For many of us, period cramps are a mild annoyance every few weeks. You might prefer to curl up on the couch with Netflix and brownies, but you can go about your normal day, perhaps with some ibuprofen. But in some cases, painful periods and heavy bleeding may make it almost impossible to go to work or school or enjoy other activities.
We talked with OB-GYN and midlife health specialist Dana Redick, MD, to find out when period cramps could signal a health problem.
What’s Normal: Periods, Adolescence and Aging
Everyone has a different normal, Redick explains. The number of days you bleed varies from woman to woman. Your menstrual cycle can be 25-35 days. Most women experience mild cramps.
Your period also changes as you get older. After your first period, you’ll probably experience cycle variation for a few years. As you get into your late teens and your early 20s, your cycles should become consistent. You’ll learn what’s normal for you.
The average woman enters menopause around age 51. As you get closer, in your late 40s, you may begin skipping periods and experiencing flow irregularity.
When to Talk to Your Doctor about Painful Period Cramps, Period Changes
“If someone plans their life around their periods, that’s not normal,” Redick says. In other words, your period cramps shouldn’t be so bad that they disrupt your everyday activities. And you should be able to address heavy flow with menstrual pads and tampons without worrying about leaks. If you’re soaking more than one large pad per hour, you need to see your doctor.
Additionally, you might see gradual changes in your cycle length and flow as as you age. But you shouldn’t have sudden changes.
Young women with low body mass indexes (BMI) or who exercise intensely might stop having periods. In some cases, the lack of a period is just one symptom of an underlying nutrition issue or eating disorder.
The bottom line is, see your doctor if:
- Your periods are so bad you can’t function.
- You’re soaking more than one large pad per hour.
- You notice any sudden changes.
What Causes Abnormal Periods?
In many cases, Redick says, women either have endometriosis or uterine fibroids.
Uterine fibroids are tumors in the wall of the uterus.
They’re rarely cancerous, although your doctor will want to keep an eye on them. They can cause what Redick calls “bleeding” or “bulk” symptoms, such as:
- Heavy periods
- Bleeding in between periods
- Frequent urination
- Inability to bend over
Every fibroid is a clone of cells that went awry, so they can behave differently depending on where the cell was, Redick explains.
Fibroids shrink and disappear as you enter menopause and your hormone levels decrease. So treatment depends on your age, symptoms and goals — some fibroids affect your ability to get pregnant. In many cases, your doctor may opt to just keep an eye on your fibroids or attempt to minimize symptoms with the hormones in birth control pills or an IUD.
Focused Ultrasound for Fibroids
If contraceptives don’t work, your doctor may try one of several treatments. UVA also can perform minimally-invasive focused ultrasound. Redick compares this to using a magnifying glass to focus sunlight and burn a hole through something. An MRI machine focuses ultrasound energy onto a small area of your fibroid the size of a grain of rice, then moves onto the next spot. Your care team will sedate you, but you’ll be awake and can go home the same day.
However, focused ultrasound won’t work on large fibroids. It also can’t focus through more than three to four centimeters of tissue, meaning most women over 250 pounds aren’t candidates. And because there’s a risk of hitting healthy tissue, doctors won’t do it if the fibroid is near your bowels or the beginning of a nerve.
With endometriosis, menstrual tissue grows outside of the uterus. This causes a lot of pain during and outside of your period.
To treat endometriosis, healthcare providers will first prescribe medication, usually birth control. If that doesn’t work, you may need surgery to get rid of the excess tissue. Surgery is also the only way to definitively diagnose the condition.
After surgery, your doctor may prescribe birth control pills to prevent recurrences. So if you want to get pregnant, doctors recommend trying right after surgery.
Polycystic ovary syndrome (PCOS) is an endocrine disorder where insulin resistance causes your body to overproduce male hormones such as testosterone. Abnormal periods are one symptom: You’ll have eight or fewer periods per year, but when you do, they’ll be really heavy.
Heavy, Painful Periods?
Make an appointment with a Charlottesville OB-GYN.
If you have PCOS, your doctor may recommend diet changes and weight loss. She may also prescribe birth control pills or other medication to manipulate your endocrine system.
Treating Period Problems with Hormones and Contraceptives
Birth control pills and some IUDs provide regular doses of certain hormones, which essentially tell your uterus what to do, Redick says. For example, if you’re experiencing really heavy periods, steady doses of estrogen and progesterone will keep your uterine lining from thickening.
This is why doctors frequently prescribe contraceptives to reduce symptoms of conditions like PCOS and fibroids. They can also help even if your doctor can’t find an underlying cause for your symptoms.
Our bodies do all kinds of weird things. How do you know when to ignore something and when to get to the doctor ASAP? We break down what’s normal and what’s not in our “Is This Normal?” series.