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Menstruation


Find out why your period may be leaving you with question marks


With all of the things that can go awry with your period, it’s easy to feel as though abnormal is the true “normal” when it comes to menstruation.


No matter when it comes, how often it comes or how heavy it comes for you, understanding your period can help you know when you’re okay and when you may need to see your doctor.


Do these abnormal period symptoms sound familiar?


SYMPTOM: Late Period


A woman’s periods begin 28 days apart on average, and the normal range is 21 to 35 days. If you’re on cyclic hormonal birth control your cycle will be nice and predictable. Not sure if your periods are late or how long they last? There are many free apps for that. Try monitoring your cycles on your phone with one of the many free and useful period tracking apps. They help predict when your next period should be arriving, when you’re ovulating, and also calculate the number of days between your cycles.


Possible Causes: Periods that occasionally fall further apart may be caused by stress, dietary changes, sleep changes, changes to your birth control or other mix-ups to your routine. An irregular cycle can also indicate perimenopause, the time leading up to the stopping of menstruation, or menopause. The average age for menopause is 51, and while it can happen as early as a woman’s 30s or as late as her 60s, menopause commonly occurs in women ages 45 to 55.


When to Call Your Doctor: If your periods regularly come further apart and you’re not going through perimenopause, this may be a sign of a larger condition, such as polycystic ovary syndrome (PCOS), so schedule a doctor’s visit.


SYMPTOM: Missed Period


Now that you know what to expect, and more or less when to expect it, what does it mean when Aunt Flo suddenly goes MIA one month? A lot of things, actually.


Possible Causes: A missed period is most notably the first sign of pregnancy—and the first thing you should check for if you’re sexually active. (Think you might be pregnant? Get the scoop on pregnancy tests and more, here.) It can also point to the onset of perimenopause, especially when accompanied by hot flashes, mood swings, trouble sleeping or other menopause symptoms.


Pregnancy and menopause aside, skipping one period is not uncommon, and not necessarily a problem, but something to note and monitor. Often a missed period is your body’s way of telling you something is off. Have you upped your exercise routine or experienced a heavy dose of stress? Are you not eating enough? Is your body fat percentage dangerously low? These are good initial questions to ask yourself if you’re not getting your period. But a missed period can also indicate something beyond your lifestyle habits that is a more serious underlying problem, such as a tumor or hormonal imbalance.


If you’re 16 years of age and still haven’t started menstruating or three months have passed since your last period, you may have what is medically known as amenorrhea, the absence of a menstrual period.


When to Call Your Doctor: If it’s been three months since your last period (and you’re certain you’re not pregnant) or you’re 16 years old and your period still hasn’t started, reach out to your doctor to get to the bottom of it.


SYMPTOM: Infrequent Periods


A missed period is one thing, but what if your late periods are frequently really late?


Possible Causes: For some women, this is desirable. If you prefer a quarterly rather than monthly friend, there are various prescription birth controls that limit your periods to four per year or less. But if you’re not perimenopausal or on one of these birth control methods, and the intervals between your periods are so long that you’re only having four to nine periods per year, you may have a hormone imbalance caused by problems with your ovaries, thyroid or pituitary gland.


When to Call Your Doctor: Over the long term, infrequent periods, called oligomenorrhea, may contribute to infertility, or may lead to endometrial hyperplasia or even endometrial cancer. So if you skip periods now and then or if your cycles consistently come far apart, talk to your doctor about possible causes and discuss possible treatment options.


SYMPTOM: Spotting Between Periods


If you are pregnant and begin to have spotty bleeding, it’s important to notify your doctor immediately. While spotting is common at the beginning and end of a pregnancy, it can also mean you’re having a complication.


Possible Causes: Outside of pregnancy, spotting can happen for several reasons. Sometimes it’s just a natural occurrence during ovulation, or the side effect of the birth control pill or an intrauterine device (IUD). Spotting can also be a sign of an infection in your vagina, cervix, uterus, fallopian tubes or ovaries, and infections can often result from a sexually transmitted disease. In some cases spotting may point to pelvic inflammatory disease, fibroids, endometriosis or even cancer (abnormal bleeding can be a sign of cervical cancer, ovarian cancer, uterine cancer and vaginal cancer), so this is one period symptom to keep an eye on. Bleeding can also occur after sex for many reasons, such as rough sex, cervical infection or sex that has disrupted the uterine lining.


When to Call Your Doctor: At some point in their lives almost every woman experiences spotting, but if your between-cycle bleeding happens regularly and if the bleeding is heavy or lasts more than a couple of days, make an appointment with your ob-gyn. If you’ve already gone through menopause and experience unusual vaginal bleeding, see your doctor right away.


SYMPTOM: Long-Lasting or Very Heavy Periods


Periods last on average four to seven days, and seem to fall unerringly during vacations, romantic getaway weekends and other times when you least want them. If your period is overstaying its welcome—and somehow ruining your entire two-week Caribbean cruise—or is worse than usual, you may be experiencing prolonged or heavy menstrual bleeding, or what is known as menorrhagia.


Possible Causes: Prolonged or heavy bleeding, which is more common in women 35 years and older, often means your hormone levels have changed for some reason, but it can also be caused by certain medications such as anti-inflammatory medications and anticoagulants, or conditions such as uterine fibroids or polyps, endometriosis and pelvic inflammatory disease.


When to Call Your Doctor: Have your periods started lasting longer than usual? Is your bleeding coming in clots or are you soaking through pads and tampons every hour for a few hours in a row? Do you need to get up in the middle of the night to change your tampon? If so, make sure to talk to your doctor so you can get to the bottom of this.


SYMPTOM: Heavy Cramps and Pain


Let’s be honest, ladies. Sometimes period cramps can be a good excuse to cash in a sick day at work or stay home from school and watch your favorite movie on repeat. But for women who experience severe cramps, these are nothing to welcome at all.


Possible Causes: Premenstrual syndrome (PMS) and its more severe counterpart, premenstrual dysphoric disorder (PMDD), are most likely to blame. Striking in the week or two before your period starts and often easing after the first couple of days of your period, the hormone roller coaster that triggers PMS or PMDD can bring on fatigue, irritation, anxiety, cramps, sadness, disinterest, loss of sex drive, aches, a loss of sex drive, and other symptoms. If you’re having pains that seem to be coming from your stomach or abdomen, this may actually be a sign of a pelvic infection and not PMS/PMDD, so it’s important to pinpoint just what kind of pain you’re feeling.


When to Call Your Doctor: An over-the-counter pain reliever and giving yourself some TLC can often ease the symptoms of PMS. If you find that your symptoms are more severe and interfere with your daily activities, talk to your doctor, as PMDD and its accompanying depression can become quite serious in some women. Along with some lifestyle changes, your doctor may recommend a treatment plan, such as hormonal birth control, to balance you out hormonally, physically and emotionally.


SYMPTOM: Changes to Your Period


Seemingly any change in your life can manifest in changes to your period. The duration, timing and intensity of your period can reflect any one of life’s frequent tweaks, making diet, exercise, stress, medication and general lifestyle all possible culprits when your cycle becomes erratic. What this means is that the clockwork-like period may be a rarity and some changes are very normal month to month.


Possible Causes: Life.


When to Call Your Doctor: Know yourself and your body, as you’re your own best judge of what is and isn’t normal for you. If your intuition and your periods tell you that something is wrong, this may just be the case. Staying on top of your regular Pap tests provides a great opportunity to speak to your doctor and monitor your health.


What If I…?


How many scenarios have you ever been too embarrassed to run by your friend, sister, mother or doctor? Most of them are likely pretty common.


…Leave a Tampon in for Too Long?

Any time you’re using a tampon it’s important to follow the directions on the packaging, which will tell you how to insert and remove a tampon, as well as how long it can safely be kept in. The biggest risk of leaving in a tampon for too long is toxic shock syndrome (TSS), a disease caused by bacteria that can cause fevers, diarrhea, headaches, nausea and other symptoms. The bacteria can be introduced through a foreign object, such as a tampon. If you think you’ve left a tampon in for too long, the first step is to remove it and then call your doctor, especially if you develop a rash, have a fever or feel ill.


…Have Sex During My Period?

There’s no medical reason to avoid having (safe) sex during menstruation. While your chances of getting pregnant from having sex during your period are low, still proceed with caution, as sperm can survive for days and early ovulation after a period isn’t unheard of. For some women, the endorphin surge from sex can even bring on the body’s own natural painkillers to ease cramps. If you use tampons, just be sure to remove them before having sex.


…Have Unusual Discharge?

Every woman has some discharge, which can vary in consistency, color and smell. This is all the work of your cervix, which produces a clear mucus that can change at different times in your cycle. You may notice an uptick in your discharge around the time that you ovulate. A bacterial infection, STD or yeast infection can bring on abnormal vaginal discharge, though, so if you notice a big change in your discharge from what is normal, see your doctor to investigate the cause. Yeast infections are often the culprit, and can be treated with an over-the-counter product and by including probiotics and yogurt in your diet.


On and On and On


As if bleeding monthly isn’t enough, your cyclic hormone fluctuations can usher in a whole mess of symptoms that can make you want to scream. Just know that if you experience any of the following, these are often normal and temporary issues that will likely be gone by the time you make it to the other side of your period. By keeping track of your symptoms, you can get to know your cycle better and be able to anticipate your symptoms. If any of your period symptoms bother you and interfere with your life, talk to your doctor about your options and find out how birth control and other treatments can help you get them under control.

Acne

Back pain

Bloating

Change in appetite

Changes in sex drive

Cramps

Disinterest

Fatigue

Insomnia and sleep changes

Irritability

Migraines and headaches

Mood swings

Sadness

Tender or swollen breasts


Einav Keet is a women's health writer, Philadelphian, and mother to son Luka.


Reviewed by Elaine Brown, MD on December 6, 2013

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