Managing Menstrual & Uterine Bleeding

Are my bleeding patterns normal?

Everybody experiences bleeding patterns differently. Try to be aware of your own body and routine, so that you know what is normal for you.

Menstrual Bleeding

Menstrual bleeding relates to a reproductive cycle of hormones, ovulation and menses. Menstrual bleeding occurs when ovaries have released an egg (ovum), the ovum has reached the uterus and the uterus lining sheds, together with the unfertilised egg.

Any person who ovulates may be able to experience pregnancy. This includes young girls, older women, queer and trans* people. Menstrual bleeding has many alternative street names, including period, bleeding, rags or visitor.

Uterine Bleeding

Uterine bleeding is when the uterus lining sheds but ovulation has not occurred. Eggs (ova) may not be released for various reasons. It may be due to stress, change in diet, a medical condition, the use of hormonal contraceptives or menopause. If you experience uterine bleeding it may not look or feel the same as menstrual bleeding. People who experience uterine bleeding are less likely to experience pregnancy than someone who experiences menstrual bleeding.

Managing Discomfort

There are ways to manage discomfort due to menstrual or uterine bleedings. Hormonal contraceptives can be used to influence regular bleeding patterns, reduce the amount of blood tissue lost during a bleed and reduce cramping and subsequent pain.

Some people also explore non-hormonal options to increase overall physical and mental health and to reduce swelling and tension during their menstrual or uterine bleeding. Each body will respond differently and it is important to find what works best for you. Non-hormonal options have been identified as they work for some people, but do not have the same scientific research to prove effectiveness as the hormonal options. Any changes in your bleeding patterns should be discussed with a clinician.

Discomfort	Hormonal Options	Non Hormonal Options
Cramping, bloating, nausea, vomiting or diarrhoea	Consider: Hormonal IUD Contraceptive Injection Contraceptive Implant Contraceptive Ring Daily Combined Hormone Contraceptive Pill Daily Progestogen Contraceptive Pill	Look after yourself: Use a hot water bottle or heat pack on your abdomen or lower back Talk to a chemist or a doctor about anti-inflammatory or anti-nausea medication Consider dietary changes such as drinking rose or chamomile tea, and avoid sugars, salt and caffeine
Irregular bleeding	Consider: Hormonal IUD Contraceptive Injection Contraceptive Ring Daily Contraceptive Pill (combined or progestogen only)	Ensure you have a healthy routine: Eat and sleep at the same times each day Get into the habit of carrying a few pads or tampons with you Use a bucket of cold water to soak underwear(avoid warm water because it sets stains) Consider using washable cloth pads Explore ways to reduce stress
Heavy bleeding	Consider: Hormonal IUD Contraceptive Injection Contraceptive Implant Contraceptive Ring Daily Contraceptive Pill (combined or progestogen only)	Allow your body time to rest: Avoid strenuous physical activities Find a warm and comfortable environment to relax Use a hot water bottle or heat pack Consider dietary changes such as eating foods high in protein and iron Talk to a doctor about non-hormonal medication which may help with heavy bleeding
Sexual activities	Consider: Hormonal IUD Contraceptive Injection	You can still have sex providing you feel comfortable: Sexual stimulation can be enhanced due to increased sensitivity Menstrual or uterine blood flow often reduces during sexual stimulation to make way for vaginal fluid If you are worried about staining sheets, put a towel down first or have sex in the shower Consider methods of sexual activity that don’t involve vaginal penetration
Other	The full range of hormonal menstrual management options include: Hormonal IUD Contraceptive Injection Contraceptive Implant Contraceptive Ring Daily Contraceptive Pill (combined or progestogen only)	Every person experiences menstruation differently. Use the resources around you: Talk to other people in your life who also menstruate about what methods they use If you don’t like buying pads and tampons consider a menstrual cup or cloth pads Map your health in a diary to identify patterns and help you to predict and plan for days of discomfort Visit a reproductive and sexual health clinic for advice

How do hormonal options work?

Hormonal contraceptives manage menstrual discomfort by stopping ovulation whilst you are using the contraceptive. Stopping ovulation means that you no longer experience menstrual bleeding. Instead you experience uterine bleeding.

For most women, uterine bleeding whilst using hormonal contraceptives reduces the amount of lining collected in the uterus. That means less cramping pain and headaches. For some women no lining is collected in the uterus at all, so they experience amenorrhea (no uterine bleeding at all). Some women prefer to use hormonal contraceptives because they save money on pads and tampons.

When to ask for advice

Seek medical advice if you are experiencing a change in your regular bleeding patterns. It may involve heavier bleeding, bleeding in between periods, bleeding during or after sex, increased abdominal pain, or migraines.

Where to get further advice

Make an appointment with a reproductive and sexual health clinic. Clinical staff will undertake a thorough health assessment to understand why you are experiencing discomfort. If you are interested in hormonal options they can discuss your various contraceptives choices. If you want to avoid hormonal options they can discuss alternative methods of menstrual and uterine bleeding management.