Periods vary a lot from person to person, and from year to year in the same person. Most changes are harmless. Some are your body's early signal of something that is easy to treat when it is found early, like fibroids, a thyroid problem or anemia, and a few need attention the same day.
This page goes through the period symptoms that are worth a visit, what they can point to, and where to read more.
Bleeding that is heavier than it should be
Heavy menstrual bleeding is one of the most common reasons to see a gynecologist, and one of the most under-reported, because many people assume their normal is everyone's normal. It is worth a visit if you:
- Soak through a pad or tampon every one to two hours for several hours in a row
- Pass clots larger than a quarter
- Bleed for more than seven days
- Need to double up protection, or change it overnight
- Feel tired, short of breath or dizzy during or after your period, which can mean anemia
Common causes include fibroids, polyps, adenomyosis, hormonal changes in the years before menopause, bleeding disorders and some medications. Most are treatable without surgery. Read more about heavy periods in your 30s and 40s and uterine fibroids.
Pain that stops you living your life
Cramping is normal. Pain that makes you miss school or work, that painkillers don't touch, or that is getting worse year by year is not something you have to put up with. It can point to endometriosis, adenomyosis or fibroids, and pain during sex or with bowel movements around your period is a particular clue to endometriosis. Our guide to endometriosis explains how it is diagnosed and treated.
Bleeding between periods or after sex
Spotting between periods, or bleeding after sex, is worth checking even if it is light. Causes range from hormonal contraception (common in the first months of a new method) to cervical inflammation or infection, polyps, and less often changes on the cervix that screening is designed to catch. Keep your Pap and HPV screening up to date, and see a doctor if it keeps happening. See abnormal uterine bleeding and cervicitis.
Cycles that are irregular, or suddenly change
A normal cycle runs roughly every 21 to 35 days. Cycles that are consistently shorter or longer than that, or that were regular and have changed, can point to:
- Polycystic ovary syndrome (PCOS), especially with acne, extra hair growth or weight change — see PCOS
- Thyroid problems
- Perimenopause, usually from the 40s onward
- Stress, significant weight change or intense training
Periods that stop
If your period is late, take a pregnancy test first. If you are not pregnant and your period has stopped for three months (or six months if your cycles were irregular), it is worth an evaluation. Our article on missing periods (amenorrhea) explains the causes and the tests.
Mood changes that take over
Irritability, low mood and anxiety in the week or two before a period are common. When they are severe enough to affect relationships or work, that can be premenstrual dysphoric disorder (PMDD), which is treatable. See PMS and PMDD.
Any bleeding after menopause
Bleeding after you have gone 12 months without a period is never considered normal. It is often from something benign, but it always needs to be checked, promptly.
When to get care the same day
Go to an emergency department, or call us right away, if you have:
- Bleeding so heavy you soak a pad or tampon every hour for more than two hours, or you feel faint or dizzy
- Severe pain on one side of the lower abdomen, especially if you could be pregnant — this can be an ectopic pregnancy
- Fever with pelvic pain or unusual discharge
- Heavy bleeding in pregnancy
What helps at the appointment
Bring a record of your last two or three cycles: start and end dates, how heavy the flow was (how often you changed protection), and any pain or spotting in between. A period-tracking app is fine. Note any medications, including hormonal contraception and blood thinners.
Frequently asked questions
What period symptoms should I not ignore?
Very heavy bleeding (soaking a pad or tampon every one to two hours, or clots larger than a quarter), periods lasting more than seven days, severe pain, bleeding between periods or after sex, cycles that change suddenly, periods that stop, and any bleeding after menopause.
Is it normal for my period to change as I get older?
Some change is normal, especially in the years before menopause, when cycles can become irregular and heavier. New heavy bleeding or bleeding between periods should still be checked rather than put down to age.
When is heavy period bleeding an emergency?
When you soak through a pad or tampon every hour for more than two hours, or feel faint, dizzy or short of breath. Go to an emergency department.
Talk to us
If something about your period has changed, or never felt right, call us at (773) 661-9049 or book an appointment. Our menstrual problems service covers evaluation and treatment.
Medical disclaimer
This article is general information, not medical advice for any individual. If you have very heavy bleeding with dizziness, or severe one-sided pain and could be pregnant, seek emergency care.