We expect our periods to be like considerate guests: arrive on time and leave when expected. Unfortunately, menstruation is not always so predictable. You may get your period a few days early or a few days late, or find that it’s heavier or lighter than usual, or that it suddenly stops, then starts again.
Such minor changes in menstrual flow are usually nothing to worry about. There are, however, instances in which abnormal periods can indicate something serious. Leading gynecologists explain how to know the difference.
* Your period arrives early or late. Did you travel to a different time zone within the past month? Were you sick? Sleep-deprived? Stressed by a family or work crisis? Did you begin a crash diet or rigorous exercise program? Any of these things can interfere with ovulation, delaying or accelerating menstruation, says Heather Johnson, M.D., an obstetrician-gynecologist a Columbia Hospital for Women in Washington, DC, and medical adviser for the National Women’s Health Resource, Center. “Some women are particularly sensitive to lifestyle stresses, whereas others get their periods like clockwork — regardless of how stressful a month they’ve had,” she explains.
If your period is late and especially heavy — and it’s accompanied by severe cramping — you could be having a miscarriage, even though you may not have realized you were pregnant.
Your flow is lighter than normal and/or lasts fewer days. You may not have ovulated. It’s normal to skip ovulation once or twice a year. If an illness or stressful situation (anything from a fight with your husband to a death in the family, depending on your sensitivity) occurs around the time you normally ovulate (usually the fourteenth day of your cycle), your brain may fail to send a signal that triggers the release of an egg. Though you may still have bleeding, it’s likely to be scanty and end sooner than usual. Some women don’t get their period at all.
If you’re pregnant without realizing it, you may have spotting around the time of your period. Consider getting tested if you think it’s a possibility.
* You are regularly irregular. If you can’t predict exactly when your next period will begin, but it usually occurs within four to six weeks of the previous one, it could be that you don’t ovulate in a timely manner. Such a slight irregularity is usually hereditary and nothing to worry about.
If you go more than six weeks between periods, however, you probably have a hormonal problem. Between 5 and 15 percent of menstruating women have polycystic ovarian syndrome, a hormonal imbalance that results in infrequent ovulation (and sometimes obesity and facial hair). See your doctor if you suspect this condition, which is usually genetic.
More uncommon causes of menstrual irregularity include tumors or disorders of the pituitary or adrenal glands, which can interfere with ovulation.
* Your cycle shifts from “like clockwork” to erratic. If you’re in your mid-30s or 40s, you may be entering perimenopause (see “Are Your Periods Ending?”). Thyroid disease can also cause unpredictable periods. An underactive thyroid can lengthen the menstrual cycle — which typically lasts 25 to 32 days — by at least a week, whereas an overactive thyroid can cause periods to come a week sooner, says Alan DeCherney, M.D., chairman of the department of obstetrics and gynecology at the University of California, Los Angeles School of Medicine. An underactive thyroid may also cause heavy periods, as well as weight gain, fatigue, and dry skin. Symptoms of an overactive thyroid include light periods, weight loss, profuse sweating, and heart palpitations.
* Your periods disappear for several months or stop altogether. If you’re over 45, chances are you’ve reached menopause, which means your periods have ended. If you’re under 40 and you’re not pregnant, the cause may be early menopause (see “Are Your Periods Ending?”).
Other causes of vanishing periods: being extremely overweight (it’s not known, however, exactly how obese you must become for menstruation to cease) or underweight (body fat drops below 15 percent of your total weight), says Dr. DeCherney. Obese women have more estrogen-producing fat cells, which can suppress ovulation. Athletes and those with eating disorders, on the other hand, may not produce enough estrogen for ovulation to occur.
* Your flow has become much heavier and/or lasts longer than seven days. Anything from a benign uterine growth to an intrauterine device can cause heavy bleeding, because these things can irritate the uterus, explains Veronica Ravnikar, M.D., professor of obstetrics and gynecology at University of Massachusetts Medical Center in Worcester. Other less common but more serious causes of heavy periods: uterine or cervical Lancer. A pelvic exam and other tests can usually uncover the problem.
* You spot or bleed at other times of the month. Spotting around ovulation is normal. But bleeding that occurs randomly should not be ignored, because it may be a sign of uterine or cervical cancer. More commonly, though, uterine growths like fibroids and polyps cause between-period bleeding — in addition to heavy periods. Certain contraceptives or hormone replacement therapy regimens (see “Drugs That Disrupt Menstruation”) can also cause irregular bleeding, though it tends to be light. interestingly, a cesarean section can also cause spotting (for years). That’s because scar tissue inside the uterus can trap menstrual blood, according to a recent study from Oregon Health Sciences University in Portland.
If you’re spotting, develop sudden pelvic pain, and you think you could be pregnant, contact your doctor immediately. You could be experiencing an ectopic pregnancy, in which a fertilized egg becomes implanted in a fallopian tube, ovary, or the cervix instead of the Uterus.
* You have debilitating cramps during menstruation. Up to 5 percent of women have severe menstrual cramps caused by endometriosis, which is usually diagnosed in the mid-30s. But severe cramps can also be a sign of fibroids or a sexually transmitted disease, Such as pelvic inflammatory disease. Mild menstrual cramps just before or during your period are normal, however.
Heavy and more frequent bleeding (soaking through one tampon or pad in an hour) can be signs of perimenopause, the one to five years preceding menopause. “In the typical woman, the menstrual cycle first shortens from twenty-eight days to twenty-four or twenty-five days,” says Veronica Ravnikar, M.D., professor of obstetrics and gynecology at the University of Massachussets Medical Center in Worcester. This is due to a rise in follicle-stimulating hormone (FSH), which causes an egg to ripen earlier. As FSH levels continue to rise, ovulation is eventually prevented and your periods come further apart, Realize, though, that 20 percent of women stop menstruating without experiencing any unusual periods.