Periods are like snowflakes—you'll never find two exactly alike. Some women have heavy and short periods, some light and long, and others sometimes skip a month. Most of what we know about our menstrual cycles seems to be an average of all our unique flows.
While your period may not follow the average flow—as very few do—it should be close. If you're noticing periods that fall to the extreme, like really heavy periods or no periods at all, you should check in with a doctor. Here, 4 things your period could be telling you:
No Periods
Could be a sign of: Polycystic ovary syndrome, low body fat, thyroid dysfunction, stress
The most common causes of missed periods are obvious: pregnancy or menopause. But if you're too young for menopause and can't possibly be pregnant, missed periods could mean you have problems with your thyroid, have a hormonal imbalance that causes cysts to grow on your ovaries, or are just way too stressed. Another possible cause: your weight. "Someone who is underweight for her height can have no periods because there isn't enough fat on her body," says Rima Mehta, MD, director of gynecology at Pennsylvania Hospital. "Women who are athletes or run 3 to 5 miles a day are sometimes too lean to have a normal period, and my recommendation to them is simple: 'You need a couple of sandwiches.' "
Consult a doctor when: You've been without a period for 3 to 6 months.
Painful Periods
Could be a sign of: Endometriosis, fibroids, vaginal scarring
It's no secret that periods are painful. Every month your uterine muscles contract and release to push blood out—and those contractions mean just about everyone will feel some pain. It's only a problem, according to Mehta, when common medications like ibuprofen or Midol don't help and if you regularly avoid going out with friends or even miss work because of the pain. One of the most common causes of life-interruptingly painful periods, according to Mehta, is endometriosis, a condition that causes the tissue you shed with each period to grow outside your uterus in places like your ovaries, fallopian tubes, and lower abdomen. Endometrial tissue that grows outside your uterus still breaks down and bleeds during each menstrual cycle, but because it has no way out of your body, the tissue builds up and can cause pelvic pain. Although there is no cure for endometriosis, surgery or pelvic floor physical therapy has helped many women manage the discomfort. Scarring from previous surgeries or structural abnormalities in your uterus—usually caused by noncancerous tumors called fibroids—can also make periods painful. In both cases, doctors recommend minimally invasive surgery to remove fibroids and scar tissue.
Consult a doctor when: You've had painful periods for 3 months and can't get relief from over-the-counter pain relievers.
Heavy Periods
Could be a sign of: Fibroids, hemophilia, hormone imbalance, blood thinners
For most women, a period starts out heavy and then tapers off toward the end of the cycle. But "heavy" means you have to change your pad every couple of hours. If you find yourself changing your pad or tampon more than once an hour or if you have a steady flow for more than 7 days, your period crosses the line from "heavy" to "abnormally heavy." And if you're constantly on edge about whether you'll bleed through your pad and end up with an embarrassing bloodstain on your pants, it's considered "extremely heavy," according to Aaron K. Styer, MD, a reproductive endocrinologist at Massachusetts General Hospital Fertility Center and Harvard Medical School. If every period causes you this stress, it could mean you have either too much or too little of one of the hormones that regulate menstruation—estrogen and progesterone—or that you have fibroids (yep, those again). Abnormally heavy periods are also sometimes a side effect of nonhormonal birth control methods like intrauterine devices (IUDs). They can also be a sign of uterine cancer, though that's rare, Styer says.
Consult a doctor when: You're changing multiple pads or tampons every hour, regularly bleeding through your clothes, avoiding spending time with friends or going to work, or getting dizzy, weak, or short of breath.
Infrequent Periods
Could be a sign of: Fibroids, hormonal imbalance, polyps
Aunt Flo doesn't always visit every 28 days. A normal menstrual cycle is anywhere from 21 to 35 days from the start of your period to the start of your next period. It's absolutely normal for women to have as few as nine periods a year, Styer says. Anything fewer than that could indicate you need to see a doctor. If you've noticed a sudden change in your menses, don't worry too much. Even women whose periods come like clockwork will likely miss a month or two at some point, and your period changes as you age, so a "normal" period for you could be something completely different at 40 than it was at 30. Hormone imbalances and fibroids again top the list of reasons periods can be few and far between, but polyps—benign growths on the inner wall of your uterus—can also be to blame. To treat polyps, your doctor might prescribe medications that regulate your hormones and lessen the symptoms, or might remove them through minimally invasive surgery.
Consult a doctor when: You have eight or fewer periods per year, or if your cycle was always regular but you've had no period for 3 months.
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