The questions.

Unfortunately, it is a common experience for people to feel that they are not taken seriously when seeking help for menstrual and period concerns. For this reason, people may feel most comfortable speaking with a GP that they trust or a clinic with lots of experience in this area. These clinics include sexual health clinics (such as SHINE SA) and women’s health clinics.

PMS stands for Pre Menstrual Syndrome. It is a combination of symptoms caused by hormonal changes, that typically occur in the week leading up to and/or the first day or two of a period. Some common symptoms include sore breasts, irritability, tiredness, anxiety, sadness and bloating. Not everyone experiences PMS, but it is a common experience for people who menstruate.

It’s said that it is normal for someone who just got their period within those next two years you can get really irregular periods. I have had my period for around 6 years and my periods still vary between 55 days in between to 24 days. My question is, is this normal?

Typically, periods are more regular and predictable after the first few years. There are some health conditions (e.g. Poly Cystic Ovarian Syndrome) which can cause irregular periods, so it could be worth discussing your cycle and any associated details with a doctor, just in case!

PMS stands for Pre Menstrual Syndrome. It is a combination of symptoms caused by hormonal changes, that typically occur in the week leading up to and/or the first day or two of a period. Some common symptoms include sore breasts, irritability, tiredness, anxiety, sadness and bloating. Not everyone experiences PMS, but it is a common experience for people who menstruate.

It’s said that it is normal for someone who just got their period within those next two years you can get really irregular periods. I have had my period for around 6 years and my periods still vary between 55 days in between to 24 days. My question is, is this normal?

Typically, periods are more regular and predictable after the first few years. There are some health conditions (e.g. Poly Cystic Ovarian Syndrome) which can cause irregular periods, so it could be worth discussing your cycle and any associated details with a doctor, just in case!

Usually once a period starts, the bleeding is continuous until the end of the period. If your bleeding stops for a few days and then starts again, this may be worth discussing with a doctor.

We might need more information to answer this one! 3 periods (1st starting on ‘day 1’, 3rd starting on ‘day 77’) would be within the typical range. 3 periods with 77 days between the start of each could be quite normal if you have only recently started your period. Otherwise, 77 days is outside the typical range for menstrual cycles. This could be worth discussing with a doctor, especially if you have any other concerns regarding your menstrual cycle.

Most hormonal contraceptives are relatively short-acting, and are cleared from the system quite quickly after they are stopped/removed. The effects of the body’s natural hormonal cycle then resume. Some kinds (such as the contraceptive injection) remain in the system for longer, and hence it can take a number of months to return to the “norm”.

SHINE SA Relationships & Sexual Health curriculum is a set of resources for delivering the Relationships & Sexuality topic of Health & Physical Education from the Australian Curriculum. This topic is part of the Australian curriculum from years 3-10. SHINE SA currently provides resources for Years 5-10, and Year 3/4 resources are in development. The placement/inclusion of specific curriculum content is based on the Australian Curriculum. With this in mind, the topic of periods is explored from Year 5, with changes and reproductive systems explored in the upcoming Year 3/4 curriculum. We always advocate for educators to take into account the needs of their cohort, and adapt content and activities to the needs and the level of their students.

Whilst the majority of South Australian Department of Education schools with a secondary component choose to implement the SHINE SA curriculum, not all schools currently run our program. Schools can opt to implement this curriculum by having educators attend a 2-day course to equip them with the resources and the confidence to facilitate the 15 lessons at each year level.

It is very common for people to feel uncomfortable or worried about periods. For many of us, we don’t have a lot of practice talking about periods as there is still a lot of stigma and secrecy regarding periods. Nobody has to talk openly about their period, or speak to anyone in particular about their experiences. It is very helpful though for people to consider who they CAN talk to or go to when they need help.

If you know someone who is concerned, you can help them by asking what they need. They may simply want to talk to someone (i.e. you); they may need more information, or they may need some support from a medical professional.

SHINE SA’s services are available to all South Australians. Some services are free to all (such as resources available on the website and borrowing books from our library). Some services are free to specific groups of people, whilst there is a cost attached for others (e.g. STI testing is free for those aged under 25, but usually incurs a cost for those aged 25 and over). Details about services, costs and access can be found at shinesa.org.au, or you can call 8300 5300 for specific questions.

For information on a wide variety of topics related to sexual health, our website has a range of fact sheets and links to trustworthy resources. We also have a range of videos available that may answer questions for those who are seeking information on a broad range of sexual health topics.

Hormonal options that also act as contraceptives can be very beneficial for managing period pain. For some people they work very well, for others, they don’t. They can be useful for people who have endometriosis or period pain, as they can make the lining of the uterus thinner, periods lighter and periods less painful. Some synthetic hormonal options contain two synthetic hormones, estrogen and progesterone. Progesterone is the main synthetic hormone that can help with period pain.

Progesterone is a hormone made by the ovaries in the second half of the menstrual cycle. A tablet of progesterone would be destroyed by the acid in the stomach, so synthetic versions of progesterone (progestogens) have been developed which survive in the stomach, and act like progesterone in the body.

Progestogens come in many forms and types including:

• tablets (e.g. norethisterone in Primolut®, dienogest in Visanne®, or less common ones like dydrogesterone in (Duphaston®), medroxy­progesterone acetate in (Provera®), levonorgestrel in (Microval®)
• attached to an intrauterine device (levonorgestrel in a Mirena®),
• a rod in the upper arm (etonorgestrel in Implanon®),
• a 3-monthly injection (medroxyprogesterone acetate in Depot Provera®), and
• as one of two hormones in the contraceptive pill.

It is important to consult your local general practitioner (GP) about what option would work best for you. Some people may experience side effects from using or taking these options, and your doctor will go through these with you.

Periods occur when the lining of the uterus is shed. During this time, chemicals called prostaglandins are released from the uterus. These chemicals cause the muscle wall of the uterus to contract and squeeze, which helps shed the lining of the uterus. This can also cause the cramping sensation you may experience at period time.

Everyone will be different at period time, some people produce more of these chemicals, and some people may be more sensitive to them, which can cause periods to be more painful. Thankfully there are lots of simple strategies to help reduce this type of pain! (see above question). If these simple strategies don’t help reduce the pain, and if the pain is preventing you from doing the things you want to do, then it is important to touch base with a general practitioner.

We do know that pain can change across a person’s life. However, if this pain is causing you distress and interrupting the things you want to do, then it is important you discuss this with a general practitioner. Check out other answers on this page for more information in reducing period pain. Cycle tracking can be a great tool to gather data (length of period, pain levels, days of pain etc) to help your health professional determine if your pain is normal or not!

These are some good resources for information about endometreosis, adenomyosis, premenstrual syndrome, postmenstrual syndrome, PCOS, menstrual dysphoric disorder and more:

Pelvic Pain Foundation Australia

QENDO

Jean Hailes

EndoZone

Shine SA

VinMec

There are lots of complementary treatments that can be helpful for some people with endometriosis. There is a lot of research to support the use of TENS machines (Transcutaneous Electrical Nerve stimulation), supplements like Curcumin, Fish Oil, Zinc and Magnesium, Acupuncture and Traditional Chinese Medicine, Psychology and mindfulness and meditation for reducing inflammation and pelvic pain.

Diet can play a large role too! It has been found that following an anti-inflammatory, Mediterranean style of eating is best for people that suffer with pelvic pain conditions. This usually includes consuming fish 2-3 times per week from varieties such as sardines, anchovies, salmon, and tuna. Eating anti-inflammatory foods daily including whole fruits and vegetables, olive oil and spices such as turmeric. Eating a fibre rich diet from whole foods such as vegetables, fruit, and whole grains. Reduce/avoid processed food, refined sugar, saturated fat, alcohol, and caffeine and limiting red and processed meats.

Exercise is also the best non-drug treatment for pain. Exercise raises the levels of endorphins in the blood stream. These brain chemicals are natural painkillers that also make you happy. Exercise can ease pain, take your mind off the pain and help combat depressive illness. The best exercise is one that you will actually do and it doesn’t have to be onerous or extreme. Walking is exercise that many people can do fairly easily, even if you start with just 10 minutes a day. Aim to build up to 30 minutes of exercise four or five times a week.

It is also important to check in with a general practitioner to discuss your pain if these methods aren’t working.

Historically there hasn’t been much interest in this area, however the last 8-10 years has seen a surge of interest in this area. There is still currently lots of research being undertaken worldwide which is very exciting! Some local research: www.pelvicpain.org.au

There are lots of reasons as to why it can take up to 7 years on average to diagnose Endometriosis.

At present the only certain way to officially diagnose endometriosis is through a laparoscopy. A laparoscopy is a keyhole surgery performed by a gynaecologist allowing them to view the inside of the abdomen to see if any lesions are present or not. A patient may be referred to a Gynaecologist by their General Practitioner after several discussions about their period pain or if they are experiencing heavy bleeding on their period.  Sometimes doctors may want to try alternate treatment options like hormonal treatments and ant-inflammatory medications before referring someone to a gynaecologist. Additionally, as the symptoms of endometriosis can be similar to other conditions (eg. IBS, PMS, PBS) , they can be misdiagnosed as those conditions and not endometriosis.

For quite a long time there has been normalisation of pain with periods. This, in combination with a lack of education regarding the signs and symptoms to look out for, can lead to a person not seeking medical advice. This is why PPEP Talk® was created, to provide education which will help young people recognise the early signs and symptoms of endometriosis and when to seek help for their pain.

The first thing for you to do is to speak with a trusted health care professional to determine the cause of your irregular bleeding, and to manage your pain. Q1, Q2 and Q6 detail several ways to help reduce period pain. We have listed some reasons below as to why a menstrual cycle may become irregular:

There are a few causes of irregular cycles:

Diet — not eating enough can cause periods to stop of become irregular. The body is not gaining the nutrients it needs to regulate cycles.

Exercise — over exercising can cause periods to stop or become irregular, especially if you are not fuelling your body sufficiently.

Stress — prolonged stress can affect a menstrual cycle, as stress hormones (cortisol and adrenaline) can disrupt period hormones. When the body is stressed, it aggravates the fight or flight response. This is designed to keep or body safe and from harm, however sometimes this response can be activated too often causing irregularities in the cycles and other symptoms such as headaches, increased heart rate and sleep disturbance.

Hormone imbalances — there are some conditions that may cause an imbalance of hormones in the body. It is best to speak to a trusted health professional to get advice for this.

Jean Hailes have a number of resources on menopause that may be useful in supporting someone going through menopause.

There are a range of sustainable, reusable period products including period underwear and menstrual cups. You can find out more about these products in SHINE SA’s factsheet on the menstrual cycle. TABOO also have a blog post ‘How sustainable are reusable period products?’ which may be a helpful resource.

Including people who don’t have periods in the conversation is a valuable starting point. Periods are everybody’s business, and talking about periods openly helps to break the stigma and embarrassment. If people who don’t have periods aren’t included in the conversation, it is near impossible for them to be the best advocates for those who do menstruate.

Teaching all children about periods and menstruation from a young age will enable them to gain a much better understanding of what those who menstruate experience when they have a period. By demystifying periods, those who don’t menstruate will be able empathise more. Also ensuring that period products are made freely available will help to normalise periods so that there is more general discussion about periods and what they entail. Teaching about the need for period justice will also help. This includes understanding that period poverty is gender equity issue that needs to be addressed. Beginning respectful relationships education when young people are in primary school will also help to minimise the stigma and taboo surrounding periods and ensure all children feel comfortable to ask questions and have gaps in their knowledge explained, regardless of their gender.

There are many ways for young people to get involved in the work to deconstruct the stigma surrounding periods. Share the Dignity is an Australian organisation that has been working hard to end period poverty. They have plenty of ideas on ways to achieve this. You can find out more from their website!

We can ask students and teachers to talk about periods before going to swimming carnivals or on school camps. This would help normalise periods and the fact that some students will be managing them and may need support to do so. It will also remind students and teachers to bring period products as well as ensure that everyone knows how and who these can be accessed from if they’re needed. That way in the event of a student having their period while they’re at the swimming carnival or away on the school camp they know in advance that they will be able to go to someone who has been designated to provide support with products and pain management and will not need to feel embarrassed or anxious about doing so.

School leaders can keep talking about the importance of having free products and what a big difference this makes to those who need them. Education is the best way. When half the population experiences periods every month for the majority of their lives, it is important that this natural bodily function is normalised.  To change people’s points of view and behaviours can sometimes take a little longer than we expect. Over time, the effort being put into normalising periods and managing them with dignity will have a positive impact at schools and across society more broadly so that public places and spaces are also supplying free period products in the same way that toilet paper is supplied and managed.

When someone is experiencing period poverty, they may be feeling anxious and upset because they don’t have what they need to manage their period effectively. This means that they may miss out on school days or social activities they enjoy, resulting in them feeling isolated and abnormal.  If this continues to occur over a long period of time, it can harm someone’s self-esteem, damage their sense of self-worth, and effect their overall health and wellbeing. They may also be struggling with pain management in addition to not being able to source the period products they need when they need them. Being able to access period products easily and reducing the stigma and embarrassment that someone can feel about what is a normal and natural body function will positively impact health outcomes.

State and federal governments are looking closely at relationships and sex education and the way they are being taught in schools. Some of the ideas children and young people have come up with around ways to improve relationships and sex education in schools were summarised in a report produced by the Commissioner for Children and Young People in South Australia. Menstruation Matters looks closely at what young people have to say about ways to reduce the stigma surrounding periods and menstruation more broadly, including starting education in primary school and extending it into different areas of the curriculum so it is normalised.  

There are many ways you can assist in raising awareness about periods at your own school. We are often surprised to learn that young people in our society are experiencing period poverty, mainly because we consider Australia to be a wealthy country where poverty doesn’t exist!  But the truth is not everyone can afford access to essential period products.

If you have a Student Representative Council at your school (most schools do) you could suggest the school runs an awareness-raising campaign to reduce stigma and embarrassment associated with periods. South Australian government schools are beginning to supply free period products, so if your school doesn’t yet have these in place, you can ask school leaders when this will happen. There are also many apps and useful websites you can visit to find out more information about periods and ways to help advocate for period justice. These could be circulated to students or placed on noticeboards. The more we keep talking about periods and period justice, the less stigma and embarrassment there will be over time.