As basically anyone who menstruates knows, certain period problems are just an unfortunate fact of life, like pain radiating through your midsection, a shorter fuse than usual (or other mood changes, take your pick, really), and bleeding more than you would like to be bleeding from your vagina.
On the flip side, some menstrual cycle problems are a clear sign that you should chat about what’s going on with your doctor—just in case—because they fall outside the bounds of what's normally expected during menstruation. Here are some period problems that are worth discussing with a medical expert.
1. You bleed through a pad or tampon in an hour or less, your period lasts longer than seven days, or both.
The medical term for an exceedingly heavy or long period is menorrhagia. (The non-medical term? “Hell on earth,” perhaps?) Menorrhagia affects more than 10 million American women each year, or about one in five, according to the Centers for Disease Control and Prevention (CDC).
These are basically periods that would fit right into a scary movie, but some people don’t even realize this kind of bleeding isn’t normal. “One of the biggest problems is someone being so used to heavy bleeding that she underplays the amount,” Lauren Streicher, M.D., an associate professor of clinical obstetrics and gynecology at Northwestern University Feinberg School of Medicine, tells SELF. “She’ll come in and say her periods aren’t too bad, then say she has to change her tampon every hour.”
One huge sign you may be dealing with menorrhagia: Passing period clots larger than a quarter, according to the CDC. While that’s technically a good sign that your body’s clotting mechanism is trying to prevent you from losing too much blood, it also indicates that you’re still passing much more blood than you should, as SELF previously reported. Even if your clots aren’t that big, soaking through a tampon or pad in an hour or less is a tip-off that your bleeding is too heavy and intense. Bleeding for more than seven days is another period problem that points at menorrhagia, the CDC notes.
Bleeding way too much or for too long is messy and inconvenient, sure, but there’s a bigger issue here. Losing more than the typical two to three tablespoons of blood during your period or bleeding for longer than seven days can lead to anemia, the CDC says. If you have anemia, you don’t have sufficient healthy red blood cells to get oxygen to all your tissues, so you may feel tired and weak, according to the Mayo Clinic.
Speaking of which, menorrhagia can throw a truly huge and annoying wrench into your day-to-day life. People with menorrhagia often can’t take part in their usual activities during their period because there’s so much blood loss and cramping, according to the CDC. If you feel tired, low on energy, or get out of breath because you’ve lost so much blood, see your doctor for evaluation.
Bleeding too much can also be a sign of various health issues, like uterine fibroids, which are non-cancerous growths in and on the uterus that can sometimes cause issues such as pelvic pain and frequent urination. Uterine polyps, which are growths on the inner lining of the uterus, can also cause heavy bleeding, as can cervical polyps, which are lumps that emerge from the cervix. Both types of polyps are typically non-cancerous but, in rare cases, may contain cancer cells.
Polycystic ovary syndrome (PCOS) is another possible heavy-bleeding cause. PCOS is a hormonal disorder that can make your periods last a long time or make them come infrequently; it can also cause excess levels of androgen hormones that result in issues like acne and increased body hair, according to the Mayo Clinic. Unfortunately, excessive bleeding from PCOS can strike after months of an MIA period. This gives your uterine lining a chance to build up over time, leading to an abnormally heavy period when it finally comes, Mary Jane Minkin, M.D., a clinical professor of obstetrics, gynecology, and reproductive sciences at Yale Medical School, tells SELF.
Heavy menstrual bleeding could even be a sign of a disorder that causes you to lose too much blood, like immune thrombocytopenia (ITP). ITP usually comes along with other symptoms like easy and excessive bruising or a rash of reddish-purple dots on a person’s lower legs. ITP can happen to anyone at almost any age, but women are two to three times more likely to develop ITP than men, according to the Mayo Clinic.
Obviously, figuring out what’s causing your heavy bleeding will be tough on your own, so you should see your doctor. They’ll typically ask about your other symptoms and perform exams to determine what exactly is going on, and treatment will depend on what you’re dealing with.
Unbearable pain also falls into the category of menstrual cycle problems that absolutely warrant a chat with your medical provider. Dr. Streicher’s rule of thumb is that if you’re experiencing even an iota of period pain beyond what you’re fine with, it’s too much.
The first step in dealing with period pain is typically to take nonsteroidal anti-inflammatory drugs, since they block hormone-like chemicals known as prostaglandins that cause uterine cramping. If that knocks out your cramps, awesome. If you’re still curled up in the fetal position after a few hours, that’s a sign that talking to a doctor makes sense for you, Dr. Streicher says. You’re likely dealing with severe dysmenorrhea (menstrual cramps), and doctors can help. Dysmenorrhea is the most commonly reported period problem, with more than half of women who get their periods experiencing it for one to two days each month, according to the American College of Obstetricians and Gynecologists (ACOG). There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea is pain that’s due to natural pain-causing chemicals associated with your period. Secondary dysmenorrhea is the result of a disorder in the reproductive system.
Fibroids are a common culprit behind secondary dysmenorrhea. So is endometriosis, a condition many experts think happens when tissue lining the uterus travels outside of it and begins growing on other organs. ( Other experts believe that tissue is actually different in that it can make its own estrogen, which can create painful inflammation in people with endometriosis.) In addition to causing extremely painful periods, endometriosis can lead to painful sex, occasional heavy periods, and infertility, according to the Mayo Clinic.
Adenomyosis, which happens when the endometrial tissue lining the uterus grows into the muscular walls of the organ, can also cause awful menstrual pain, along with expelling big clots during your period and pain during intercourse. You’re most at risk for adenomyosis if you’ve had uterine surgery (like a C-section or fibroid removal) in the past, you’ve given birth before, or you’re middle aged (most cases of adenomyosis happen in women who are in their 40s and 50s, according to the Mayo Clinic).
3. Your period often takes you by complete surprise.
An unexpected period is a classic annoying menstrual cycle problem. Pour one out for all the times you thought you’d have a period-free vacation, only for it to show up right as you hit the beach. Fun! Irregular periods could be due to a number of different things that are (at least somewhat) in your control, like stress and travel, Dr. Streicher says. But they can also happen because of various health conditions.
Take thyroid issues, for example. Hypothyroidism, which is when your thyroid gland in your neck doesn’t produce enough hormones, can lead to an irregular period, according to the Mayo Clinic. It can also cause myriad other symptoms, like heavier than usual periods, fatigue, constipation, dry skin, weight gain, impaired memory, and more. Treatment typically involves taking medication that mimics the thyroid hormone.
On the flip side, hyperthyroidism, which is when your thyroid gland is overactive, can cause light or infrequent menstruation, along with issues like sudden weight loss, rapid heart rate, increased appetite, and more frequent bowel movements, according to the Mayo Clinic.
Irregular periods can also be a sign of premature ovarian failure, which is when a person younger than 40 starts losing their normal ovarian function, according to the Mayo Clinic. Premature ovarian failure can cause menopausal symptoms like hot flashes, night sweats, vaginal dryness, and difficulty conceiving. Doctors can offer estrogen therapy to relieve symptoms like hot flashes (typically in conjunction with progesterone to avoid increasing the risk of cancer if you take estrogen alone). They can also counsel you about the possibility of in vitro fertilization if you’d like to physically conceive and carry children in the future.
PCOS and uterine polyps, which we discussed earlier, could be behind irregular bleeding, too.
4. Your period decides to ghost you for a while.
While it’s true that you can sometimes randomly miss a period for reasons like stress, you shouldn’t just ignore a long-term missing period. Missing at least three menstrual cycles in a row qualifies as amenorrhea, the Mayo Clinic explains, and it’s usually very much worth bringing up to your doctor. (Keep in mind that the use of some hormonal birth control methods—especially the hormonal IUD—can make your period basically disappear. Still, it can be smart to check with your doctor, just in case, when this happens.)
If your period randomly disappears and you have even the smallest chance of being pregnant, first and foremost, you should find out if you are, Alyssa Dweck, M.D., a gynecologist in Westchester, New York, and assistant clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, tells SELF. “Sometimes people miss the obvious,” she notes.
If you’re not pregnant, talking to a doctor can help you make sure there’s not another health issue going on, like PCOS. . Here are a few other things that could be making you miss your period:
Excessive exercise: As Dr. Dweck explains, this can put so much stress on your body that you no longer ovulate regularly or at all. She says she most commonly sees this with athletes like marathon runners, ballet dancers, and gymnasts—but excessive exercise (and/or intense weight loss) can sometimes signal an eating disorder.
Breastfeeding: Some people don’t get their periods back until after they’ve stopped breastfeeding, says Dr. Dweck. “In the first couple months after delivery, your menstrual cycle could be halted because ovulation is suppressed,” she explains. If you’re not nursing exclusively (so, you’re supplementing with formula), it’s more likely that you’ll start ovulating again and get your period. If you’re not ready to get pregnant again, Dr. Dweck highly recommends using some form of birth control, whether it’s a condom, the birth control pill, an IUD, or another method. Talk to your doctor to figure out what makes sense for you.
Stress: Serious stress—caused by things like losing a loved one or a traumatic event like a car accident—can cause a change in your flow, including the loss of your period, notes Dr. Dweck. “This happens at the level of your brain,” she explains. “The signals that usually tell your ovaries it’s time to ovulate and get your period go awry due to the stress you’re under.” Fortunately, the loss of your period is usually temporary under these circumstances. But if your cycle doesn’t return to normal for so long that it’s worrying you, see your doctor to find out if something else is going on.
5. You’re spotting a ton between periods.
The weird thing about spotting is that it’s one of those period problems that can actually be totally normal—to a certain extent. For example, spotting isn’t necessarily worrisome if you’ve just started a new type of birth control, or are pregnant (spotting can actually be totally fine during pregnancy), Dr. Minkin says. But if nothing in your life has changed and you start spotting between periods, it’s time to check in with your doctor.
Oftentimes, something that’s ultimately pretty harmless is causing this menstrual cycle problem, like a benign uterine or cervical polyp that’s prompting you to bleed between periods. But spotting is also a common sign of pelvic inflammatory disease (PID), which happens when sexually transmitted bacteria from infections like chlamydia and gonorrhea spreads to reproductive organs like your uterus, fallopian tubes, and ovaries. In addition, pelvic inflammatory disease can cause issues like fever, strange vaginal discharge that smells bad, and burning when you pee.
If you have PID, your doctor will first address the STI in question with antibiotics, says the CDC, then treat your partner for an STI if necessary. Pelvic inflammatory disease is a leading cause of chronic pelvic pain and infertility in women, so if you suspect you have it, getting quick treatment is of the essence.
More rarely, spotting in between periods can be a sign of cervical cancer, according to the Mayo Clinic. Various strains of human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cervical cancer. (It’s important to note that HPV is very common, and most people with the virus never develop cervical cancer or any other type of cancer.) Symptoms of cervical cancer can include watery, bloody discharge that might have a bad odor and pelvic pain, including during intercourse, according to the Mayo Clinic. Even though this likely isn’t your issue, you’ll want to get checked out, just in case. Treatment for cervical cancer may involve a hysterectomy, radiation, or chemotherapy.
6. You have debilitating mood issues before your period.
When your estrogen and progesterone drop before your period, you may experience the typical mood swings that can come with premenstrual syndrome (PMS). (Bear in mind that this may not be as drastic if you’re using hormonal birth control, which keeps your hormones more stable throughout your cycle.)
But if you deal with severe mood swings, irritability, anger, a lack of enjoyment in things you usually enjoy, and other symptoms that affect your life, you may have premenstrual dysphoric disorder (PMDD). PMDD happens when you experience these symptoms in the week before your period, then they start getting better in the first few days of bleeding, and disappear in the weeks after your period. It’s listed in the DSM-5, the most recent version of the Diagnostic and Statistical Manual of Mental Disorders, for good reason: This psychological issue can be devastating.
“If you suspect you have PMDD, the one thing I would encourage is keeping a daily record of the severity of your symptoms,” Dr. Minkin says. If you notice these symptoms only appearing the week before your period, PMDD might be your issue. If you realize you’re constantly dealing with these symptoms and your period just makes them worse, it could be premenstrual exacerbation, which is another way of saying you have a mental illness like depression that gets worse during your period thanks to hormonal changes.
Either way, talking to a doctor may help. If you have PMDD, your doctor may have you take antidepressants in the timeframe when you usually experience symptoms, then stop once your period starts, Dr. Minkin says. (If you have premenstrual exacerbation, they may recommend staying on the antidepressants through the month and potentially upping your dosage in the week before your period.)
Or your doctor may suggest you go on birth control using a synthetic version of progesterone called drospirenone, Dr. Minkin says, like Yaz and Beyaz. These are FDA-approved to treat PMDD. Though experts aren’t sure why they can be so successful in this arena, it may be because drospirenone reduces a person’s response to hormonal fluctuations. It’s also a diuretic, meaning it can flush out liquids that could otherwise cause fluid retention and contribute to things like bloating.
7. You have excruciating migraines before or during your period.
If migraines were even remotely considerate, they’d at least leave you alone when you’re about to get your period. Unfortunately, period migraines are another issue you can add to the list of common period problems.
It’s not that menstruation will just randomly cause migraines in unsuspecting people who have never had one, but people with a history of migraines may experience them before or during their periods, according to the Mayo Clinic, which adds that this may be due to estrogen fluctuations. “They tend to get the headache right as they go into their periods, and it seems to get better after they have had their menses for a day or two,” Dr. Minkin says.
If you’re dealing with this, your typical migraine medication may work for you. As you probably know if you’ve grappled with migraines, the treatment options are legion. They include pain-relieving medications to relieve symptoms ASAP and preventive drugs to ward off migraines altogether, according to the Mayo Clinic. In the former camp, you have choices like anti-nausea meds and triptans, which constrict swollen blood vessels and block pain pathways in the brain. In the latter, you’ve got meds like tricyclic antidepressants, which affect brain chemicals like serotonin that may be implicated in migraines.
No matter which period problems are affecting you, you don’t have to suffer in silence.
You have no reason to feel embarrassed about your period—or the many period problems that can come with it. Talk of menstrual cycle problems is becoming so much more common because, hey, sometimes they’re just the lot we’re dealt as people with vaginas. Celebrities are out here talking about menstruation) problems, too! Some pad commercials even—gasp—use red “blood,” these days! What a time to be alive.
If you’re having period problems, see your doctor for help. If they aren’t committed to relieving your symptoms, that’s a sign you should try to find a more sympathetic medical professional who can help you find the best treatment.
This article was originally published on SELF