Menstrual & Period Management

Menstrual health is a critical indicator of overall wellbeing. Changes in bleeding pattern, cycle length, pain severity or premenstrual symptoms can signify a hormonal imbalance or an underlying gynaecological condition. Proper assessment ensures early treatment, improved quality of life and optimised fertility.

Dr Rebecca Mackenzie-Proctor provides specialist-level menstrual care with a thorough diagnostic approach, evidence-based treatments, and a personalised plan that reflects your goals, age, and reproductive priorities.

Understanding a Healthy Menstrual Cycle

A normal menstrual cycle typically:

• Occurs every 24-38 days

• Has bleeding lasting 2-7 days

• Varies by <7 days month-to-month

• Is accompanied by manageable discomfort

• Allows functional daily activity

Irregular, painful, heavy or unpredictable cycles warrant investigation.

Common Menstrual Concerns

• Heavy menstrual bleeding (HMB)

• Painful periods (primary dysmenorrhoea or secondary to endometriosis/adenomyosis)

• Irregular or absent periods

• PMS & PMDD

• Post-pill irregularities

• Adolescent cycle issues

• Perimenopausal cycle changes

Why Menstrual Changes Happen

Hormonal Imbalance

• Oestrogen excess → heavy bleeding

• Low progesterone → irregular cycles

• Androgen excess → PCOS patterns

• Perimenopausal fluctuations → unpredictable bleeding

Structural Causes

• Fibroids

• Polyps

• Adenomyosis

• Uterine septum or anomalies

Ovulatory Dysfunction

• PCOS

• High stress

• Low weight or energy deficiency

• Thyroid disease

• Prolactin abnormalities

Coagulopathies

Up to 20% of adolescents with severe HMB have a bleeding disorder (e.g., Von Willebrand disease).

Assessment & Diagnosis

A thorough evaluation may include:

• Hormonal testing (FSH, LH, oestrogen, progesterone, prolactin, thyroid)

• Ultrasound for fibroids, adenomyosis, ovarian pathology

• Screening for PCOS

• Ferritin and iron studies

• Pelvic exam

• Endometrial biopsy in selected cases

For adolescents, a “normal range” for cycle irregularity is carefully interpreted.

Heavy Menstrual Bleeding (HMB)

Causes include:

• Fibroids

• Polyps

• Coagulopathies

• Endometrial dysfunction

• Adenomyosis

Management options range from non-hormonal therapies to hysteroscopic surgery.

Painful Periods (Dysmenorrhoea)

Differentiating primary dysmenorrhoea from endometriosis or adenomyosis is crucial.

Management may include:

• NSAIDs

• Hormonal suppression

• Pelvic physiotherapy

• Laparoscopy where appropriate

Treatment Options

Non-hormonal

• NSAIDs: reduce both pain and menstrual volume

• Tranexamic acid: reduces heavy bleeding by ~50%

• Iron supplements: for iron deficiency

• Lifestyle & dietary adjustments: reducing inflammatory triggers

• Physiotherapy: pelvic floor hypertonicity, pain with periods

Hormonal Treatments

• Combined Oral Contraceptive Pill

Benefits:

• Lighter, more predictable bleeding

• Reduced period pain

• Symptom stabilisation for PMS

Progesterone-Only Options

• Progesterone only pill (POP)

• Depo injection

• Implant

• Mirena IUD (most effective long-term HMB treatment)

Cyclical or Continuous Regimens

• Continuous dosing reduces PMS, dysmenorrhoea, and heavy bleeding.

GnRH Analogues (short-term use)

Used for:

• Severe endometriosis

• Adenomyosis

• Pre-surgery optimisation

Surgical (when indicated)

• Hysteroscopic polypectomy/fibroid resection

• Laparoscopy for endometriosis/adhesions

• Treatment of uterine anomalies

Surgical Options

Hysteroscopic Procedures

• Removal of polyps

• Resection of submucosal fibroids

• Treatment of uterine adhesions

• Correction of septate uterus

These are day procedures with quick recovery.

Laparoscopic Surgery

Indicated for:

• Endometriosis

• Adenomyosis (selected cases)

• Ovarian cysts

• Pelvic adhesions

Endometrial Treatment

• Options vary with age, fertility plans and bleeding severity.

Surgery is always guided by:

• Fertility goals

• Age

• Symptom burden

• Response to medical therapy

Other menstrual issues: 

Menstrual Health & Fertility

Healthy cycles are central to fertility. Cycle issues can indicate:

• Anovulation → difficulty conceiving

• Endometriosis → reduced implantation

• Adenomyosis → miscarriage risk

• Thin lining → hormone imbalance

• Irregular cycles → unpredictable ovulation

Dr Mackenzie-Proctor’s dual expertise in gynaecology + fertility ensures menstrual treatment always considers future reproductive plans.

Amenorrhoea (Absent Periods)

• Functional hypothalamic amenorrhoea

• PCOS

• Premature ovarian insufficiency

• Post-pill amenorrhoea

• High-performance athletic activity

Adolescent Menstrual Care

A gentle, supportive approach for teens includes:

• Education on cycle norms

• Early endometriosis identification

• Treatment for severe pain

• Acne + androgen symptom support

• Addressing iron deficiency

• Non-hormonal or light-touch hormonal options

Early intervention prevents years of unnecessary suffering.

Perimenopause & Menstrual Changes

The transition to menopause can cause:

• Heavy bleeding

• Short cycles

• Missed periods

• PMS-like irritability

• Hormonal sensitivity

Management may include:

• Low-dose hormonal therapy

• Cyclical progesterone

• IUD for bleeding control

• Iron optimisation

• Monitoring of endometrial thickness

PMS & PMDD 

Biological Basis

PMDD is associated with:

• Serotonin sensitivity

• Neurosteroid fluctuation

• Oestrogen withdrawal

• GABA receptor changes

Treatment Options

Understanding luteal-phase hormonal sensitivity guides treatment.

• SSRIs (luteal or continuous dosing)

• Continuous hormonal suppression

• Lifestyle adjustments (exercise, sleep, stress)

• Nutraceuticals (B6, magnesium, Vitex, saffron)

• CBT and mindfulness strategies

• In severe cases: GnRH analogues with add-back therapy