As a young woman, have you ever been asked whether you have experienced abnormal menstrual bleeding? You may be wondering–how do I even know if my period is normal or abnormal? When someone asks you if your period is abnormal, what they’re really asking, in simpler terms, is has your period ever happened:
Your doctor may tell you that an irregular cycle once or twice over a period of years is not too concerning. Even so, I think all of us girls can think of a moment in our lives when we were bleeding even though we were not supposed to be. Immediate panic ran through our minds, with each of us asking the question, am I okay? Is the bleeding ever going to stop?
As a young, teenage girl experiencing many bodily changes, you deserve to understand what to expect, what’s normal, and when to seek help. When it comes to abnormal periods, there are two categories to cover:
1. Absent or irregular cycles
2. Heavy or abnormal bleeding
First, let’s cover what is considered normal, and then we’ll cover which warning signs warrant a call to the doctor.
Related: Things Teenage Girls Always Wanted to Know about Gynecology: Painful Periods
What’s Normal for Periods?
A menstrual cycle is counted from the first day of her period until the first day of the next period. For most women, this takes 28 days on average, or about once per month. Anywhere between 23 to 38 days is considered regular.
The bleeding phase of your cycle should last between two to seven days. So that means the day you start your period is day #1 and if you bleed for five days, you’ll have around 23 days without bleeding before your period restarts the cycle.
It is normal for the volume of bleeding to change each day, but a normal amount of bleeding for the full length of a period is about five tablespoons, or 80 mL. This equates to about 10 fully saturated tampons or pads. You should not need to change your tampon or pad more than every two hours (if the reason you’re changing is due to flow volume). On average, if your bleeding is regular, a single pad or tampon should absorb three to five hours worth of blood.
When to be Concerned about Absent or Irregular Period Cycles
If you’re having any of these problems below, call your doctor to make sure there is not an underlying problem.
● You have not had your period in over 3 months
● You have less than six periods per year
● You are older than 15 and have not had your first period
Possible Causes & Treatment of Irregular Cycles
Hormonal imbalances, pregnancy, and being underweight or overweight can all lead to irregular or absent periods. Proper diet, exercise, and stress reduction are some natural ways that can help get your menstrual cycle back on track. If natural adjustments are not effective at regulating your cycle, there are some tests your doctor can run to investigate further.
Some tests can be done if you’re missing your period including:
● Pregnancy test
● Blood tests for hormone levels
● Ultrasound
● MRI
If medication is required, hormonal intervention, such as birth control pills, may help correct an imbalance. Read more about treating irregular periods in our patient education resources:
Absent or Irregular Periods or basic version.
When Heavy Periods Become a Problem
Losing too much blood can be life-threatening. Because women bleed during their menstrual cycle, they are more susceptible to conditions caused by blood loss, such as iron deficiency anemia. Anemia limits the blood’s ability to carry oxygen to cells. Symptoms of anemia include weakness, fatigue, headaches, shortness of breath, dizziness, and pale skin.
Call your doctor if you are concerned about the amount you are bleeding, have any of the signs of anemia, or if you have these menstrual symptoms:
● Periods last longer than 8 days
● Soaking pads or tampons every two hours or less
● Large clots (clumps of blood)
● Spotting between periods
● Periods less than 3 weeks apart
What Causes Heavy Menstrual Bleeding & How to Treat
Heavy bleeding during your menstrual cycle can be caused by several things, including clotting disorders, medications, hormonal imbalances, ovary malfunction, fibroids, and more. To find the cause, your doctor may order diagnostic tests including:
● Blood tests for hormone or iron levels
● Biopsy of uterine tissue
● Ultrasound or hysteroscopy imaging
Treatments will vary depending on the cause. Often, heavy bleeding is managed through hormonal birth control that can help regulate your hormones and menstrual cycles. Other non-hormonal medications can also help reduce bleeding. If the cause is physical, surgical procedures may be necessary, but this is in extreme cases.
For more information on heavy periods or abnormal uterine bleeding, see our patient education resource.
It’s normal for teenage girls to experience some irregular bleeding when they first begin
menstruating. The body usually takes a few months after the first cycle to normalize all on its
own. If you’re concerned after reading about abnormal periods above, there is no harm in
asking a gynecologist if what you’re experiencing is normal or not.
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