Have you ever wondered ‘are my period symptoms normal’, ‘when should I see a doctor about period cramp pain’, or ‘how much blood is too much period blood’? Let’s break down some of the frequently asked questions about your period medical concerns and when to see a doctor. Note: No one knows your body better than you. If you feel something is abnormal for you, it doesn't hurt to talk with your healthcare provider.
Am I bleeding too much during my period?
The best way to know if your period blood flow is within the “normal” range is by how frequently you need to change your period products. The flow of menstrual blood can vary throughout the day. For example, you may find your flow is heaviest when you wake up, this happens because blood collects stagnantly in the vaginal canal overnight and gushes when you stand up. It’s normal to find your flow heavier after positional changes or with a cough/sneeze.
Consult your health provider when… you consistently need to change your pad/tampon every two hours or less or have a heavy period flow for more than seven days straight. These characteristics fall under a term called menorrhagia which means heavy menstrual bleeding(1). Menorrhagia can occur because of your birth control, hormone related issues, endometriosis, bleeding disorders, fibroids, cysts, polyps, and more.
Should I be concerned with blood clots in my period blood?
Blood clots during your period are generally common. They may present as bright red, dark/purple red, and sometimes even blue/black (learn more about period blood colours here). Clots occur when larger amounts of blood pool in the uterus or vagina and coagulate together to slow the bleeding. If your clots are small and minimally occurring, they aren’t cause for concern.
Consult your health provider when… your period clots are larger than the size of a quarter or if you are experiencing frequent and/or painful clots during your period(2). Frequent, large, or painful clots could be a sign of an underlying health condition such as polyps, fibroids, endometriosis etc. similar to menorrhagia.
Helpful tip: Add your size and frequency of blood clots to your period tracking information to be able to easily share the patterns with your provider.
Should I see my doctor if I miss a period or have irregular periods? What about multiple periods a month?
Periods can be missed/irregular for several reasons, such as:
stress
nutritional changes
new medications
over-exercising
changes in sleep schedules
weight fluctuations
possible pregnancy
Some people just have irregular cycles though, where they may go 40+ days occasionally without a period. As a rule of thumb, one or two missed periods (when pregnancy is ruled out) annually is not cause for concern. Life happens, our bodies can respond to many external changes/factors, and sometimes we may never know why we missed a period.
Consult your health provider when… you are missing three or more periods annually. If you have nine or less periods per year it could indicate that you aren’t ovulating regularly. If ovulation isn’t occurring, it’s important to identify the cause.
Similarly, if you’re experiencing periods more often than every 21 days, consult with your provider with any period medical concerns. Irregular periods can be a result of hormonal imbalances, reproductive conditions, nutritional deficiency, or other underlying conditions that may be a period medical concern for you. There are ways your providers can work with you to get to the root cause and work to regulate your cycle.
How much pain is normal with period cramps?
Many of us are familiar with the aches and pains of menstrual cramps. They occur as our body secretes hormones to contract our uterus, which causes spasms/cramping. It can be difficult to identify if your pain is “normal”, as many of us think we need to live with the level of period pain we experience. Mild to moderate cramping local to the lower abdomen is normal so long as you can still function in your day-to-day life. If heat and pain medications provide good relief for you to still go to school/work, you likely have “normal” amounts of period cramps.
Consult your health provider when… your period pain is radiating to other areas, accompanied by nausea/vomiting, not responding to pain medication, or impacting your ability to go to school/work(3). Extreme period pain can be a sign of hormonal imbalance, endometriosis, cysts, fibroids, and other possible underlying conditions. A regular period does not disrupt your ability to live your life; if it is, talk to your health provider about steps to take to manage your cycle.
Is it normal to bleed between periods?
Many of us will experience spotting between periods sometime in our menstrual life. This breakthrough bleeding may be a result of stress, medication changes, and hormonal fluctuations. Most of the time it’s not a cause for concern, but it is always good to check in and decide what limits are normal with your provider.
Consult your health provider when… you regularly experience vaginal bleeding between periods. Breakthrough bleeding mid menstrual cycle could be a sign of hormonal imbalances, fibroids, cysts, polyps, and other underlying conditions.
If your breakthrough bleeding is accompanied by other symptoms as well such as nausea, pain, or fever, alert your doctor of those correlations. Most of the time it’s not of any origin of concern and may just be a response to medications, birth control, stress, sleep changes, or smoking. Regardless of what you think it may be, it is always important to check in with your health provider to ensure they don’t have any period medical concerns about the breakthrough bleeding(4).
Note from joni: We hope you find these tips helpful in your healthcare journey. Please note this is not medical advice and if you have any concerns at all, please seek the advice of your healthcare provider.
Resources
Heavy menstrual bleeding. (2017, December 20). Retrieved February 18, 2021, from https://www.cdc.gov/ncbddd/blooddisorders/women/menorrhagia.html
Menorrhagia (heavy MENSTRUAL BLEEDING). (2020, July 01). Retrieved February 19, 2021, from https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829
Armour, M., Armour, A., Parry, K., Institute, N., Manohar, N., Health, S., . . . Smith, C. (2019, August 13). The prevalence and academic impact Of dysmenorrhea In 21,573 young women: A systematic review and meta-analysis. Retrieved February 19, 2021, from https://www.liebertpub.com/doi/10.1089/jwh.2018.7615
Team, W. (2020, August 18). Bleeding between periods? How to tell if it's a problem. Retrieved February 19, 2021, from https://health.clevelandclinic.org/when-should-you-worry-about-spotting-between-periods/
About the Author
Victoria Alexander (she/they) is the face behind The Elephant in the Womb, a space centred around reproductive health education and menstruality. Victoria strives to further stand up for inclusive menstrual equity and actively works with local government to achieve LGBTQ+ centred period and pregnancy care options. Read Victoria's full bio here.