Women’s menstrual cycles are almost as individual as they are — there’s a large variation in what is ‘normal’. The cycle can take from 24 to 35 days (counting the day you start bleeding as the first day); bleeding can last for between two and seven days; and the amount of blood lost can range from 10ml to 80ml (the average being around 35ml). If blood loss is heavy it can lead to anaemia (iron deficiency).

To familiarise yourself with what is ‘normal’ for you, it’s a good idea to keep a menstrual dairy. Some women are extremely regular, others less so, but once you get a feel for your usual pattern, you can be more alert to ‘abnormal’ variations.

Heavy periods (also called menorrhagia) may be caused by things like fibroids, pelvic inflammation, hormonal disturbances, tumours, and IUDs, but there may also be no apparent cause (this is known as ‘dysfunctional uterine bleeding’). If your periods become much heavier than what’s normal for you, you should seek advice from a health practitioner as it may indicate an underlying problem.

Shortages of iron, zinc, Vitamin B6 and Vitamin A have been suggested as causes of excessive bleeding, so supplements may help (but beware of taking large amounts of Vitamin A without supervision). Food intolerance may be a factor for some women, and if you’re being treated for candidiasis, your periods may get heavier for a while before settling down again. Make sure you eat plenty of iron-rich foods such as green leafy vegetables and lean meat to counteract the possibility of anaemia. Among the herbs, bayberry, raspberry leaves, golden seal, sage or shepherd’s purse may be useful, and supplements of dolomite (calcium and magnesium) taken for a few days before and during the period have been reported as effective.

Period pain (dysmenorrhoea) varies greatly among women. There are two types: primary dysmenorrhoea is related to the uterus actually contracting under the influence of prostaglandins (hormones); secondary dysmenorrhoea tends to extend outside the time when you are actually bleeding and can be caused by problems such as cysts, fibroids, polyps, infections or tumours.

You should investigate the cause if you feel you are experiencing secondary dysmenorrhoea, but there are many self-help treatments that can help relieve the pain. A hot water bottle against the abdomen can be soothing, as can a warm bath or shower. Exercise, especially swimming or yoga may help. Try massaging the uterus directly — pressing into your abdomen just above the pubic hairs; or experiment with acupressure — direct pressure on the Achilles tendon behind your ankle. Eat plenty of fresh fruit and vegetables, vegetable juices, fish and liver. Useful supplements may include magnesium, calcium and potassium; and the herbs crampbark, cimicifuga, chamomile, golden seal and raspberry leaf.

Amenorrhoea — absence of periods — is most commonly the result of pregnancy or breast-feeding. But if this is not the case, you should consult a health practitioner to try and track down the reason. Amenorrhoea can be caused by hormonal imbalances, extreme loss of weight (for example, as a result of a disorder such as anorexia nervosa — see separate entry), or by some drugs used to treat high blood pressure or cancer.

Cessation of menstruation is known as menopause.

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Anxiety commonly shows itself in irritability. We react too quickly and too much to all manner of minor frustrations. We become upset by things which would not normally disturb us. We are more sensitive to noise, and are easily irritated by it. The noises at work which we had not previously noticed become a source of irritation; and at home the noise of the children brings us to distraction. We tolerate it as long as we can, then suddenly let go. We punish the child too severely, and then immediately regret it.

If someone finds fault with what we have done, we normally take the criticism in stride. But when we are anxious, we overreact to the situation; we flare up, we say what we should not say, and then regret it. The girl in the restaurant attends to us in the usual way, but because we are tensed up we feel that she is unbearably slow. The mannerisms and quirks of our friends and relatives, which we once enjoyed, now irritate us. There soon develops an atmosphere of tension in the home. Members of the family become cautious; they are restrained, and no longer laugh arid joke openly for fear of triggering off this unnatural irritability. The anxious one senses that the others are acting differently toward him, he becomes still more on edge, and the cloud of misunderstanding deepens.

A young woman in her early thirties, extremely tense and aggressive, came to consultation on account of her intense irritability with her two young children. These were her exact words: «With her like she is how could I be relaxed?» «It is not as if I am completely ignorant. I have had experience with doctors and that makes me a bit doubtful.»

For some years her husband had been under treatment for a peptic ulcer which I thought might easily be related to his wife’s irritability.

Her state was so severe that I arranged for her admission to a hospital, but she was so irritable and aggressive that she promptly left against advice. However, she returned to me some months later, just as irritable as ever, but determined to seek help. It took her several sessions to learn to do the relaxing mental exercises. She then underwent an extraordinary change in personality; she could smile and be pleasant in a way that had not seemed possible before. She learned to cope with the children and tolerate frustration without undue irritability.

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