So, how are we to know when skipping a few periods is medically sound vs. a sign that something bigger, like polycystic ovarian syndrome (PCOS) — in which the ovaries go overboard on testosterone and other androgen production — is kicking in? The first step is to ditch any idea of “normal” and figure out what’s normal for you.
By paying attention to your monthly cycle — including how frequently you bleed, how much you bleed, how long you bleed, and how much physical pain strikes — you’ll best realize when a change in your period occurs, which is the first step in discovering an underlying health problem. And, should your body-mind connection not be so attuned, there’s an app for that (or 20), which will track these stats and more.
Once you get a sense of what’s rhythmically right for you, then you can start to delineate between what might not be worth worrying about and when something may be wrong (and warrant a trip to the OB/GYN). We talked with Dr. Lauren Streicher, assistant clinical professor of obstetrics and gynecology at Northwestern University’s medical school and author of The Essential Guide to Hysterectomy, about the most common freakouts that come with changes in periods and when to see a doctor for help.
After ruling out pregnancy (and here’s where an app comes in handy) figure out exactly how many periods you’ve skipped. If it’s fewer than three periods, there’s no need to book an emergency appointment with your OB/GYN, according to Dr. Streicher. “Missing a period once in a while is no big deal,” she says. “A lot of times someone is going to miss her period for reasons, like stress or travel.” But, if your normal cycle has been disrupted for three months or more (a condition called amenorrhea), it’s time to take the money you’ve saved from not buying tampons over the past few months and use it to pony up for a co-pay to see your doctor.
“The major concern when someone isn't getting a period is that she will be getting an endometrial build-up in the lining of the uterus, which can be problematic down the road,” Streicher says. Other health problems tied to missing three or more periods include endometriosis, thyroid problems, premature ovarian failure (POF) and polycystic ovarian syndrome (PCOS).
Likewise, disordered eating and extreme weight loss can cause periods to vanish for long chunks of time. And, those who suffer from eating disorders and amenorrhea are also at risk to lose bone density. "The normal hormone cycle gets disrupted when there's no body fat," Streicher says. "The concern is that [such women] risk osteoporosis because their estrogen levels are so low."
Your Periods Are Painful
It’s easy to think that cramping is just part of the raw deal we get with menstruation, and that we should put to up with it, no matter how intense it gets. Since pain is so subjective, and such a tough thing to measure, it’s hard to know when period-associated pain warrants a trip to the doctor. In many cases, a couple of ibuprofen, naproxen, or acetaminophen pills will help kill the pain. Research also shows that sex, exercise, and applying heat can also reduce menstrual pain.
But, if you find that cramping and pain around the time of your period is so severe that it leaves you bedridden, then it’s time to seek medical help. “It’s never normal to have such bad pain with your periods that you have to stay home, cancel normal activities, and you're not able to do the things that you like to do,” Dr. Streicher explains. “There’s a big difference between the person who needs a couple of Advil and the person who looks at the calendar before they schedule anything because [they’re preparing for severe menstrual] pain.”
Heavier periods are the most high-maintenance kind. But, when they become a health concern is often indicated by the number of cubic centimeters (CCs) you bleed. Doctors often cite a total blood loss of 80 CCs as being a point at which further medical examination is necessary. But, it’s not like we’re going to measure the stuff, so Dr. Streicher suggests a more intuitive cue as far as how much is too much. “What I tell women who notice a big change in how much they bleed is to notice how many pads or tampons they’re using. If they were going through four or five pads or tampons a day and suddenly, they’re going through 10, that is something to get checked out,” she says.
Heavier periods have been linked to everything from smoking to endometriosis and uterine fibroids (noncancerous growths on the uterus that can cause back pain or make it tough to pee). All three of these health concerns have been linked to infertility, so re-regulating a period after a big change in flow can potentially help with reproductive health down the road.
Heavy periods can also reduce red blood cell counts and deplete iron levels. If you experience heavy periods, your doctor may suggest oral contraceptives and lifestyle changes, like boosting iron and vitamin C intake, with foods like fish and red peppers, about two weeks before your period in order to prevent the onset of anemia.
You’re bleeding more than once a month.
Though it’s often stated that a “normal” period should come every 28 days, it’s perfectly normal to have one every 21 to 35 days. Women can even have a period only 14 days from her last and have nothing to worry about. “If this happens once in a blue moon, don't get crazed about it,” Dr. Streicher says. But, if you find that you’re bleeding every two weeks, then it’s a good idea to get that checked out, as bleeding between regular periods may indicate changes in hormone levels or even miscarriage.
The Bottom Line
While Streicher says it’s “very common” to have a funky change occur with your period, only to return to normal, it’s important to gauge what’s normal for you, then look for major changes like missing a period for four months, heavy bleeding for several continuous months, and debilitating pain. Changes like this require medical attention, as they can help reveal other medical conditions or nip further complications in the bud.
And, just like there is no “normal” period for all women, says Dr. Streicher, there is no specific guideline for period irregularities for women of all ages. “Any of the gynecologic conditions increase with age, so the approach is very different with the 23-year-olds who say they had a couple of heavy periods and the 44-year olds that come in with heavy periods. The older you are, the greater the chance that there is something amiss that you may need to get checked out.” So, if there’s something amiss, don’t delay — after all, none of us are getting any younger.
Illustrated by Ly Ngo