When to Visit Your Doctor About Your Period

Ann Peters, M.D., MS, is an experienced gynecologist and surgeon in The Gynecology Center at Mercy. Dr. Peters recently responded to questions from Motherly.com, a women's wellness site focusing on pregnancy and parenting, on the topic of when a woman's period may be of medical concern. The following are Dr. Peters' responses:

1. What are the unusual signs of a period flow that can be considered a medical concern?

Period flow can vary from woman to woman. Some women start off with spotting for 1 to 3 days followed by heavier bleeding (aka an actual flow generally 2 to 4 days) which is usually then followed by another 2 to 3 days of lighter bleeding before it stops. Other women will start immediately with heavier bleeding and then have more days of light bleeding or spotting towards the end and nothing in the beginning of their period. Women can vary vastly on the combination of these patterns which can be normal as long as the overall bleeding of one's period stays under 7 days. If the overall flow length is persistently longer than this or women experience bleeding in between periods they should be evaluated. Generally, doctors would recommend evaluation if this is something that has occurred with more than 3 periods in a row. It is not unusual for women to have a "one off' period once in a while, but if there is a persistent abnormal pattern they should be seen. Women should also be seen if their cycle is exceedingly heavy. Generally changing a pad every 2 to 3 hours on the heaviest day of one's cycle is considered normal. If women are requiring more frequent changes or using a pad in combination with tampons, there is generally an underlying cause that should be evaluated.

2. When should someone go to the doctor about their period?

Patients should be seen if their periods last more than 7 days, their bleeding is excessive indicated either by the frequency of pad/tampon or menstrual cup changes or size of clots. They should also visit the doctor if their periods are irregular for more than 3 months.

3. Are blood clots OK? How many/how big would be a concern?

Small blood clots can sometimes occur (dime to quarter sized) on the heavier days and can sometimes be normal, however, presence of blood clots during one's cycle can often be an indication of women having abnormally heavy periods and hence should be evaluated. Clotting is generally the body's response to heavier bleeding as it means the body is trying to activate extra factors and proteins in the blood to help slow down excess bleeding which then manifests in clots. The clots are generally a good thing as it means that the body is trying to counteract extra or dangerous bleeding. It can however signal that their periods are heavier than they should be which is more commonly a sign of an underlying problem with a woman's period (i.e. fibroids, adenomyosis, endometriosis, or uterine polyps being the most common etiologies).

4. How many days does a typical flow last?

Typically less than 7 days.

5. Is it normal to have an irregular cycle?

Irregular periods are not normal. An irregular cycle is anything from the start of one's period to the next period starting less than 21 days or more than 35 days. Periods can vary from person to person and month to month between women but should be within this range. It would not be unusual to fluctuate within a couple of days in this time range (i.e. a woman may have a 26-day cycle one month and then a 30-day cycle the next). However large fluctuations should be investigated (i.e. one month, 21 days, the next 35 days, the next 28 days) as this is more unusual. Skipping periods or cycle length more than 35 days usually indicates that a woman is not ovulating and should be investigated, as it could be an underlying issue such as menopause, premature ovarian failure (i.e. early menopause), polycystic ovarian syndrome (PCOS), or an early pregnancy even with abnormal bleeding.

6. Is it normal to have extreme pain/cramping during a period, or is this a sign you should see a doctor?

It is okay to experience some degree of cramping with one's period and need an occasional ibuprofen, Aleve, or Motrin for pain relief when the flow is the heaviest. However, cramping to the point where you have to constantly use these medications around the clock for multiple days, take time off work/school, or use many ancillary management options like heating pads is generally a sign of abnormal periods and underlying health conditions such as endometriosis, fibroids, or adenomyosis should require an appointment with their physician.

7. Is nausea normal during your period?

Sometimes. However, it can also be a response to pain that women are experiencing and hence a sign of something abnormal. Generally other gastrointestinal symptoms such as painful bowel movements, bloating, nausea, vomiting are signs of more severe conditions with the most common one being endometriosis.

8. Is there anything else you want women to know?

Unfortunately, women are often led to believe that painful periods are normal and "part of being a woman" and often not provide much relief other than being told that they should use over the counter pain medications. When this becomes the norm rather than the exception women should be referred to their gynecologists for treatment options such as medical management with hormonal options and investigation for other more serious conditions such as fibroids, endometriosis and adenomyosis. An ultrasound or MRI may be indicated to investigate further. If surgery is indicated based on the etiologies found, women should be referred to minimally invasive gynecologic surgeons as management of these very common conditions often require more advanced surgical training for more successful management with better treatment outcomes.

Dr. Peters focuses on the evaluation and treatment of a wide range of gynecologic conditions including endometriosis, chronic pelvic pain, uterine bleeding and fibroids. She has specialized training in minimally invasive gynecologic surgery. Her research accomplishments include publications in several major gynecology journals, including the American Journal of Obstetrics and Gynecology and the Journal of Minimally Invasive Gynecology.