Is Your Period Normal?

It’s bad enough we have to deal with monthly menstrual cycles, but what happens when we’re stuck with an extra heavy flow? Should we be worried? Find out what’s normal, what’s not, when to see your doctor and how to find relief... If you’re like most women, you’ve experienced heavy or irregular menstrual bleeding. At best, it’s a nuisance, with painful cramps and bloating that make that time of the month much more annoying. At worst, it could be a symptom of a more serious condition, such as endometrosis or fibroids. With a little insight into your own cycle, you can figure out whether heavy bleeding is reason to run to a doctor, or if you should just stay in your “period panties." Know Your Flow Every woman is unique. So to understand what’s abnormal, you first have to know your normal menstrual cycle. Then you can determine why you’re bleeding is heavier than usual. Most periods last 3-7 days and occur every 21-35 days. To measure the length of yours, count from the first day of bleeding to the last during each cycle. To determine its frequency, count from the first day of bleeding in one cycle through the first day of bleeding in the next. Keep track of them in your calendar and eventually you should see a pattern in both numbers. A day or two variation is nothing to worry about, but any bigger differences in cycle length or frequency are reasons to see your doctor, says Colleen Stockdale, M.D., assistant professor of obstetrics & gynecology at the University of Iowa. A normal flow is trickier to measure. What’s heavy to one woman can be light to another. A “heavy flow” is defined as more than 3-4 tablespoons of blood, which obviously is difficult to measure. The Mansfield-Voda-Jorgensen Menstrual Bleeding Scale, created as part of a research project that has been tracking thousands of women’s menstrual cycles for more than 70 years, is a six-point scale that helps accurately determine flow based on the use of pads and tampons: 1. Spotting. A drop or two of blood, not even requiring sanitary protection, though you may prefer to use some. 2. Very Light Bleeding. Needing to change a low-absorbency tampon or pad 1-2 times per day. 3. Light Bleeding. Needing to change a low- or regular-absorbency tampon or pad 2-3 times per day. 4. Moderate Bleeding. Needing to change a regular-absorbency tampon or pad every 3-4 hours. 5. Heavy Bleeding. Needing to change a high-absorbency tampon or pad every 3-4 hours. 6. Very Heavy Bleeding or Gushing. Protection hardly works; you would need to change the highest absorbency tampon or pad every 1-2 hours. If you soak through more than one pad or tampon every hour for 2-3 hours straight, call your doctor or head to an emergency room. But just because your menstrual flow falls into the heavy-bleeding category doesn’t mean that something’s wrong. Some women just have heavier flows than others. Bleeding to Worry About Many problems can cause heavy periods, Stockdale says. Sometimes, it’s simply age, a change in contraception or life-stage that’s to blame. For example, some women who’ve had several children find that their periods get heavier because of structural changes to the uterus that doctors don’t entirely understand. A sudden change in flow is what you need to watch for: If you don’t normally bleed heavily and suddenly start, or if you start bleeding between cycles, see your doctor. It can be a sign of a another problem, says Stephanie McClellan, M.D., founder of the Doctor's Office for Women in Newport Beach, Calif., including: Uterine polyps or fibroids. Both are usually benign growths that occur inside the uterus and cause bleeding. Cervical polyps or precancerous changes to the cells of the cervix. Common sexually transmitted infections (STIs), such as gonorrhea and chlamydia. If left untreated, both can lead to bleeding. A yeast or bacterial infection. Untreated, these vaginal illnesses can cause bleeding. Medical conditions that affect reproductive organs, such as endometriosis (see below). General medical conditions, such as von Willebrand’s disease, a bleeding disorder, and thyroid disease. Obesity, diabetes and hypertension. Women who are overweight or have diabetes or hypertension are at higher risk for uterine hyperplasia – the abnormal thickening of the uterine lining. Cancer. More rare, irregular menstrual bleeding can be the result of cancer. Getting a Diagnosis The first step to determine what's causing heavy bleeding is an exam given by your ob-gyn to check out your anatomy. Your doctor will be able to tell quickly if your uterus is larger than normal or has any lumps or other telltale trouble signs. An ultrasound may be done to check for fibroids or polyps. Also, get tested for anemia, because many women with heavy periods develop it, McClellan says. Anemia leaves you feeling fatigued or even dizzy or light-headed. A blood test can also assess whether there’s thyroid dysfunction causing the symptoms. In cases where cancer is suspected (or if your doctor simply wants to rule it out), you’ll need a biopsy to diagnose cancerous cells in the uterus, cervix or elsewhere. A Different Kind of Pain “Top Chef” host Padma Lakshmi brought a painful – and common – cause of heavy menstrual bleeding into the national spotlight when she shared with Lifescript that she had endometriosis. Endometriosis occurs when the same tissue that normally lines the uterus grows elsewhere in the body, including the ovaries, bladder or bowels. Even though it’s not in the uterus, this tissue still responds to hormones during the menstrual cycle – and thickens monthly just as the uterine lining does. Besides heavy and irregular bleeding, pain is the most common symptom. It results from scar tissue, called adhesions, that forms when the uterine tissue breaks down at the end of the menstrual cycle. Some women experience chronic pelvic pain; others just feel more crampiness than usual during their periods. For some women, having sex or going to the bathroom hurts. Doctors don’t know what causes endometriosis and the condition can go undiagnosed for years. It can strike at any age, although it’s more common in women in their 30s and 40s. Having a family member with endometriosis increases your risk. But many women with no known risk factors develop the disorder. Fortunately, the same treatment options for heavy menstrual bleeding offer help to women with endometriosis. For more information, read Painful Periods? It May Be Endometriosis, and Ending Endometriosis Pain: An Expert Q&A. How to Get Relief from Heavy Bleeding Treatments for heavy menstrual bleeding vary with the cause. If a woman has fibroids, taking the hormone progesterone often shrinks them. Surgery is another option, and it’s often the treatment of choice for cervical polyps, Stockdale says. If your normal periods are heavy, hormone therapy may make them lighter. Stockdale recommends daily progestin therapy or the Mirena IUD (with hormones) for women. For women who want birth control too, she prescribes the mini-pill (progesterone only) or regular oral contraceptives (with estrogen). All contain synthetic progesterone that works to thin the uterine lining and reduce menstrual bleeding. For women who don’t want to take hormones, Lysteda, approved by the Food and Drug Administration in 2009, helps reduce menstrual bleeding with a protein called tranexamic acid to support normal blood clotting. If painful periods are disrupting your quality of life, two outpatient procedures promise relief. Endometrial ablation permanently thins the uterine lining, so it can’t build up to thick levels. Uterine artery ablation blocks blood flow to the uterus. Both procedures may cause cramping and discharge afterward, and isn’t an option for women who want to get pregnant or who have endometriosis, Stockdale says. Talk to a doctor about your options. Cramps? Try This Even if your flow isn’t heavy, you’ve probably had cramps; they’re the result of uterine contractions. Every woman has her favorite remedy. Many head straight for the big bottle of Motrin – for good reason. A 2009 study found that ibuprofen is more effective at easing menstrual pain than acetaminophen, the active ingredient in Tylenol. Here are other tried-and-true natural relief methods: Regular exercise: Get out and get sweaty – even if it’s the last thing you feel like doing. Even a walk around the block will help. Take your vitamins: Calcium, magnesium and zinc supplements have been shown to reduce cramping and common PMS symptoms. Turn up the heat: Take a hot bath or use a heating pad on your lower stomach. Breathe: Stress reduction and relaxation techniques, like yoga, massage therapy and deep breathing exercises, help with all types of pain, and provide extra rest you might be craving during your period too. Make some love: Sexual activity can help with cramps, but you have to reach orgasm to reap the benefits. Don’t forget to lay down a towel first. Dana Demas is a freelance writer and a frequent contributor to Lifescript. Women’s Health: How Much Do You Know? There's no substitute for good health, and when it's gone, it's often gone for good.