Period Concerns to Discuss With Your Doctor

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I bet you agree that just having your normal period every month is problem enough! But there are changes to your menstrual cycle that should be evaluated by your doctor.

Normal menstruation results from a series of complex processes that must occur precisely each month. From your first period until you reach menopause a normal menstrual cycle comes every 21 to 35 days and lasts for no more than 7 days.

Once you establish regular cycles, which can sometimes take a couple of years after your periods start, you will be able to recognize changes in your menstrual cycle. Everybody's normal cycle is a little different. Sometimes small things can go wrong and trigger dramatic changes in your cycle.

Here are 5 signs that you may need to see your doctor about your menstrual period.

Your Period Is Late

If you are sexually active you should take a pregnancy test even if you are using birth control. Pregnancy is the most common reason for a missed period. If your pregnancy test is negative it is likely that you had an anovulatory cycle.

An anovulatory cycle means that you did not ovulate. If you do not ovulate your ovaries do not produce the hormone changes needed to trigger your period. It is common to have an occasional missed period due to not ovulating. For example, if you are stressed about an exam or starting a new job and not sleeping or eating very well, you may not ovulate. If that happens you will also miss your period. Missing a period here or there is normal and does not need medical attention.

But, if you typically have regular periods and then miss three periods in a row, you should see your doctor. When this happens it is called secondary amenorrhea. Missing three periods in a row is probably a sign of an underlying problem which is continuing to interfere with your body's ability to ovulate. Some possible reasons why you might not be ovulating include:

  • Chronic stress
  • Significant weight loss
  • Significant weight gain
  • Intense and strenuous physical activity

Some very uncommon reasons why you may not be getting your period include:

  • Thyroid disorders
  • Premature ovarian failure

Your Periods Are Irregular

This is different than missing an occasional period or not getting your period at all. You probably had irregular periods when you first started menstruating. This can be completely normal, but after a year or so your periods should start to become regular. If your periods don't become regular within 2 years of starting your menstruation you should talk to your doctor.

Maybe your periods have just become irregular. It can take several months to figure out this pattern. When your periods are irregular the number of days between your periods are usually not the same every month, which means you will skip one or two or even more months in a row between your periods. This will seem strange to you if you have always had regular periods.

The difference between irregular periods and amenorrhea is subtle. In one condition you stop ovulating all together so you don't menstruate. While in the other, you ovulate less frequently so you get your periods irregularly.

In fact, it is possible to miss your period 3 months in a row and then the next month get your period. You would have first been given the diagnosis of secondary amenorrhea but then it would have been changed to irregular periods. Examples of conditions associated with irregular periods include:

You Have More Than One Period a Month

The interesting thing about this is that you really are not having two periods a month. You need to ovulate before you can get your period and you only ovulate once a month at most.

So, what's going on then?

If you are bleeding twice a month you are likely bleeding every two weeks. That means you are still ovulating and getting your normal period once a month. But, then you are having some breakthrough bleeding at the time of ovulation which happens roughly two weeks after your period. This type of bleeding can be caused by hormonal changes and can be common in some types of birth control. Some other causes of breakthrough bleeding include:

  • Stress
  • Endometritis 
  • Uterine fibroids 
  • Uterine polyps

Your Period Lasts Longer Than 7 Days

Having your period for more than 7 days is not normal. Longer period length is usually associated with heavier bleeding as well. This type of problem period can happen gradually over several months with your period becoming longer and maybe heavier each month. This type of bleeding pattern is common with uterine conditions like:

Your Period Is Very Painful

Painful periods can be chronic. And if associated with longer and heavier periods, pain with your period or dysmenorrhea can support the diagnosis of adenomyosis and uterine fibroids.

However, sudden onset of pain with your period is not normal and usually indicates an acute problem. If this happens you should see your doctor right away. Possible causes of sudden and severe pelvic pain during your period include:

  • Pelvic inflammatory disease (PID)
  • Ovarian cyst
  • Ectopic pregnancy
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