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Even though periods are an incredibly common part of womanhood, there’s still a lot that can be confusing about menstruation, including when your period symptoms are really a sign of an underlying medical issue.
As a pre-teen, learning about your period might have felt taboo (that is, if you were taught about it at all). Getting your first period was probably a mix of emotions—maybe embarrassing, definitely exciting. Now that you’re more acquainted with your menstrual cycle, you probably view it as little more than a side effect of having a uterus (and a reminder to pull out your period panties). But when it comes to your period, small changes could signal something larger is off with your body.
How do you know when it’s time to go to the doctor about your period symptoms? Here are six signs to look for.
1. If your period lasts more than 7 days or comes with a heavy flow
The first day of your menstrual cycle is when you bleed through your vagina to shed the lining of the uterus (the endometrium). The bleeding typically lasts around 2 to 7 days, and you can use a pad, tampon, cup or period underwear to contain the blood.
“Your menstrual flow should not last longer than seven days,” Latasha N. Murphy, MD, gynecologist and surgeon in The Gynecology Center at Mercy Medical Center in Baltimore, MD, tells Motherly. “The flow should not be heavy enough to change one pad per hour for consecutive hours.” If you’re seeing a lot of blood that quickly soaks through a pad and/or large clots, call your doctor or seek immediate medical care.
2. If you have an irregular cycle
The length of your menstrual cycle can vary, but it typically lasts around 28 days from the first day of your period to the day before your next period starts.
Around day 14 of your menstrual cycle, an egg is released from your ovary and moves into one of the fallopian tubes in a process known as ovulation. Afterward, progesterone levels begin to increase and estrogen levels decrease. Usually around day 28, the endometrium will shed if the egg is not fertilized by sperm.
Monte Swarup, MD, FACOG, board-certified in OB/GYN and founder of HPV Hub, tells Motherly that you should see a doctor if your menstrual cycles are “longer than 35 days or shorter than 21 days.” Additionally, reach out if you experience irregular periods, “in which cycle length varies by more than 7 to 9 days.”
Related: Can you get pregnant on your period?
Occasional irregular periods aren’t a cause for concern. “Abnormal cycles can occur at any age,” says Dr. Swarup. “But at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9 to 14). During perimenopause (around age 50), the number of days between periods may change. It is common to skip periods or for bleeding to get lighter or heavier at this time.”
ACOG suggests talking to your doctor if your periods are usually regular but have become irregular over several months. Dr. Murphy explains, “Irregular menses may indicate hormone imbalance, pregnancy or structural problems such as uterine fibroids or polyps.”
3. If your period symptoms disrupt your everyday life
“Feeling pain before or during your menstrual period is very common,” says Dr. Swarup. More than half of women and girls with periods have some pain for 1 to 2 days each month, according to ACOG. This is caused by your uterus contracting and releasing prostaglandins, which causes muscle cramps that can be felt in your lower stomach or back.
Other symptoms of your period can include:
- Breast tenderness
However, if your period pain disrupts your everyday activities or makes it hard to sleep, ask your healthcare provider for help. Painful periods could be caused by medical conditions such as endometriosis, cysts in the ovaries, adenomyosis or fibroids.
“If you have to plan life events around your cycle because it is too heavy or painful, you should bring this up to your doctor,” says Dr. Murphy.
4. If pain relievers aren’t helping
ACOG recommends taking pain relievers like ibuprofen to ease cramps. Start taking it one to two days before you start bleeding and continue through the first two to three days of your period. You can also try exercising regularly throughout the month, taking a warm bath, using a heating pad on your abdomen or lower back, and getting more sleep right before and during your period.
If these don’t work, see a doctor.
“If you have to rely on pain medication, skip work/school, or lay in the bed all day due to pain, that should prompt medical evaluation,” says Dr. Murphy.
Your doctor may prescribe hormone treatment, such as birth control pills or a hormonal intrauterine device (IUD) to lessen pain.
5. If you haven’t had a period for 3 months or if you’ve never had one
Most women get their first period between the ages of 12 and 13, according to the ACOG. One in 25 women who are not pregnant, breastfeeding, or going through menopause will have amenorrhea at some point in their lives.
Primary amenorrhea is when you’ve never had your first period by your 15th birthday (or three years since your breasts developed).
Secondary amenorrhea is when a woman who already menstruates doesn’t get her period for at least 90 days and can happen at any age.
Sometimes amenorrhea is caused by pregnancy, breastfeeding and menopause, but it could also result from certain medical conditions and medications, per ACOG.
Other things that cause secondary amenorrhea include:
- Low body weight
- Rapid weight loss
- Eating disorders
- Problems with the hypothalamus or pituitary gland
- Polycystic ovary syndrome (PCOS)
- Problems with the thyroid gland
- Primary ovary insufficiency
- Chronic medical conditions such as kidney failure or inflammatory bowel disease (IBD)
“If your postpartum period does not return up to three months after you've stopped breastfeeding, you should also alert your healthcare provider,” adds Dr. Swarup.
6. Abnormal bleeding could also indicate a trip to the doctor
Dr. Swarup also mentions the following red flags when it comes to your period:
- Bleeding or spotting between periods
- Bleeding or spotting after sex
- Heavy bleeding during your period
- Bleeding after you’ve gone through menopause
- Passing blood clots the size of a quarter or larger
Your doctor may perform a physical exam, including a pelvic exam, and lab tests to check for underlying conditions.
“A blood test called a complete blood count (CBC) can help determine if you have anemia or an infection,” explains Dr. Swarup. “You may have tests for certain bleeding disorders. You may have a pregnancy test and tests for sexually transmitted infections (STIs).”
Based on your symptoms and your age, other tests may be needed, according to Dr. Swarup, including an ultrasound exam, hysteroscopy, endometrial biopsy, sonohysterography, magnetic resonance imaging (MRI), and/or computed tomography (CT).
When it comes to your period, there are different versions of normal for everyone
Your cycle may even vary slightly from month to month, which is where period tracker apps such as Clue can be helpful. However, if something feels off to you or is affecting your daily life, don’t be afraid to call your doctor to talk through it.
“No matter if your period flow is normal or you experience concerns that are mild or severe,” adds Dr. Swarup, “talk with your OB-GYN or other healthcare provider for help and answers about your body.
At the very least, you can rule out a medical concern and lower your anxiety about your period.
In any case, your period is inconvenient at best. We've found some stellar products that can help make it a little easier. Shop them below!
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Latasha N. Murphy, MD, is a gynecologist and surgeon in The Gynecology Center at Mercy Medical Center in Baltimore, MD. Dr. Murphy specializes in the diagnosis and treatment of routine and complex gynecological conditions including endometriosis, chronic pelvic pain, ovarian cysts, irregular period cycles and abnormal bleeding.