Roughly every month, many women deal with cramps, headaches, bloating, irritability and fatigue — or any combination of these and other symptoms that can occur before a woman’s menstrual cycle. For some, these symptoms are a fact of life, and they’ve never thought of them not existing.
Thanks to the change in hormone levels during your menstrual cycle, certain menstrual symptoms are normal and sometimes inevitable. But there are symptoms you should pay close attention to, which can signal problems related to your period or other aspects of your health.
Each woman’s body is different, leading to a wide variety of how women experience menstruation. However, if you experience these menstrual symptoms, don’t ignore them. Talk to your healthcare provider about what they might mean and how you can find relief.
1. Heavy bleeding
Around every 24 to 38 days, many women begin their menstrual cycle by discarding the buildup of the lining of the uterus. The blood and tissue make their way through the cervix and out the vagina.
But heavy bleeding — or bleeding that lasts more than 8 days or is unusually heavy — isn’t normal.
“You may have heavy menstrual bleeding if you saturate your pad or tampon more than every two hours, or if you frequently have blood clots the size of a quarter or larger,” says Alicia A. Shields, DO, FACOG, a gynecologist at Main Line HealthCare OB/GYN in Blue Bell.
Menorrhagia isn’t just annoying — it can also lead to other health problems, like anemia (when you don’t have enough red blood cells).
Heavy menstrual bleeding can also be a sign of uterine related issues (such as uterine polyps, fibroids, pre-cancer or cancer), peri-menopause, thyroid issues, a blood clotting disorder or other systemic disease. If your bleeding is happening when you aren't expecting your period, this could be the sign of an early pregnancy issue, such as a miscarriage or ectopic pregnancy.
2. Very painful periods
A little pain during your period — called dysmenorrhea — is common. But if your menstrual cycle makes it hard for you to go about your daily routine, there may be something else going on.
Pain from your period occurs when the muscles and blood vessels contract to shed the lining of the uterus. But it can also be a result of other health conditions, such as:
- Endometriosis, which is when the lining of the uterus spreads outside the uterus
- Adenomyosis, which is when the lining of the uterus forms tiny masses of cells, called nodules
- Fibroids, which are growths on the uterine wall
- Problems with the reproductive organs, like the uterus or fallopian tubes, that a woman is born with
- Other health conditions, like urinary disorders or inflammatory conditions of the bowel
3. Irregular or skipped periods
The average menstrual cycle ranges between 24 and 38 days, leaving a lot of room for what’s considered normal. But if your periods are more or less frequent than that — or you skip them completely — that might be a sign to talk to your healthcare provider.
Irregular periods can be a result of:
- Perimenopause, the precursor to menopause, when hormone levels first begin to change
- Hormone conditions, such as thyroid dysfunction, high levels of prolactin and Cushing’s syndrome
- Excessive exercise or a severe lack of nutrition, which can make you not ovulate to save energy
- Birth control, including pills, implants and intrauterine devices (IUDs)
- Certain medications, such as ones that treat mental health conditions and epilepsy
4. Breast tenderness or other changes
Checking for changes in your breasts is an important part of detecting signs of breast cancer as early as possible. But it gets a bit tricky when it comes to your period symptoms.
“As a result of hormone changes, you might experience swelling, tenderness and fullness during your menstrual cycle. Your breasts may also feel more dense and bumpy, especially near the armpit,” says Dr. Shields.
While some changes are expected, it’s important to pay attention to when these changes occur and what they feel like.
For instance, period-related breast changes usually become the most severe just before you get your period. They also get better during or just after your period.
Concerning signs also include:
- A new, changing or unusual lump in your breasts
- A lump that is on just one side
- Nipple discharge
5. Major mood swings
Emotional and mental symptoms of your period can range from feeling irritable to extra tired to depressed. However, if your symptoms are severe, you may have premenstrual dysphoric disorder (PDD).
PDD can cause extreme depression, anxiety and irritability. It can also lead to:
- Panic attacks
- Excessive crying
- A loss of interest in daily activities
- Trouble focusing
- Sleep problems
- Feelings of being out of control
- Thoughts of suicide
Symptoms of PDD usually subside a few days after your period begins.
When menstrual symptoms feel abnormal
Menstrual symptoms that feel concerning or impact your daily routine should never be ignored. Instead of suffering in silence, talk to your healthcare provider. They can help determine the cause of your symptoms by asking questions and doing necessary testing. Your provider can also help you find relief, whether it’s treating the root cause or suggesting other treatments.
It’s always important to listen to your body, whether your concerns are about your menstrual cycle or your health in general. Together, you and your healthcare provider can figure out what’s going on and get the treatment you need.