Some women may get their period like clockwork—the same day every month—with no serious cramps or problems. But others aren’t so lucky.
The menstrual cycle can be irregular. It can disappear for months—even when you’re not pregnant. You can have heavy bleeding and severe cramps with it. Or you may experience a range of other symptoms. Here are some of the more common problems.
Absent periods, called amenorrhea, is when your period stops. The most common cause is pregnancy. But there are other reasons you may miss your period.
- Extreme dieting or weight loss can cause missed periods. Girls and women who have anorexia nervosa—an eating disorder where people severely limit their calorie intake—may stop menstruating altogether. The weight loss causes the body to stop releasing estradiol and progesterone so girls and women don’t ovulate or get a period.
- Intense exercise or sports training can also interfere with your menstrual cycle. An athlete’s fat mass may be so low that it may cause the body to think that it is in a state of starvation. That stops the release of hormones that lead to ovulation and a period.
- Extreme stress or use of some drugs, such as corticosteroids, can interfere with your menstrual cycle.
- Women who are approaching menopause often miss periods. This can start in your ‘40s. As women get closer to menopause, their period will stop for longer stretches. A woman is considered in menopause when she hasn’t had her period for 12 months.
- Hormonal disorders such as hypothyroidism, pituitary gland tumors, and polycystic ovary syndrome (PCOS) can also cause missed periods.
What to do
It is important to find out why you’re not having your period and try to treat it. If it lasts too long, you may not be able to get pregnant. In addition, the hormones that are needed for a healthy menstrual cycle also support other areas of your health, like your bones and heart.
If you are sexually active and miss a period, take a home pregnancy test or see your doctor for a blood pregnancy test, which is more accurate.
If you miss two periods and are certain you are not pregnant, see your doctor. They will want to figure out whether the absent periods are caused by problems with your reproductive hormone levels or a different hormonal disorder. You may need to have blood tests to check your hormone levels.
Treatment will be based on the underlying cause. Changing medicines or treating a hormonal disorder can restart your menstrual cycle.
Problems with your period—such as pain, heavy bleeding, or irregular bleeding—are incredibly common. You are not alone! But you should talk to your healthcare provider whenever you have concerns. —Dr. Huma Farid
Menstrual bleeding typically lasts about 4 to 5 days. Though it may look like more, most women lose only about 2 to 3 tablespoons of blood. Heavy periods cause twice as much blood loss or last for more than 7 days.
If you need to change your tampon or pad in less than 2 hours, or you pass large blood clots (the size of a quarter or larger), then you may have a heavy period. You may also have really intense cramps.
Heavy periods are common in girls just starting their periods and in women nearing menopause. But some women may always have heavy periods.
Heavy periods may be caused by other disorders, including:
- Uterine growths, such as fibroids or polyps.
- Adenomyosis (when the endometrium grows in the muscular wall of the uterus).
- Using an intrauterine device (IUD).
- In some women, heavy periods may mean they’re not ovulating regularly. The level of the hormone progesterone is too low to regulate the shedding of the uterine lining, resulting in longer and unpredictable periods.
What to do
See your doctor if you have had several heavy periods. Your doctor will do a pelvic exam and possibly an ultrasound, endometrial biopsy, or other tests to examine your uterus.
See your doctor if you think you may have had a miscarriage. You may need a dilation and curettage (D&C) to remove any remaining tissue in your uterus.
Hormonal birth control is the most common treatment for heavy periods. Fibroids or polyps may need to be removed if they are the cause of the heavy bleeding.
Iron supplements are often recommended for women with heavy bleeding to prevent iron-deficiency anemia. You can also take over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, Aleve) to relieve cramps. (They reduce contractions of the uterus.)
Periods that are fewer than 21 days apart, or more than 35 days apart, are considered irregular. Irregular periods are a normal part of adolescence and of perimenopause (the years before menopause). The hormones that regulate menstruation are more likely to fluctuate during these times.
Some women have irregular periods most of their lives. Others experience changes in their normal patterns because of stress, diet, travel, illness, or exercise.
Irregular periods are not always a sign of a medical problem. Still, they can make you worry and be an inconvenience. You may also have unexpected spotting midway through your cycle and be unprepared when your period does come.
What to do
See your doctor if you have irregular periods. They will do a pelvic examination. They may also run blood tests to check levels of the hormones that regulate menstruation and hormones from the pituitary gland, thyroid gland, and hypothalamus.
Higher-than-normal levels of male hormones, which happen in women with PCOS, can also affect periods. They can also cause excessive hair growth and acne.
Your doctor will treat any underlying disease or hormonal problem. Birth-control pills can also help regulate periods.
Women often think that the only solution for problems with your period is menopause or a hysterectomy—but there are many treatment options that can help. —Dr. Farid
About 80% of women have some cramping during their periods. It is caused by the release of substances called prostaglandins, which trigger painful muscle spasms of the uterus. It’s a normal, although painful, part of your period.
- Cramps in the lower abdomen
- Aching pain in the back or legs
- You may also have diarrhea, constipation, vomiting, headache, or dizziness.
The pain usually begins the day the period starts, and stops by the end of the second or third day. Periods often stop being so painful when a woman reaches her 30s or after pregnancy.
For some women, the pain may be caused by fibroids, pelvic inflammatory disease, or endometriosis. Using a copper IUD can make pain worse in women who already have painful periods.
When there is an underlying issue, the pain may feel different than normal cramps. It may begin after years of not having any cramps.
Some women feel pain during ovulation, halfway through their menstrual cycle. This is called mittelschmerz and is caused by the release of an egg from the ovary.
What to do
See your doctor about any menstrual pain that is severe or that you have not experienced before. They will perform a pelvic examination to look for underlying causes.
You can take NSAIDs like ibuprofen (Advil, Motrin, Aleve) to relieve cramps. Take them when you first feel discomfort. Some women find it helps to start taking them 1 to 2 days before the expected start of their period.
Birth control pills can also help prevent pain by preventing ovulation. They lessen the amount of blood in the endometrium (the lining of the uterus). Periods tend to be lighter and less painful.
Keeping details such as when your period occurs and how many times you changed a tampon, pad or menstrual cup is very important. —Dr. Farid
Premenstrual syndrome (PMS) is a group of symptoms that occur during the time between ovulation and menstruation. This is when the ovaries are making progesterone. Symptoms include bloating, headaches, mood swings, and depression.
At least 75% of women experience one or more of the symptoms of PMS. But about 5% have symptoms severe enough to disrupt their lives and relationships. This is called premenstrual dysmorphic disorder (PMDD).
The exact causes of PMS are not known. Studies suggest that certain brain chemicals (particularly one called gamma-aminobutyric acid, or GABA) respond abnormally to changing sex hormone levels.
- Depression and irritability are the most widely reported psychological symptoms.
- Cravings for sweet or salty foods.
- Bloating in the abdomen and swollen hands or feet.
- Tender breasts.
- Nausea, diarrhea, or other gastrointestinal issues.
- Dental and mouth problems, such as gum inflammation, cold sores, canker sores, and swollen salivary glands.
What to do
Your doctor may ask you to keep track of your period and any symptoms you have.
- Eat smaller meals. Some women find that eating five or six small meals a day helps relieve symptoms.
- Avoid caffeine, nicotine, alcohol, and reduce salty and sweet foods.
- Exercise. Regular exercise can ease mood swings by raising the level of endorphins (brain substances that promote a sense of well-being) and reducing bloating.
- Prescription prostaglandin inhibitors, particularly when started 1 day prior to the start of your period, can help with PMS symptoms.
- For women with PMDD who are experiencing mood swings or depression, antidepressants, taken either right around the menstrual cycle or daily, can help stabilize mood.
- Hormonal birth control can help reduce symptoms of PMS.
- Yoga may help.
- Acupuncture may help.
Home remedies for cramps
These strategies may help:
- Keep warm. Place a heating pad or hot water bottle over your abdomen, sip warm liquids, and take hot baths.
- Elevate your legs slightly (over a pillow) while lying down.
- Lie on one side, in a fetal position, with your knees bent.
- Get a massage or back rub.
- Relax with meditation or slow, deep breathing.
Dr. Huma Farid is an obstetrician/gynecologist at Beth Israel Deaconess Medical Center and an instructor in obstetrics and gynecology at Harvard Medical School. She directs the resident colposcopy clinic and is the rotation director for labor and delivery at BIDMC. Dr. Farid graduated from Harvard Medical School. When not involved in resident education or patient care, she enjoys reading and writing.