What's a problem? What's normal?
According to textbooks, your period should come every 28 days or so, and the menstrual fluid you lose is on average, six to nine tablespoons. The trouble is, your body can’t read textbooks, and it may do something very different.
Some women have:
Periods that don’t come regularly (in fact very few have a consistent 28-day cycle)
- Heavy periods—a very heavy flow of blood each month
- Painful periods
- An absence of periods (called amenorrhea)
A few women have a combination of menstrual problems. Sometimes these things are normal; sometimes it means something is wrong. So if your periods aren’t regular, or are too heavy or painful or if your period stops coming, you should talk to a doctor.
Typically, after a woman has been menstruating for a year or two, she will get her period every month or so. Therefore, most women get about 12 or 13 periods a year. If menstruation DOESN’T happen every month, a woman will only get five or six periods a year. This would be considered infrequent, and she should see a doctor.
You might not have had a period for a few months, and when it comes, it might last one day or ten. This is normal. Your body will take a while to settle into a cycle, and it could take two years or more.
However, if you've been menstruating awhile, there are some things that can delay menstruation one month, making it appear that you’re "skipping" a period. The most common reason to skip a period is pregnancy. But other reasons for menstrual problems include:
- Weight loss
- A really big decrease in calories eaten
- An excessive amount of physical activity (for example, running over 40 miles per week)
- Extreme stress or excitement
- Summer—it isn’t unusual to skip a period during the summer. The additional hours of daylight can affect your cycle.
When women get near the end of their reproductive years, "skipped" periods may be a sign of approaching menopause.
"Regular" periods mean the time between periods is pretty much the same from month to month. Women can have their periods every 21 to 35 days, and 28 days is the average. But when you first start menstruating, the cycle isn’t usually regular. You could have one period and then wait six months for the next one! This isn’t unusual. Until your body adjusts, the time between your periods may be unpredictable. But after that, it should regulate itself. If not, see your doctor concerning menstrual problems.
Bleeding or "spotting" between periods
The only type of normal bleeding or "spotting" (light bleeding) between periods is spotting that happens for some women when they ovulate (which is about 14 days before the start of the next period). If you have any other type of bleeding or spotting between cycles, you should see your doctor.
Absence of periods
Sometimes your periods may stop altogether, a condition known as amenorrhea.
This menstrual problem can be caused by:
- Dramatic weight loss. Amenorrhea is a frequent telltale sign of the eating disorder anorexia nervosa, an illness in which someone, usually a young woman, starves herself in order to be thin
- The "binge/purge" disorder, bulimia, in which the patient eats a lot of food (bingeing) and then makes herself throw up (purging)
- Excessive exercise, like running more than 40 miles per week, or elite training in ballet/gymnastics, etc.
- Polycystic Ovary Disease (multiple cysts on the ovary)
- On some very low dose birth control pills, there may be little or no menstrual flow
Heavy periods are defined by a flow that requires the highest absorbency tampon or pad that must be changed sooner than recommended, usually within an hour.
The reasons women have heavy periods include:
- The natural flow is just heavy
- Use of the birth control method called an IUD (intra-uterine device)
- Hormonal imbalance (too little or no progesterone)
- Fibroids or polyps (growths that sometimes occur in the uterus)
- Thyroid problems (the thyroid is a gland in the neck that helps control many body functions)
- Endometriosis—a condition in which cells from the lining of the uterus travel and grow in other parts of the body
- Cigarette smoking
- Childbirth—(Many women have heavy flow during the first year or so after childbirth)
Some of these conditions don’t need to be treated. Others may require treatment.
When to see a doctor about heavy periods
If you have a normally heavy period, there is usually no need for concern. However, you should see a doctor if you experience "flooding" (leaking through a super absorbency pad or tampon within one hour). If your periods get heavy and change in consistency, you should see a doctor. If no medical reasons are found for heavy flow, the doctor may prescribe oral contraceptives, or use cyclical progesterone to regulate the periods.