Menstrual cycles often bring about a variety of uncomfortable symptoms leading up to your period. Premenstrual syndrome (PMS) encompasses the most common issues, such as mild cramping and fatigue, but the symptoms usually go away when your period begins.
However, other, more serious menstrual problems may also occur. Menstruation that is too heavy or too light, or the complete absence of a cycle, may suggest that there are other issues that are contributing to an abnormal menstrual cycle.
Remember that a “normal” menstrual cycle means something different for every woman. A cycle that’s regular for you may be abnormal for someone else. It’s important to stay in tune with your body and to talk to your doctor if you notice any significant changes to your menstrual cycle.
There are several different menstrual problems that you may experience.
The menstrual cycle is the monthly series of changes a woman’s body goes through in preparation for the possibility of pregnancy. Each month, one of the ovaries releases an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn’t fertilized, the lining of the uterus sheds through the vagina. This is a menstrual period.
PMS occurs one to two weeks before your period begins. Some women experience a range of physical and emotional symptoms. Others experience few symptoms or even none at all. PMS can cause:
- breast soreness
- food cravings
- excessive fatigue
- feelings of stress
- mild stomach cramps
You may experience different symptoms every month, and the severity of these symptoms can also vary. PMS is uncomfortable, but it’s generally not worrisome unless it interferes with your normal activities.
The menstrual cycle, which is counted from the first day of one period to the first day of the next, isn’t the same for every woman. Menstrual flow might occur every 21 to 35 days and last two to seven days. For the first few years after menstruation begins, long cycles are common. However, menstrual cycles tend to shorten and become more regular as you age.
Your menstrual cycle might be regular — about the same length every month — or somewhat irregular, and your period might be light or heavy, painful or pain-free, long or short, and still be considered normal. Within a broad range, “normal” is what’s normal for you.
Keep in mind that use of certain types of contraception, such as extended-cycle birth control pills and intrauterine devices (IUDs), will alter your menstrual cycle. Talk to your health care provider about what to expect.
When you get close to menopause, your cycle might become irregular again. However, because the risk of uterine cancer increases as you age, discuss any irregular bleeding around menopause with your health care provider.
To find out what’s normal for you, start keeping a record of your menstrual cycle on a calendar. Begin by tracking your start date every month for several months in a row to identify the regularity of your periods.
If you’re concerned about your periods, then also make note of the following every month:
- End date: How long does your period typically last? Is it longer or shorter than usual?
- Flow: Record the heaviness of your flow. Does it seem lighter or heavier than usual? How often do you need to change your sanitary protection? Have you passed any blood clots?
- Abnormal bleeding: Are you bleeding in between periods?
- Pain: Describe any pain associated with your period. Does the pain feel worse than usual?
- Other changes: Have you experienced any changes in mood or behavior? Did anything new happen around the time of change in your periods?
Menstrual cycle irregularities can have many different causes, including:
- Pregnancy or breast-feeding: A missed period can be an early sign of pregnancy. Breast-feeding typically delays the return of menstruation after pregnancy.
- Eating disorders, extreme weight loss or excessive exercising: Eating disorders — such as anorexia nervosa — extreme weight loss and increased physical activity can disrupt menstruation.
- Polycystic ovary syndrome (PCOS): Women with this common endocrine system disorder may have irregular periods as well as enlarged ovaries that contain small collections of fluid — called follicles — located in each ovary as seen during an ultrasound exam.
- Premature ovarian failure Premature ovarian failure refers to the loss of normal ovarian function before age 40. Women who have premature ovarian failure — also known as primary ovarian insufficiency — might have irregular or occasional periods for years.
- Pelvic inflammatory disease (PID): This infection of the reproductive organs can cause irregular menstrual bleeding.
- Uterine fibroids: Uterine fibroids are noncancerous growths of the uterus. They can cause heavy menstrual periods and prolonged menstrual periods.
Another common menstrual problem is a heavy period. Also called menorrhagia, heavy periods cause you to bleed more than normal. You may also have your period for longer than the average of five to seven days.
Menorrhagia is mostly caused by imbalances in hormone levels, especially progesterone and estrogen.
Other causes of heavy or irregular menstrual bleeding include:
- vaginal infections
- inflammation of the cervix
- underactive thyroid gland (hypothyroidism)
- noncancerous uterus tumors (fibroids)
- changes in diet or exercise
In some cases, women may not get their period. This is called amenorrhea. Primary amenorrhea is when you don’t get your first period by age 16. This may be caused by an issue with the pituitary gland, a congenital defect of the female reproductive system, or a delay in puberty. Secondary amenorrhea occurs when you stop getting your regular periods for six months or more.
Common causes of primary amenorrhea and secondary amenorrhea in teens include:
- overactive thyroid gland (hyperthyroidism)
- ovarian cysts
- sudden weight gain or loss
- stopping birth control
- premature ovarian failure
- pelvic inflammatory disease (a reproductive infection)
- stopping birth control
Not only can your period be lighter or heavier than normal, but it can also be painful. Cramps are normal during PMS and they also occur when your uterus contracts as your period begins. However, some women experience excruciating pain. Also called dysmenorrhea, extremely painful menstruation is likely linked to an underlying medical problem, such as:
- pelvic inflammatory disease
- abnormal tissue growth outside of the uterus (endometriosis)
The first step in diagnosing menstrual problems is to see your doctor. Your doctor will want to know about your symptoms and for how long you’ve been experiencing them. It may help to come prepared with notes on your menstrual cycle, how regular it is, and any symptoms you have been experiencing. Your doctor can use these notes to help figure out what is abnormal.
In addition to a physical exam, your doctor will likely do a pelvic exam. A pelvic exam allows your doctor to assess your reproductive organs and to determine if your vagina or cervix is inflamed. A Pap smear will also be performed to rule out the possibility of cancer or other underlying conditions.
Blood tests can help determine whether hormonal imbalances are causing your menstrual problems. If you suspect that you may be pregnant, your doctor or nurse practitioner will order a blood or urine pregnancy test during your visit.
Other tests your doctor may use to help diagnose the source of your menstrual problems include:
- endometrial biopsy (used to extract a sample of your uterine lining that can be sent for further analysis)
- hysteroscopy (a small camera is inserted into your uterus to help your doctor find any abnormalities)
- ultrasound (used to produce a picture of your uterus)
The type of treatment will depend on what’s causing the problems with your menstrual cycle. Birth control pills can relieve symptoms of PMS, as well as regulate heavy flows. If a heavier or lighter than normal flow is related to a thyroid or other hormonal disorder, you may experience more regularity once you start hormone replacements.
Dysmenorrhea may be hormone related, but you may also require further medical treatment to address the problem. For example, antibiotics are used to treat pelvic inflammatory disease.
For some women, use of birth control pills can help regulate menstrual cycles. Treatment for any underlying problems, such as an eating disorder, also might help. However, some menstrual irregularities can’t be prevented.
In addition, consult your health care provider if:
- Your periods suddenly stop for more than 90 days — and you’re not pregnant
- Your periods become erratic after having been regular
- You bleed for more than seven days
- You bleed more heavily than usual or soak through more than one pad or tampon every hour or two
- Your periods are less than 21 days or more than 35 days apart
- You bleed between periods
- You develop severe pain during your period
- You suddenly get a fever and feel sick after using tampons
Remember, tracking your menstrual cycle can help you find out what’s normal for you and what isn’t. If you have questions or concerns about your menstrual cycle, talk to your health care provider.