3, no. 6, 27 Sept. 2010, pp. 895–901., doi:10.3892/mmr.2010.377.
The major structural issue faced by women who are struggling to conceive, is the presence of abnormal tissue somewhere in the reproductive system. Depending on where the blockage is, movement of the egg from the ovary, along the fallopian tube, and to the [uterus](https://nabtahealth.com/glossary/uterus/) may be impeded and/or the male’s [sperm](https://nabtahealth.com/glossary/sperm/) may not be able to reach the egg. An abnormally shaped [uterus](https://nabtahealth.com/glossary/uterus/) may hinder [implantation](https://nabtahealth.com/glossary/implantation/) of a fertilised egg, or prevent a pregnancy from proceeding to term. #### **[Endometriosis](https://nabtahealth.com/glossary/endometriosis/)** [](https://nabtahealth.com/what-is-endometriosis/)[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) occurs when endometrial-like tissue forms outside of the [uterus](https://nabtahealth.com/glossary/uterus/), leading to a chronic inflammatory reaction and distortion of the pelvic anatomy. Women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/) often experience [heavy, painful periods](https://nabtahealth.com/i-have-painful-periods-could-it-be-endometriosis/) and discomfort in the areas where the endometrial deposits have formed. It is a very common condition, affecting 6-10% of the female population, although 25% of these will be [asymptomatic](https://nabtahealth.com/glossary/asymptomatic/). Amongst infertile women, the prevalence of [endometriosis](https://nabtahealth.com/glossary/endometriosis/) is particularly high, at 25-50%; and of those who have clinically diagnosed [endometriosis](https://nabtahealth.com/glossary/endometriosis/), 30-40% will struggle to conceive. In cases of severe [endometriosis](https://nabtahealth.com/glossary/endometriosis/) the resulting pelvic anatomy distortion can be so extensive that it provides a physical barrier against fertilisation. However, there are other mechanisms that contribute to [](https://nabtahealth.com/can-endometriosis-make-it-harder-to-get-pregnant/)[endometriosis](https://nabtahealth.com/glossary/endometriosis/)\-induced [infertility](https://nabtahealth.com/glossary/infertility/). Often women with the condition have concurrent endocrine/ovulatory disorders, which cause impaired follicular growth and disrupted hormone secretions. The immune system is also involved because it has been found that some women with [endometriosis](https://nabtahealth.com/glossary/endometriosis/) have antibodies in their endometrium that prevent embryo [implantation](https://nabtahealth.com/glossary/implantation/). This is a topic that is not well understood and requires further research into its prevalence, causes and implications. [Laparoscopic](https://nabtahealth.com/what-is-a-laparoscopy/) removal of the endometrial deposits is the first line treatment approach for many women with the condition, particularly those who are struggling to conceive. This has been shown to improve fertility in women with mild [endometriosis](https://nabtahealth.com/glossary/endometriosis/). It is generally considered that in more severe cases, or when there are co-existing (male or female) fertility issues, a multi-disciplined approach to treatment will be necessary. #### **Uterine [Fibroids](https://nabtahealth.com/glossary/fibroids/)** [Uterine](https://nabtahealth.com/a-simple-guide-to-fibroids/) [fibroids](https://nabtahealth.com/glossary/fibroids/) are the most common form of non-cancerous growths in females of reproductive age. They are found in 5-10% of infertile women and, as the name suggests, they are located in and around the uterine cavity. It is unclear exactly what causes [fibroids](https://nabtahealth.com/glossary/fibroids/) to grow, although there is thought to be a genetic component and a link with [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) levels. Some studies have suggested that there is an increase in [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) receptors in fibroid tissue compared to the surrounding tissue, indicating a role for these hormones in the growth of the [fibroids](https://nabtahealth.com/glossary/fibroids/). As the levels of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) decline with age, so does the growth of [fibroids](https://nabtahealth.com/glossary/fibroids/). They usually first form during the reproductive years, when a female’s hormone levels are high, then reduce in size as she approaches the [menopause](https://nabtahealth.com/glossary/menopause/). Only those [fibroids](https://nabtahealth.com/glossary/fibroids/) that are present in the muscular walls of the [uterus](https://nabtahealth.com/glossary/uterus/) (intramural) or project into the cavity of the [uterus](https://nabtahealth.com/glossary/uterus/) (submucosal) have been shown to impact fertility, suggesting that the predominant issue is formation of a structural barrier to conception. Depending on their size and exact position, [fibroids](https://nabtahealth.com/glossary/fibroids/) can alter the position of the [cervix](https://nabtahealth.com/glossary/cervix/), the shape of the [uterus](https://nabtahealth.com/glossary/uterus/), block the [fallopian tubes](https://nabtahealth.com/glossary/fallopian-tube/) and/or alter the blood flow to the [uterus](https://nabtahealth.com/glossary/uterus/). This can make it more difficult for the [sperm](https://nabtahealth.com/glossary/sperm/) to successfully reach the egg, as well as hindering [implantation](https://nabtahealth.com/glossary/implantation/) of a fertilised egg. The first line approach for [treating](https://nabtahealth.com/treating-fibroids/) [fibroids](https://nabtahealth.com/glossary/fibroids/) that are affecting fertility is to perform a myomectomy. This surgery involves using [](https://nabtahealth.com/what-is-a-laparoscopy/)[laparoscopy](https://nabtahealth.com/glossary/laparoscopy/) to visualise and excise the fibrotic tissue. This technique significantly improves fertility rates, although in up to 30% of cases the [fibroids](https://nabtahealth.com/glossary/fibroids/) will regrow over time. There are newer, non-surgical, ablative techniques, however, many of these are not suitable for those who wish to have children, as they alter the integrity of the endometrium and increase the risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) during subsequent pregnancies. #### **Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/)** [](https://nabtahealth.com/what-are-uterine-polyps/)[Polyps](https://nabtahealth.com/glossary/polyps/) are non-cancerous growths found in various body tissues, including the nasal lining, the vocal cords and within the colon. Those that affect fertility are found in the endometrium and consist of endometrial glands, connective tissue and blood vessels. They are the most common uterine structural abnormality, affecting approximately 10% of the female population. Despite this, many women only learn that they have endometrial [polyps](https://nabtahealth.com/glossary/polyps/) when they undergo clinical investigations for abnormal bleeding or unexplained [infertility](https://nabtahealth.com/glossary/infertility/). Most [polyps](https://nabtahealth.com/glossary/polyps/) are diagnosed following [transvaginal ultrasound](https://nabtahealth.com/glossary/transvaginal-ultrasound/) investigation or hysteroscopy. Exactly how endometrial [polyps](https://nabtahealth.com/glossary/polyps/) contribute to poor fertility and increased risk of [miscarriage](https://nabtahealth.com/glossary/miscarriage/) is not well understood. They seem to hinder embryo [implantation](https://nabtahealth.com/glossary/implantation/); a theory supported by the finding that they are the most commonly observed abnormality in those who experience recurrent [implantation](https://nabtahealth.com/glossary/implantation/) failure following [IVF](https://nabtahealth.com/glossary/ivf/). It has also been suggested that they impede [sperm](https://nabtahealth.com/glossary/sperm/) transport and make the endometrium less receptive to receiving a fertilised egg. [Polyps](https://nabtahealth.com/glossary/polyps/) are most commonly found in women between the ages of 35 and 55. However, it has been suggested that they are more common in younger women than was previously thought; existing in a latent state and only being identified following investigative procedures for other issues, including unexplained [infertility](https://nabtahealth.com/glossary/infertility/). One suggestion for why younger women are less likely to develop [polyps](https://nabtahealth.com/glossary/polyps/) is that the cells of their endometrium undergo continuous cycling and, as such, any [polyps](https://nabtahealth.com/glossary/polyps/) that do form, spontaneously regress without causing any issues. As with uterine [fibroids](https://nabtahealth.com/glossary/fibroids/), there seems to be a hormonal association, with increased [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) receptors in polyp tissue. Furthermore, women on certain hormonal medications are at greater risk, for example, Tamoxifen. This is a partial [oestrogen](https://nabtahealth.com/glossary/oestrogen/) receptor agonist used in the treatment of breast cancer and women who take it are at greater risk of developing [polyps](https://nabtahealth.com/glossary/polyps/). Hormone Replacement Therapy ([HRT](https://nabtahealth.com/glossary/hrt/)) may also increase the risk, but this seems to be dependent on the dose of [oestrogen](https://nabtahealth.com/glossary/oestrogen/) and [progesterone](https://nabtahealth.com/glossary/progesterone/) a woman is prescribed. There are also studies that suggest that women who have non-communicable diseases (NCDs) such as diabetes, [hypertension](https://nabtahealth.com/glossary/hypertension/) and obesity have an increased likelihood of developing endometrial [polyps](https://nabtahealth.com/glossary/polyps/), however, more work is needed to substantiate these findings. In some cases, diagnosed [polyps](https://nabtahealth.com/glossary/polyps/) do resolve spontaneously; and this seems to be associated with increased age according to limited studies. If a doctor suspects that [polyps](https://nabtahealth.com/glossary/polyps/) are contributing to a couple’s [infertility](https://nabtahealth.com/glossary/infertility/), he or she will probably recommend a procedure known as a polypectomy, to excise the growths. Usually this procedure will be carried out in advance of any additional fertility treatment (Assisted Reproductive Techniques), as it can improve the overall outcome. #### **Other Structural Abnormalities** Scarring to the [uterus](https://nabtahealth.com/glossary/uterus/) that has occurred as a result of previous infections, injuries, or surgical procedures can impede [implantation](https://nabtahealth.com/glossary/implantation/) and, therefore, affect fertility. Having an unusually shaped [uterus](https://nabtahealth.com/glossary/uterus/) can make falling pregnant difficult. It can also reduce the chances of carrying a baby to term. [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-failure-to-ovulate/) [Infertility](https://nabtahealth.com/glossary/infertility/) - Failure to Ovulate [Causes of Female](https://nabtahealth.com/causes-of-female-infertility-infection/) [Infertility](https://nabtahealth.com/glossary/infertility/) - Infection Nabta is reshaping women’s healthcare. We support women with their personal health journeys, from everyday wellbeing to the uniquely female experiences of fertility, pregnancy, and [menopause](https://nabtahealth.com/glossary/menopause/). Get in [touch](/cdn-cgi/l/email-protection#5b223a37373a1b353a392f3a333e3a372f3375383436) if you have any questions about this article or any aspect of women’s health. We’re here for you. **Sources:** * Al Chami, A, and E Saridogan. “Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/) and Subfertility.” _Journal of Obstetrics and Gynaecology of India_, vol. 67, no. 1, Feb. 2017, pp. 9–14., doi:10.1007/s13224-016-0929-4. * Bulletti, C, et al. “[Endometriosis](https://nabtahealth.com/glossary/endometriosis/) and [Infertility](https://nabtahealth.com/glossary/infertility/).” _Journal of Assisted Reproduction and Genetics_, vol. 27, no. 8, Aug. 2010, pp. 441–447., doi:10.1007/s10815-010-9436-1. * Cook, H, et al. “The Impact of Uterine Leiomyomas on Reproductive Outcomes.” _Minerva Ginecologica_, vol. 62, no. 3, June 2010, pp. 225–236. * Kennedy, S, et al. “ESHRE Guideline for the Diagnosis and Treatment of [Endometriosis](https://nabtahealth.com/glossary/endometriosis/).” _Human Reproduction_, vol. 20, no. 10, Oct. 2005, pp. 2698–2704., doi:10.1093/humrep/dei135. * Lieng, Marit, et al. “Prevalence, 1-Year Regression Rate, and Clinical Significance of [Asymptomatic](https://nabtahealth.com/glossary/asymptomatic/) Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/): Cross-Sectional Study.” _Journal of Minimally Invasive Gynecology_, vol. 16, no. 4, 2009, pp. 465–471., doi:10.1016/j.jmig.2009.04.005. * Marcoux, S, et al. “Laparoscopic Surgery in Infertile Women with Minimal or Mild [Endometriosis](https://nabtahealth.com/glossary/endometriosis/). Canadian Collaborative Group on [Endometriosis](https://nabtahealth.com/glossary/endometriosis/).” _New England Journal of Medicine_, vol. 337, no. 4, 24 July 1997, pp. 217–222., doi:10.1056/NEJM199707243370401. * Nappi, Luigi, et al. “Are Diabetes, [Hypertension](https://nabtahealth.com/glossary/hypertension/), and Obesity Independent Risk Factors for Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/)?” _Journal of Minimally Invasive Gynecology_, vol. 16, no. 2, 2009, pp. 157–162., doi:10.1016/j.jmig.2008.11.004. * Nijkang, N P, et al. “Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/): Pathogenesis, Sequelae and Treatment.” _SAGE Open Medicine_, vol. 7, 2 May 2019, doi:10.1177/2050312119848247. * Serhat, Esra, et al. “Is There a Relationship between Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/) and Obesity, Diabetes Mellitus, [Hypertension](https://nabtahealth.com/glossary/hypertension/)?” _Archives of Gynecology and Obstetrics_, vol. 290, no. 5, 24 Nov. 2014, pp. 937–941., doi:10.1007/s00404-014-3279-4. * “What Are Some Possible Causes of Female [Infertility](https://nabtahealth.com/glossary/infertility/)? .” _National Institutes of Health_, [www.nichd.nih.gov/health/topics/](http://www.nichd.nih.gov/health/topics/infertility/conditioninfo/causes/causes-female)[infertility](https://nabtahealth.com/glossary/infertility/)/conditioninfo/causes/causes-female. * Wong, M, et al. “The Natural History of Endometrial [Polyps](https://nabtahealth.com/glossary/polyps/).” _Human Reproduction_, vol. 32, no. 2, Feb. 2017, pp. 340–345., doi:10.1093/humrep/dew307.
