Dr Dharshini Gopalakrishnakone, The Obstetrics & Gynaecology Centre

Most people joke about not offending women during their Premenstrual Syndrome (PMS). Exactly why do women tend to be more grumpy / teary before their periods? 
A biochemical reason causes the sudden drop in certain hormonal levels the week before the next period starts. This is why pregnant women are usually glowing and happy! Women suffering with PMS and mood swings, should see their doctor, who may consider supplements such as B6, cognitive behavioural therapy, transdermal oestrogen with micronized progesterone, continuous oral contraceptive pills containing drospirenone or even SSRIs (anti-depressives).

Is it normal to have very painful and heavy periods?
Sometimes pain and even quantifying periods can be very subjective, but if the patient is unable to cope with activities of daily life because of either their period, then this is significant. Bleeding associated with clots, changing pads every hour or so on heavy days and symptoms of anaemia are considered severe symptoms and a doctor should be consulted.

Is it possible to get pregnant if a woman has intercourse during her period?
Some women have very short period cycles and may ovulate (the one day during the cycle when the egg is released) as day 10 of the cycle or even earlier. Sperm can survive up to 5-7 days within the pelvic cavity after intercourse. Hence technically, it is very possible to get pregnant as a result!

Why do some women suddenly stop having their periods when they lose too much weight?
Losing weight is excellent when done for health reasons and the patient maintains a BMI above 19. Losing weight at a fast rate within a very short time or excessively till BMI is below 19 causes the brain to recognise stress and modify the release of hormones such that ovulation and subsequently menstruation ceases. When there is no ovulation, there is no period. Hence patients with anorexia nervosa are at a risk of losing their periods and associated possible fertility issues.

One of the fears women who use tampons have is that the tampons may get “lost” and they cannot retrieve the tampon from the vagina –  is this a legitimate fear or myth?
Absolute myth! The tampon is inserted into the vagina and has no other orifices adjoining it aside from the tiny cervical canal leading to the uterus. There is no possible way for a tampon to sneak through the cervical canal so it can never be lost.

Can you offer some quick, brief tips on safe tampon use?
Some women do not change it regularly enough! Even if you feel comfortable, it’s best to change tampons at least every 4-6 hours a day, and more if there is heavy flow. To avoid toxic shock syndrome, try to avoid the super absorbent ones unless very necessary and wash hands before insertion, maintain good hygiene and change regularly.