Dr. Veronica, Is My Period Normal? -The Toast

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Many people think their period is abnormal in some way, and that’s because menstruation is awful. It’s painful, kind of gross (Ed. note to all moon goddesses – not yours, obviously, yours is a Righteous Flow of Empowerment and it heals lepers), and incredibly inconvenient. But in some women, it actually is abnormal. How do you know if you’re one of them? I’m going to take several of the most common questions I get, and try to answer them here briefly. Feel free to ask more questions in the comments, and I’ll try to respond helpfully.

Q: My period comes fairly regularly every month, but it varies by a few days. Sometimes it might be the 25th, or the 30th, or the 22nd. I can never tell exactly when it’s going to come. Is this normal?

A: Yes, this is normal. A typical cycle length is around 28-30 days, but some women have longer or shorter cycles, and this can vary from month to month. If your period is coming every month, then this is not a problem. If your cycle length isn’t constant, though, it might be harder to know when you’re ovulating, which is only a problem if you’re trying to get pregnant, or trying to use the rhythm method (which I do not recommend) to prevent pregnancy.

Q: My period sometimes doesn’t come every month. It might skip one or two months at a time, pretty frequently. Is this normal?

A: No, this is not normal. This is called oligomenorrhea, which is fancy medical talk for “too little menstruation.” What’s probably going on is that you’re not ovulating regularly. Every month your estrogen and progesterone levels fluctuate in a specific pattern, and that allows your body to know when to ovulate, and when to menstruate. If these fluctuations don’t happen correctly, then your menstrual rhythm will be out of whack.

Why is this a problem? It can mean that your estrogen and progesterone are out of balance. In women with oligomenorrhea, often their estrogen levels are too high, and their progesterone levels are too low. This can cause the lining of your uterus to grow too thick, which is called hyperplasia. Over time, hyperplasia can lead to uterine cancer. This can be prevented by evening out the hormone levels in your body – with hormonal contraception like the birth control pill, patch or ring, or the progesterone injection (Depo Provera), a progesterone implant (Nexplanon) or the progesterone-containing IUD (Mirena), all of which can protect your uterine lining. So if your periods are very irregular and too infrequent, you should see a doctor to ask if birth control and endometrial protection might be helpful for you.

Also, oligomenorrhea can be associated with a syndrome called Polycystic Ovary Syndrome, or PCOS. This can come with symptoms like acne, male-pattern hair growth (facial hair/chest hair), pre-diabetes or full diabetes, and excessive weight gain. PCOS is fairly common, but still important to manage carefully. See your gynecologist if you think you might have PCOS.

Q: Sometimes I have a little spotting in between periods. Is that normal?

A: Probably not. Spotting once in a blue moon is okay, but if it happens frequently, it’s annoying and potentially fixable. You could have an endometrial polyp, which is an overgrowth of the uterine lining. Or you could have fibroids, which are balls of fibroid tissue that commonly grow in the uterus. You could also have an infection, like chlamydia, especially if the spotting only started recently. Depending on certain risk factors, your doctor may want to check for uterine cancer. So if you’re having frequent spotting, that’s worth making an appointment.

Q: My periods are really heavy – sometimes I use up to 10 pads or tampons a day. Do I just have to live with it?

A: No! That’s called menorrhagia, or excessive menstrual bleeding. Menorrhagia can be caused by a number of things, including polyps, fibroids, or something called adenomyosis (growth of endometrial glands in the muscle of the uterus). All of these things can be managed with both medication and surgery, and you should see your doctor to get an ultrasound and see which management options might be right for you.

If your bleeding used to be normal and then became too heavy, that’s an especially good reason to see a doctor ASAP. Your doctor may want to check your uterine lining. More commonly, you could have new growth of polyps or fibroids that can be removed and reduce your bleeding.

Also, if you have iron deficiency or anemia and you have heavy periods, reducing the bleeding can really help. If you have ever needed a blood transfusion from bleeding, you should definitely talk to a gynecologist.

Q: Did you just say cancer?? Do I have cancer?!?!

A: Probably not. Uterine cancer can cause irregular or heavy bleeding, so we always keep in the back of our minds when evaluating someone for bleeding, but it’s much less common than other causes that I mentioned. Everyone is at risk for uterine cancer, but some things put people at increased risk, such as family history of uterine or colon cancer, age over 40, obesity, oligomenorrhea (see above), and diabetes. If you have any of those risk factors and have abnormal bleeding, it’s a good idea to discuss with your doctor.

Q: My periods aren’t that heavy – maybe 3-5 pads a day, but they’re so annoying. Is there anything I can do about that?

A: Yes! Even if your bleeding isn’t excessive, periods can suck. Hormonal contraception (pill, patch, ring, shot, implant, IUD) can reduce or eliminate your period, and it’s not bad for you. In fact, they can protect against certain forms of cancer, and they do not cause infertility. So if you would like to have a lighter period (or sometimes none at all), talk to your gynecologist.

Q: My period lasts 3 days, and then I have light spotting for 2 more days. Is this OK?

A: Yes, this is normal.

Q: At the end of my period, I get a dark brown discharge, and sometimes weird small clots of brown. Is this normal?

A: Yes, this is normal. When blood reacts with oxygen, it turns brown. At the end of the period, the flow is light, and the blood sits around in the vagina longer, so it can turn brown or clot.

Q: My periods are really painful. Sometimes I can’t get out of bed, and I lie there, moaning and writhing. What can I do?

A: A lot. Painful periods are called dysmenorrhea. I always recommend that people start with a pain reliever like ibuprofen (aka Advil or Motrin) or Naprosyn (aka Aleve), which are more effective than Tylenol for period cramps. You can even take them around the clock while you have your period if you know the pain is going to come back. If that’s not enough (or you can’t take those for medical reasons), consider hormonal contraception. It can really reduce the pain associated with your period. You don’t need to suffer.

Q: When I get my period, I have loose stools or diarrhea. Is there something wrong with me?  

A: Nope, you’re fine. The uterus and intestine both contain the same kind of smooth muscle. The signals that are telling the uterus to contract (thereby expelling the blood and causing cramps) also stimulates anything that’s nearby – and the colon/rectum is very nearby. Hence the pooping.

Q: I’ve tried to discuss this with my doctor, but s/he just blows me off or says it’s normal. What should I do?

A: It’s possible that it is normal. If your doctor gave you a reasonable explanation, and you feel like you got good information, then that may be the case. If you feel still uninformed, you have 2 options: (1) you can gather your thoughts/questions in a list, and go back for another visit. Sometimes we just need a second discussion to make sure all questions got answered. Or, (2) you can get a second opinion (preferably not The Internet). No good doctor should ever be offended by a second opinion. In fact, I encourage it. A second doctor might disagree, or if they agree, they might explain it in a way that helps you feel more comfortable with the management plan.

Q: Does my weird period mean I can’t get pregnant?

A: Probably not. While skipping periods (therefore not ovulating regularly) might make it harder to get pregnant, most menstrual irregularities are independent of fertility.  The best way to know if you can get pregnant is to actually try to get pregnant. If you have tried to get pregnant for a full year (or 6 months if you’re over 35) and haven’t been able to, talk to your doctor. (Stay tuned for more about fertility in a later post….)

The bottom line is that if something is bothering you, see your doctor to ask more.

If you’re not quite sure, ask away in the comments!

From our lawyer (he says hi, by the way): “This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual. Through this site, Dr. Ades provides general information for educational purposes only. The information provided in this site is not a substitute for medical or professional care, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. The Toast and Manderley, LLC is not liable or responsible for any advice provided herein. If you believe you have any other health problem, or if you have any questions regarding your health or a medical condition, you should promptly consult your physician or other healthcare provider.”

Veronica Ades, MD, MPH, is an obstetrician-gynecologist in New York City. She is an assistant professor at the NYU School of Medicine. She also works with Medecins Sans Frontieres/Doctors Without Borders (MSF). Her personal blog can be found here and her MSF blog can be found here.

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