From missed periods to painful periods, menstrual cycle problems are common, but usually not serious. Follow this chart for information regarding changes in your cycle.

SYMPTOMS DIAGNOSIS SELF-CARE
Begin here
1. Have your periods become painful? No --> Go to Question 5.*
Yes, go down
2. Have you been more emotional, fatigued or irritable, or do you have more bloating or weight gain than usual, or do you have trouble concentrating or sleeping just prior to your periods? Yes --> This may be normal MENSTRUAL CRAMPS, or you may have PREMENSTRUAL SYNDROME (PMS). --> Use over-the-counter medicine such as ibuprofen or naproxen for bloating and pain. Avoid caffeine and alcohol. Make changes to the way you eat and exercise. Eat smaller, more frequent meals that are high in complex carbohydrates such as fruits,vegetables and whole grains, and take a daily multivitamin and calcium. See your doctor if symptoms get worse.
No, go down
3. Do you have a sexually transmitted disease, or do you have a fever or foul-smelling vaginal discharge? Yes --> You may have a serious infection around your ovaries, fallopian tubes, and uterus called PELVIC INFLAMMATORY DISEASE (PID). -->

URGENT

See your doctor right away. Any infection in the abdomen can be serious.

No, go down
4. Do you have pain at other times such as during sex, ovulation or bowel movements? --> You may have ENDOMETRIOSIS, a problem with the lining of the uterus, or OVARIAN CYSTS. --> See your doctor.

*5. Are your periods heavier or are you bleeding longer than usual? No --> Go to Question 9.**
Yes, go down
6. Do you use an IUD? Yes --> The IUD may have caused this change in the pattern of your bleeding. --> See your doctor.
No, go down
7. Do you have a constant feeling that you need to urinate, or do you have pelvic pressure, constipation or pain in your back or legs? Yes --> Your symptoms may be from FIBROIDS, noncancerous tumors of the uterus. --> See your doctor.
No, go down
8. Do you have muscle aches, swelling or stiffness in your joints, tightness or swelling in your throat, and/or weakness in your legs? Yes --> You may have a problem with your THYROID GLAND such as HASHIMOTO’S DISEASE. --> See your doctor.

**9. Are your periods irregular, infrequent or have they stopped? No --> Go to Question 14.***
Yes, go down
10. Do you have breast tenderness, abdominal fullness or nausea? Yes --> You may have an OVARIAN CYST, or you may be PREGNANT. --> If you could be pregnant, do an at-home pregnancy test. If it’s positive, see your doctor for confirmation. If you don’t think you’re pregnant and symptoms continue, see your doctor.
No, go down
11. Are you on birth control pills? Yes --> Some women will miss a period while on BIRTH CONTROL PILLS. There is a small chance you could be PREGNANT. --> Wait to see if you have a period at the end of your next pack of pills. See your doctor if you have signs of pregnancy or you don’t have a period after the second month.
No, go down
12. Are you 35 years old or older? Yes --> Periods that stop after years of regularity may be caused by normal or premature MENOPAUSE. Irregular periods may be due to FIBROIDS, HORMONE PROBLEMS, or other medical conditions. --> See your doctor.
No, go down
13. Have you felt sluggish, or have you gained or lost weight without trying? Yes --> You may have a HORMONE PROBLEM, such as a THYROID GLAND problem. Periods may stop or become irregular if your weight falls dramatically, as can occur with ANOREXIA NERVOSA. --> See your doctor.
No, go down
***14. Are you bleeding at times other than your period, or again after having gone through menopause? Yes --> Your bleeding could be from FIBROIDS, ENDOMETRIOSIS, or from a serious condition such as ENDOMETRIAL CANCER. --> See your doctor right away. Early detection of endometrial cancer is important for successful treatment.
No, go down
For more information, please talk to your doctor. If you think the problem is serious, call your doctor right away.

This tool has been reviewed by doctors and is for general educational purposes only. It is not a substitute for medical advice. The information in this tool should not be relied upon to make decisions about your health. Always consult your family doctor with questions about your individual condition(s) and/or circumstances. Source: American Academy of Family Physicians. Family Health & Medical Guide. Dallas: Word Publishing; 1996.