From the time you get your period, you’re tracking it. Gynaecologist Dr Katharine White knows patients who plan sex, their holidays and even their outfits round their cycles – and then sometimes it changes. Before you freak out, here’s what she wants you to know:
Suddenly need to double your usual pads or tampons? If one period is crazily heavy, wait it out, but if a few in a row are, you may have developed a polyp or fibroids in your uterus. This sounds scary, but these benign growths are more of a nuisance than a danger. Or you may be experiencing a hormonal imbalance in your thyroid or pituitary gland – also completely treatable. Your doctor can order blood tests or an ultrasound scan to figure out the cause.
An adult’s cycle can range anywhere from 21 to 35 days (in the teens, up to 45 days). Some women never have regular periods, but if yours are becoming more random – or if you’re suddenly skipping two months (or more) – tell your doctor. The most common cause is polycystic ovarian syndrome (PCOS), which often occurs in your twenties. It’s a complex condition, so a doctor will discuss treatments with you.
Any amount of blood after sex can be scary. If it’s a relatively rare thing, though, you don’t need to worry. Happening often? Head in for a check-up. It could be an infection, such as bacterial vaginosis, a cervical polyp or a sign of an STI.
Birth control is usually the culprit. Breakthrough bleeding is especially common with a new method, but it usually resolves itself on its own: after two to three months on the Pill, or three to six months with an intrauterine device (IUD, also known as the coil). If the bleeding doesn’t improve in that time, talk to your doctor about switching methods. And if you’ve been on the same birth control method for a long time and start spotting, your doctor should know that too – the bleeding could be caused by an infection or a benign growth.
First, take a pregnancy test. But if you’re not pregnant or on a hormonal birth control* method and you’ve gone three months or more without a period, it’s time to be evaluated. (*Occasionally skipping a period is normal – sometimes the hormones do such a good job of thinning out your uterine lining that you don’t bleed at all.) The most common cause in your twenties and thirties is PCOS – early diagnosis is the best way to manage symptoms. In your forties, it could be peri-menopause (the transition to menopause). But if you have an IUD or the contraceptive implant, having your periods stop is common. I tell my patients: enjoy not having to buy tampons.
Stars Daisy Ridley and Lena Dunham have discussed their struggles with endometriosis, a disorder in which tissue that normally grows inside the uterus starts to grow outside it. In the UK, one in ten women of reproductive age suffer from it but, traditionally, “It’s not a condition many women are aware of,” says gynaecologist Dr Jamie Renslo. Thanks to the headlines, though, more women with abnormal bleeding are wondering whether endo is the cause. Heavy periods and spotting are two symptoms, but a better indicator? Your cramps. “The severity of the pain is the distinguishing factor,” says Dr Renslo; endo-associated cramps are usually so intense that they interfere with your quality of life. (Another tell-tale sign is difficulty getting pregnant.) It takes surgery to look for other causes of the symptoms and confirm a diagnosis, so if your doctor suspects you have endo, they may try to treat it first. Various methods of contraception can suppress the growth of uterine lining, which can help to relieve symptoms.