It can be hard to work out what’s normal when it comes to menstruation, write Dr Esther Lau and Professor Lisa Nissen

For many women, “that time of the month” is a regular occurrence, albeit sometimes a bit of an annoyance. Yes, they can get cranky, and bloated, cramps, and food cravings, but these symptoms do pass.

The confusing thing for many women is that their menstrual cycle will not fall into the “textbook” 28-day cycle – what is “normal” will depend on each woman.

So working out what is “normal” is important, but who even remembers what happened last week, let alone their period last month?

Keeping a “period diary” each month can be helpful, and there are convenient phone apps that can be used to keep track of e.g.:

  • the start and end date of each period;
  • the flow;
  • symptoms;
  • mood;
  • unexpected bleeding e.g. bleeding between periods; and
  • pain e.g. when/where it occurs, and if it is worse then usual.

There are many reasons for why menstrual cycles can become irregular, and having these period diaries can be useful for helping doctors make a diagnosis.

For instance, endometriosis – where endometrial tissue grows outside of the uterus – affects 10% of at some point in their life.

However, symptoms can vary greatly between women. Some women may experience no symptoms at all, while others can experience debilitating pelvic pain, menstrual changes, and bowel symptoms.

The symptoms also do not always relate to the extent/severity, and the variability of the symptoms mean that there can be a seven to 10 year delay in diagnosis!

The Worldwide Endo March (in March) is about raising awareness and funds for research, and to encourage women to – “end the silence” and seek help so they can get a timely diagnosis and the appropriate care.

Periods and menstruation can be an uncomfortable topic for many women – and they may feel it is “women’s business” or “just hormones”, so it may not be a topic they voluntarily to discuss or bring up – even when there are issues.

Pharmacists can opportunistically have a conversation with women when they purchase over-the-counter analgesics for period pain to make sure there are no other red flags that might warrant referral.

Dr Esther Lau and Prof Lisa Nissen are from the School of Clinical Sciences, Queensland University of Technology.