Introduction and Summary
Whether you are a teenager just at the beginning of your journey, a young adult starting to think about having children, or a middle-aged woman heading towards menopause, you may experience all kinds of symptoms related to your period. Everyone’s cycle is different, and what is cause for concern for your best friend might be totally normal for you.
This guide will answer all of your period-related questions whether you’re worried about your period being late, you can’t stand the pain of cramps, or you’re so irregular that you can’t ever predict your next period.
The topics I will cover are:
- What Is an Abnormal Period?
- Cramps and Painful Periods
- Heavy Periods
- Irregular Cycles and Late Periods
- When Should I See a Doctor if My Period Is Late and I Am Not Pregnant?
What Is an Abnormal Period?
This is a difficult question to answer, because what is normal for some might be abnormal for others. On average, a period lasts between four and seven days, and occurs every 28 days. But the range of a “normal” cycle is anywhere from 21 to 35 days. Anything that occurs outside of that range could be considered “abnormal.”
Remember that “abnormal” doesn’t necessarily mean dangerous. Some menstrual abnormalities may be temporary or easily treatable.
The following are some of the most common issues that fall into the abnormal period category. The rest of this guide will delve into more details about each of these.
- Dysmenorrhea: This means severe menstrual cramps. Over 50% of women at one time experience this pain. The pain can be caused by your period itself, or due to other underlying causes discussed below.
- Menorrhagia: The most common type of abnormal bleeding and it refers to very heavy and/or prolonged periods.
- Amenorrhea and oligomenorrhea: Amenorrhea means the absence of a period and oligomenorrhea means periods that are light or are infrequent. Both can be causes of late or irregular periods.
Please note that this guide focuses exclusively on menstrual bleeding, and not on spotting and other types of non-menstrual bleeding that occurs between periods. For information on spotting, please click here.
Cramps and Painful Periods
Q: Why Am I in so Much Pain Every Month?
Clinically called dysmenorrhea and commonly known as cramps, there are two main types of dysmenorrhea.
Primary dysmenorrhea refers to cramps that are caused by your period and generally occur with each period. This type of cramping usually beings a day or two before your bleeding starts. Pain is felt in the lower abdomen, back, or even the upper thighs. Cramps usually last 12 to 72 hours. Other common symptoms include nausea, vomiting, fatigue, and diarrhea.
The cramping feeling is caused by uterine contractions. Your uterus contracts, or tightens, throughout your cycle due to a chemical called prostaglandin.
While you are menstruating, it contracts more strongly in order to shed its lining. During contractions, it can press up against blood vessels, which cuts off the oxygen supply to the uterus’ muscle tissue. When that muscle loses oxygen supply, you feel pain.
The level of pain can vary from person to person. Women who have a higher build up of prostaglandins will feel stronger contractions and more pain.
When cramps are caused by a problem in the reproductive organs, it is called secondary dysmenorrhea. This type of cramping tends to begin earlier in the cycle and lasts longer than regular cramps.
There are several conditions that can cause this type of cramping, and most of them require medical intervention:
- Endometriosis: The tissue that is meant to line the inside of the uterus grows outside of the uterus.
- Adenomyosis: The lining of the uterus grows inside the muscle of the uterus.
- Pelvic Inflammatory Disease (PID): A bacterial infection that starts in the uterus and spreads to other organs.
- Cervical Stenosis: A narrowing of the opening to the uterus.
- Fibroids: Benign tumors that grow on the wall of the uterus.
In some cases, period-like pain can be caused by an intrauterine device (IUD)—a copper and plastic device that fits inside the uterus to prevent conception. It has been known to cause period cramps, particularly in the first few months after insertion.
Q: When Will the Pain Go Away?
The answer to this question depends on whether your cramps are due to primary or secondary dysmenorrhea. If they are primary, the pain is likely to start just before you get your period, reach its maximum on the first day of your period, and then decline over the next couple of days.
The good news is that while this pain may start at an early age, when you get your first period, it may become less painful as you age.
If your cramps are due to secondary dysmenorrhea, they will probably begin a few days before your period starts and may last even past the end of your period. Unfortunately, while secondary dysmenorrhea often begins later in life, it does tend to worsen over time, depending on the cause.
Q: How Do I Know if the Pain I Feel Is Normal?
Clearly, no one wants to be in pain ever. But primary period pains are common and are considered normal if the following conditions are met:
- Pain occurs only on the first couple days of your period.
- Pain goes away with medication such as over-the-counter pain medications.
- There is no impact on daily activities.
If, however, you experience any of the following, you will need to see your doctor for further investigation and treatment:
- Painful cramps and heavy bleeding: If your pain is so severe that it disrupts your regular routine and cannot be controlled by over-the-counter (OTC) medicines and/or if you bleed enough to change your tampon or pad every two hours, you may be suffering from uterine fibroids, a benign growth in or on the uterine wall. Fibroids can expand the surface area of the uterine lining causing more intense cramping and bleeding. After an exam, you doctor might order a pelvic ultrasound for further evaluation. A common treatment for the pain associated with your period is birth control pills.
- Constant dull pain: This is a symptom of pelvic inflammatory disorder or PID. This is usually caused by an untreated sexually transmitted disease. A doctor will perform a pelvic exam and send laboratory testing to evaluate for common causes of this infection. This type of infection is treated with antibiotics.
- Severe pain on one side: A possible cause is ovarian torsion Ovarian torsion occurs when the ovary has twisted, cutting off the blood supply to the ovary and fallopian tube. This is an emergency, and treatment requires emergency surgery. Rupturing of ovarian cysts—harmless fluid-filled sacs that develop on the ovaries—can also cause sudden pain on one side. An ultrasound is often used to determine the cause of the pain.
- Cramps that do not respond to medication: If over-the-counter pain meds do not relieve your cramps, they may be caused by endometriosis. Up to 10% of women suffer from this condition in which uterine tissue grows outside of the uterus. Often, hormone treatments are effective in managing endometriosis.
Q: How Can I Treat the Pain of Cramps?
There are a few simple things you can do to ease the pain:
- Take medications such as ibuprofen or acetaminophen
- Use a heating pad
- Avoid caffeine
- Avoid smoking and alcohol
- Massage your lower back and abdomen
- Exercise regularly
If your pain is too strong and none of the above works, you can ask your doctor for stronger pain relief or discuss oral contraceptives, which can also help reduce the pain. In some cases, particularly those having to do with secondary dysmenorrhea, the goal of treatment is often finding and treating the underlying cause of the pain..
Q: Why Is My Period So Heavy?
Also known as menorrhagia, heavy (i.e. filling a pad or a tampon in less than 2 hours) or extended (i.e. lasting for more than a week) menstrual bleeding is usually caused by hormonal issues, certain conditions that impact the uterus, or an assortment of other conditions. The most common causes of heavy menstrual bleeding are:
- Hormonal imbalance: When the hormones estrogen and progesterone are properly balanced, the build-up of the uterine lining is regulated and shed during menstruation. If the hormones are not balanced, the lining may overdevelop and cause heavy bleeding when it sheds. Imbalances can be caused by a number of reasons including polycystic ovary syndrome, obesity, insulin resistance, and thyroid hormone abnormalities.
- Uterine fibroids: As described above, these benign tumors can cause heavy bleeding in addition to cramping.
- Adenomyosis: his condition is characterized by the uterine lining growing within the walls of the uterus and causing heavy bleeding and cramping.
- IUD: Non-hormonal IUDs can be associated with heavy bleeding in some women.
- Cancer: While rare, uterine and cervical cancer can lead to heavy periods and abnormal bleeding in general.
- Medications: Some anti-inflammatory medications, hormonal medications, and anticoagulants can cause heavy menstrual bleeding.
- Other medical conditions: Liver and kidney disease are also associated with heavy menstrual bleeding.
Q: How Do I Know if My Heavy Bleeding is Cause for Concern?
What looks like a lot of blood may not be as much as you think. The average woman loses about 1 ounce (35 ml) of blood during a regular period. Bleeding is only considered excessive and abnormal if it’s over 2.7 ounces (80ml).
You may be wondering, how am I supposed to measure how much blood I am losing? The simplest way is to consider that a fully saturated regular tampon or pad absorbs one teaspoon or 5 ml of blood. If you are completely filling seven tampons or pads during your entire period, you are well within the average range. Up to 16 tampons would still be considered normal. Another good rule of thumb is if you find yourself changing your tampon or pad every 2 hours or less, then you are bleeding heavily.
Despite the clinical definition, that excessive bleeding is more than 2.7 ounces (80 ml), if your life is disrupted by heavy bleeding then you should see a doctor. In addition, if you feel tired, dizzy, light-headed, or find it difficult to concentrate, you may have anemia, or a low blood count, and should speak to your doctor.
Q: What Are the Dangers of Heavy Bleeding?
The most common complication of heavy menstrual bleeding is anemia. When you lose large amounts of blood, you do not have enough red blood cells to carry oxygen to the tissues throughout your body. You may start to feel tired and weak and your skin may be pale. Anemia needs to be treated or it can become serious and even fatal.
Q: How Can I Stop Heavy Period Bleeding?
Treatment for heavy period bleeding depends on the cause of the bleeding as well as other factors including your age, health, medical history, and your reproductive plans (i.e. do you want to have children, are you done having children, etc.). The following are common treatments menorrhagia:
- Iron supplements to help produce more red blood cells to carry oxygen and treat anemia.
- Ibuprofen and naproxen can reduce pain as well as the amount of blood lost.
- Birth control pills which can regulate periods and control the amount of bleeding.
- Antifibrinolytic medicines designed to reduce bleeding by stopping clots from breaking down.
- Dilation and Curettage (D&C): A procedure to remove the top layer of the uterine lining in order to reduce bleeding.
- Hysteroscopy: This involves using a special tool to see inside the uterus and and examine the lining.
- Endometrial ablation or resection: All or part of the uterine lining is removed. After this procedure a woman will not be able to have children.
- Hysterectomy: This is a surgical procedure where your uterus is removed.
Irregular Cycles and Late Periods
Q: What Is Considered an Irregular Cycle?
Every woman’s body and cycle is different and over time you will learn what is normal for you. In general terms, your cycle is irregular if the length of it keeps changing and you cannot predict when your next period will come.
Q: What Causes Irregular Periods?
There are plenty of things that can happen to cause your cycle to get off track (or never get on track to begin with), and most of them are not cause for concern:
- Age: When you are young it can take anywhere from a few months to a year for a pattern to emerge. As you get older and closer to menopause, your period is likely to also become irregular.
- Exercise, diet, and weight: If you make sudden or rapid changes to your exercise regime, nutrition intake, or weight you may find yourself with irregular periods. Once you stop the intense exercise or your body gets used to your new eating habits or new weight, routine will probably reestablish itself.
- Stress: Sometimes stress is the catchall and blamed for just about any ailment or random symptom. And sometimes it truly is the culprit. It can’t hurt to try some relaxation and stress-reducing techniques and see if that impacts your cycle.
- Birth control: Changes to your birth control method can disrupt your cycle, but it should normalize within a couple of months.
Q: When Should I See a Doctor About Irregular Periods?
There is usually no cause for major concern when it comes to irregular periods, but, to be on the safe side, you should check with your doctor if:
- You are under 45 and your period suddenly becomes irregular.
- You get your period more than every 21 days or less than every 35 days.
- Your period lasts for over 7 days.
- There is at least a 20-day difference between your shortest and longest cycles.
Q: How Can I Regulate My Cycle?
There is limited proof of the efficacy of alternative or home remedies for treating irregular periods. Based on anecdotal evidence, the following things may have a positive impact on regulating your cycle.
- Low-fat vegetarian diet
- Increased intake of dairy products
- Increased dosages of vitamins E, B1, and D3
- Consumption of ginger powder
Other common treatments for menstrual irregularity includes oral contraceptives and placement of a hormone-releasing intrauterine device (IUD).
Q: Why Is My Period Late?
A menstrual period is considered late if 5 days have passed since the day you expected your period to begin. A period is considered missed if you have had no bleeding for 6 weeks since the start of your last period.
When it comes to irregular periods, a late period is possibly the most frightening, particularly for women who are not trying to become pregnant. There are many reasons why a period may be late, aside from pregnancy. Some of these are similar to the causes of irregular periods, but are repeated here for those of you who skipped straight to this section.
Please note that this article is not about pregnancy, but if your period is late and you may be pregnant, you should take a pregnancy test or see a doctor.
Here are a couple of quick tips for taking a pregnancy test:
- You can take a test as early as the first day of your missed period, but if you are unsure of that date, you can test from 21 days after you had unprotected sex.
- You can purchase an easy-to-use pregnancy test at any pharmacy. They are also often available at grocery stores and convenience stores. There are many different brands, but all use the same method in which you dip a stick into your urine (either collect your urine in a cup or pee directly on the stick). Within a couple of minutes you will have either a positive or negative result.
- Keep in mind that false positives are rare, but a negative test could mean that you took it too early and you might actually be pregnant. If your period still does not come, test again in a few days.
If your period is late and you are not pregnant, it could be one of these reasons:
- Stress: This can lengthen or shorten your cycle and can even stop menstruation completely. Make sure you find time to relax.
- Sudden weight loss: If you significantly restrict the calories you eat, you could impact the production of hormones needed for your body to ovulate.
- Being overweight: If you are overweight, you may produce too much estrogen which can stop your period or cause it to be late.
- Too much exercise: While exercise is a good thing, if you do it excessively you can impact the hormones that regulate your period. Similarly, if you lose too much body fat, you can also stop ovulating.
- Contraception: The birth control pill sometimes causes a period to be late or missed. Depo provera, a common type of birth control given as an injection every three months, can also result in missed periods.
- Menopause: As you approach menopause, you may start missing periods as your estrogen levels decrease and you ovulate less frequently.
- Polycystic ovary syndrome (PCOS): With this condition, your ovaries contain a large amount of underdeveloped sacs in which eggs should develop. These sacs are not able to release an egg, so ovulation (and thus your period) do not occur.
When Should I See a Doctor if My Period Is Late and I Am Not Pregnant?
If you know you are not pregnant (i.e. have taken a test and it’s negative or you are not sexually active) and you have missed more than three periods in a row, you should see a doctor.
Every woman’s cycle is unique, and it may take some time for you to recognize what is normal for you. There are plenty of reasons why you may have irregular periods or uncomfortable symptoms, most of which are not dangerous or cause concern.
Most women can carry on with their daily routines regardless of what is happening with their menstrual cycle, but if your life is regularly disrupted or you are worried about your symptoms, do not be embarrassed to chat with a doctor. (You can even do it now, on KHealth.)
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