It is interesting how the medical community draws conclusions based on the average person. In reality, no two women, and therefore no to menstrual cycles are alike. What may be perfectly normal for one woman is cause for alarm in another. Still, in the law of averages, there should be very little deviation from what is considered “normal”. If you are experiencing any of these things, your period may be trying to get the message across that what you once considered “normal” is actually worth a little attention. 1
Your Not Experiencing a Period (Amenorrhea)
Could be a sign of: Pregnancy, menopause, medication side effect, lifestyle issue, structural problem or hormonal imbalance
Amenorrhea has a variety of causes, the most obvious of which are pregnancy and menopause. If you suspect you are pregnant, over-the-counter pregnancy tests are highly accurate when performed correctly and results should be confirmed by your doctor so you can begin prenatal care as soon as possible. If you are nearing age 45 or older and do not have a period for one or more months, ask your doctor to confirm you are, in fact, beginning menopause.
But what if you are still young and there is no way you can be pregnant? Chances are, women will skip a period at some point in their life due to one of four factors – medications, lifestyle factors, structural problems, or hormonal imbalances. Contraceptives, blood pressure medication, anti-depressants, and some allergy medications all may interfere with your period or cause it to stop altogether. Likewise, low body weight, stress, or excessive exercise can all cause your body to quit producing the hormones necessary for reproductive function. You period should resume once you stop taking the medication or resolve the lifestyle cause. More significant underlying causes like Polycystic Ovarian Syndrome (PCOS), a pituitary tumor, or thyroid malfunction can result in hormonal imbalances that would stop you from menstruating. And in a small population, structural problems like the absence of reproductive organs, uterine scarring, or an abnormally structured vagina could have the same result. 2
When to consult a doctor: If your period is usually regular and there is a chance you are pregnant, consult your doctor after your first missed period. Otherwise, consult a doctor if you have missed your period for three consecutive months.
Your Period Blood is a Strange Color or You Are Passing Clots
Could be a sign of: Miscarriage, Fibroids, Thyroid problems, Changes in hormone levels
While it may feel like you are bleeding profusely during your period, your body actually only loses between 4 and 12 teaspoons of blood. But the color and consistency can tell you a lot about your overall health. If you were pregnant and are bleeding heavily and passing grey clumps of tissue and blood clots, you may have miscarried. Miscarriage may be mentally and emotionally devastating but there is often an underlying cause that can be addressed by talking to your obstetrician or fertility specialist.
Fibroids are noncancerous tumors that form in the uterus and are so common, most women have experienced them at some point in their lives. While most women do not experience symptoms at all, many women with fibroids have heavier than normal bleeding during their period. The same is true for women with thyroid problems. In fact, every one of the potential underlying causes of unusual colors of period blood are tied to the same root cause – hormone levels. 3
Famously, Alisa Vitti, a holistic health counselor and functional nutritionist on The Doctor Oz Show, has said your period should take on the color of cranberry juice, last between 2 and 7 days, and start and end on time. If it takes on the color and consistency of strawberry jam, or if it appears like mashed blueberries, you are likely experiencing changes in hormone levels.
When to consult a doctor: When the color and consistency of your period changes in any way, if you are pregnant and are experiencing excessive bleeding, or if you have concerns about the amount of blood you are losing during your period.
Spotting Between Periods
Could be a sign of: Pregnancy, ovulation, birth control side effect, low progesterone levels
Spotting between periods is often referred to as “breakthrough bleeding” and is generally caused by certain hormonal birth control medications, especially those that are injectable, implantable, or intra-uterine and designed to minimize or eliminate your period. 4 In fact, it is very common for women to not experience a full period when on these medications and instead, spot periodically. Eventually, the breakthrough bleeding should go away as hormone levels in the body stabilize. 5
On another note, spotting between periods can happen when a fertilized egg implants in the uterine wall. This discharge known as “implantation bleeding” and is usually very light pink or brown, since it takes longer to travel out of the body. It typically happens 6 to 12 days after conception and lasts a few hours or even happens as a single spot.
But the single most common cause for spotting between periods is low progesterone levels. This is especially true if you are over the age of 35. Why this magic number? Between the ages of 35 and 50, women may experience a 75% drop in progesterone levels. 75%! If your body lost 75% of just about anything else, chances are you would be dead. Instead, when progesterone levels drop you start to notice a variety of symptoms, the most obvious of which is spotting between periods.
When to consult a doctor: If you are trying to conceive and are spotting between periods, taking a home pregnancy test a few days after your missed period will show whether your spotting was implantation bleeding or simply a lighter period. If it comes back positive, consult with your doctor to begin prenatal care. If you are on hormonal birth control designed to minimize or eliminate your period, consult your doctor before stopping said medication. Finally, if you suspect you are progesterone deficient, talk to your doctor about performing a simple saliva or blood test to confirm before beginning progesterone treatments with over-the-counter products.
Your Period Is Painful or You Are Experiencing Worsening PMS
Could be a sign of: Hormonal imbalance, Endometriosis, or Fibroids
Most women can tell when their period is coming. They have a headache, mood swings, changes in sleeping or eating habits, or simply don’t feel like themselves. In fact, it is estimated that three out of four women experience Pre Menstrual Syndrome (PMS) in some form 6. But women who are experiencing a hormonal imbalance often notice a worsening of their PMS symptoms. Remember that 75% drop in progesterone levels you experience between 35 and 50? When your body is no longer producing enough progesterone to balance the amount of estrogen, you tend to experience the usual PMS symptoms, but in amplified form. 7 What was once a little headache or a little fatigue is now a full blown migraine with crushing fatigue. Hormonal imbalances can also cause excessive cramping and pain during your period.
But if you are not over the age of 35, it is possible your painful period is due to uterine fibroids or endometriosis. While many women never notice symptoms of fibroids, some notice intense pelvic pain or pressure as the fibroids begin to die. Likewise, the primary symptom of endometriosis is pelvic pain during your period. 8
When to consult a doctor: If you have pain during your period that does not go away after a day, if you are over 35 and suspect you have a progesterone deficiency, or if you are experiencing back pain in addition to pelvic pain, it is time to talk to your doctor.
Your Period Is Irregular
Could be a sign of: Stress, annovulation, peri-menopause, PCOS, thyroid problems
The optimal cycle length is between 25 and 35 days from the first day of your period to the first day of your period the next month. If your cycle is less than 25 days long, chances are you did not ovulate (annovulation). 9 In a healthy menstrual cycle, estrogen is produced in the first half with the highest levels being produced during ovulation. Once ovulation occurs, estrogen levels drop and the follicle that once held the egg begins producing progesterone to allow the egg to be fertilized and implant in a soft uterine lining. If you do not ovulate, progesterone levels do not rise to the level they should and a period begins fewer than 25 days into your menstrual cycle. Estrogen levels also do not decrease they way they should, leaving excess estrogen in the body. This condition is called a Luteal Phase Defect and may have a tremendous impact on your ability to conceive. 10
Polycystic Ovarian Syndrome (PCOS) is an endocrine system disorder where the ovaries are enlarged and contain small, fluid-filled cysts that surround the eggs. The most common symptom of PCOS is actually longer times between periods or fewer than 8 periods in a year. While this may sound like a dream to many of us who dread our periods the way we do dental appointments, fewer periods during the year also mean hormonal imbalances, heavier or longer periods when they do occur, and painful ovulation 11. PCOS has also been linked to depression, high blood pressure, infertility, and cancer of the uterine lining because of the consistently high levels of estrogen in the body.
While PCOS and, in fewer cases, thyroid problems can certainly lead to annovulation, it is more typically caused by stress or peri-menopause. In fact, one study showed that women over 35 tended to have shorter times between periods and 44% of a those women’s periods were annovulatory. 12 Another reason why getting older has been linked to conditions like progesterone deficiency. If you do not ovulate, you tend to become estrogen dominant.
When to consult a doctor: While PCOS can happen later in a woman’s reproductive life, it is usually diagnosed in the first few years after a girl starts her period. Still, it is good to follow up with your doctor any time you experience changes in what is normal for your menstrual cycle.
This all boils down to one simple truth. Pay attention to your period. Sure, we would all like to forget that it actually happens every single month but in actuality, your period can tell you a lot about what else is happening in your body. If you are busy, keep a period journal in a small notebook to track when you experience any mid-cycle cramping (this can be a sign of ovulation) or when your cycle begins and ends (so you can see if you are falling into a pattern within what is considered “normal”). Track when your period begins on your phone’s calendar so you can notice any PMS symptoms and especially keep track of whether your blood falls into the “cranberry juice” category or is more “strawberry jam” or “frozen, mashed blueberries”. Above all else, don’t be afraid to talk to your doctor if you are experiencing anything that seems abnormal to you. While it may seem awkward to discuss the consistency of your period blood or the tenderness in your breasts, your doctor is one of your best resources in diagnosing and preventing more serious complications.
- American Academy of Pediatrics Committee on A, American College of O, Gynecologists Committee on Adolescent Health C, Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics. 2006;118(5):2245-50. ↩
- Amenorrhea Causes – Mayo Clinic . 2016. Amenorrhea Causes – Mayo Clinic . Available at: http://www.mayoclinic.org/diseases-conditions/amenorrhea/basics/causes/con-20031561. ↩
- WebMD. 2016. Menstrual Blood Problems: Clots, Color, and Thickness. Available at: http://www.webmd.com/women/guide/menstrual-blood-problems-clots-color-and-thickness. ↩
- Schrager S. Abnormal uterine bleeding associated with hormonal contraception. Am Fam Physician. 2002;65(10):2073-80. ↩
- a. Delaying your period with birth control pills – Mayo Clinic . 2016. Delaying your period with birth control pills – Mayo Clinic . Available at: http://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/womens-health/art-20044044. ↩
- Biggs WS. Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American Family Physician. 2011. ↩
- Uterine fibroids Symptoms – Mayo Clinic . 2016. Uterine fibroids Symptoms – Mayo Clinic . Available at: http://www.mayoclinic.org/diseases-conditions/uterine-fibroids/basics/symptoms/con-20037901. ↩
- Endometriosis Symptoms – Mayo Clinic . 2016. Endometriosis Symptoms – Mayo Clinic . Available at: http://www.mayoclinic.org/diseases-conditions/endometriosis/basics/symptoms/con-20013968. ↩
- Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012;85(1):35-43. ↩
- Fehring RJ, Schneider M, Raviele K. Variability in the phases of the menstrual cycle. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2006 May-Jun;35(3):376-84. ↩
- Polycystic ovary syndrome (PCOS) Symptoms – Mayo Clinic . 2016. Polycystic ovary syndrome (PCOS) Symptoms – Mayo Clinic . Available at:http://www.mayoclinic.org/diseases-conditions/pcos/basics/symptoms/con-20028841. ↩
- Van Voorhis BJ, Santoro N, Harlow S, Crawford SL, Randolph J. The Relationship of Bleeding Patterns to Daily Reproductive Hormones in Women Approaching Menopause. Obstetrics and gynecology. 2008;112(1):101-108. doi:10.1097/AOG.0b013e31817d452b. ↩