DxD Session held on August 27, 2018.
A/Prof Fong graduated with the top medal in Obstetrics and Gynaecology and was awarded the Gold Medal in the Master’s Examination in Obstetrics and Gynaecology (NUS). In 2014, he led a team to transplant an ovarian tissue back into a patient with ovarian failure, which led to Asia’s first baby conceived naturally from implanted ovarian tissue. His expertise and key interests are in the treatment of complex gynaecological problems such as stage 3/4 endometriosis, difficult fibroids and ovarian cysts, congenital genital tract abnormalities, as well as fertility.
Many women experience pain during their periods. Most of the pain is a result of the process of the uterus contracting to release the menstrual blood.
However, if the pain you experience begins before the onset of bleeding and interferes with your daily activities, there may be an underlying condition other than the typical uterine cramping. Some of these symptoms might be related to endometriosis, fibroids, an ovarian cyst, which may make periods especially painful.
Dr Fong responded to readers questions on:
- Causes of painful periods
- Abnormal bleeding
- Irregular periods
- How fibroids are treated
- Complications that might arise
When should I be concerned about spotting in the middle of my period cycle?
Mid cycle spotting is not uncommon, and it occurs around the time of the ovulation, due to a temporary drop in the levels of hormones (which helps to build up the inner lining of the womb).
If you have taken the birth control pill and it stops the mid cycle spotting, it indicates ovulation as the likely reason for the mid cycle bleeding. This is because the birth control pill works by inhibiting ovulation (hence preventing pregnancy).
What could be the cause of bloating and cramping in the abdomen?
Bloating and cramping are what doctors term as "vague" symptoms as they do not specifically point to any particular organ or structure in the body, yet sometimes these can be the first signs of something more serious happening within the body.
For a younger person, female, like yourself, it very often could be due to hormonal changes or fluctuations during the menstrual cycle. Some are associated with "premenstrual symptoms" such as headaches, mood change, feeling of water retention, or even acne outbreaks.
Will switching contraceptive pills help with heavy spotting between periods?
Thanks for your question.
It may be helpful if we explore some of the causes for this intermittent bleeding - sometimes termed as "breakthrough bleeding".
If the pill is not taken on a daily / regular basis, the temporary drop in the level of hormones can lead to intermittent bleeding. If you are on any long term medication (eg some antibiotics or anti-epilepsy medication) that increases hormonal metabolism/ breakdown, this can lead to a lowered level of the contraceptive hormone and this can also lead to bleeding.
What is the best method to delay my period if I'm going for an overseas trip?
You should be able to delay the onset of your menses till after the trip. Usually we will recommend starting to take some hormone pills at least 3-4 days prior to your menses, and to continue throughout the trip, till you are back.
Once home, you can stop the hormone pills and then your menses should come within the next 1-2 days.
Does irregular menses affect the chances of getting pregnant?
If you are only having menses once a year, this is highly unusual and I would highly suggest that you see a gynaecologist for evaluation.
Normal cycle length usually ranges between 24 to 38 days - that is, most women would have a menstrual bleed a month.
While some women do have a longer cycle length of say 45 to even 60 days, a history of having menses only 2-3 times a year would immediately alert the gynaecologist to look for the possibility of polycystic ovarian syndrome.
Is it abnormal to have a 4-week long period?
Menstruation can be assessed according to frequency (24 -38 days), regularity (+/- 7days), duration (<8 days) and volume (whether heavy, normal or light).
If you have been bleeding for about 4 weeks, it is considered as a form of abnormal uterine bleeding (AUB) and you should probably seek a medical consult.
AUB can be both pregnancy or non-pregnancy related causes. Examples of pregnancy related causes can be threatened miscarriage, ectopic pregnancy or early miscarriage.
Is a smelly white discharge after my periods a sign of an STI or fungal infection?
The best advice I can give is actually to go for a check. There are reliable tests to check for infections such as chlamydia, gonorrhea and other possible STIs. While a white discharge is often associated with a fungal/ yeast infection, which sometimes flare up with the menses, there can be a concurrent bacterial infection which may or may not be sexually transmitted.
What are my surgical options to remove fibroids and the length of recovery?
Dear Poh Ching,
Treatment is dependent on whether the fibroids are affecting the woman's quality of life e.g. heavy menstrual bleeding, severe pain, anemia etc.
If removal is required, surgical options include hysteroscopic surgery, laparoscopic surgery, and for some cases, open surgery. The type of surgery performed will be dependent on the assessment done by the gynaecologist to determine the nature and location of the fibroids.
When should I be concerned about blood clots during my period?
Usually some variation in the volume of flow and presence of clots do occur from cycle to cycle. However, if you do notice there has been a consistent increase over a number of cycles, then one should consider the possibility of fibroids and endometrial polyps.
Why do I have bleeding in between periods?
Some women experience mid cycle spotting for a couple of days and this might actually be a sign of ovulation. This is because just before ovulation occurs, there is a little dip in the level of hormones produced by the ovary. This results in slight spotting before the levels build up quickly again.
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