What’s normal and what’s not about your period?

You may not spend much time thinking about your period, other than wondering why it always seems to hit during vacation, but paying attention to the patterns of your menstrual cycle offers a window into your overall health, experts say. Monthly heavy bleeding, for instance, could be caused by fibroids; going for months with no period may mean your hormones are out of whack.

And while an occasional anomaly is normal, changes that persist for three months warrant attention. Here are five period patterns that should send you straight to your OB-GYN for advice.

If you have a very heavy bleeding, you need a new super maxi pad or tampon every two hours and/or you’re passing several clots the size of walnuts daily for about three days.

It probably is an over or under active thyroid, fibroids (non-cancerous growths in the uterus) or benign uterine polyps. Another possibility: adenomyosis, a condition in which uterine endometrial tissue migrates into the muscle wall. If you’ve always had extremely heavy periods, you may have von Willebrand’s disease, a minor bleeding disorder.

Your doctor will likely do a pelvic exam, feeling your uterus for fibroids or other growths. To get a closer look, she may use a hysteroscope, a telescopel-ike instrument inserted through the vagina. And order blood tests to check for a thyroid or bleeding disorder or anaemia.

Treatments, your doctor can remove polyps during an outpatient procedure and medication can regulate an over or under active thyroid. Otherwise, treatment depends largely on how much you’re bothered by the bleeding. For some women with fibroids or a mild case of von Willebrand’s, switching to the pill or the Mirena IUD can reduce bleeding. The progesterone in both decreases menstrual flow by 90 per cent, though it may take a year to see the full effect.

Fibroids that are painful or casing anaemia may warrant a myomectomy (surgery that removes the growths but keeps your uterus intact), endometrial ablation (which uses heat, cold, electrical energy or laser beams to destroy the lining of the uterus) or uterine artery embolisation (blocking of blood flow to the fibroid).

If you have a skipped periods, you haven’t had your period in more than three months.

It probably is perimenopause or the beginning of menopause (if you’re in your mid-40s or older), a hormonal imbalance or pregnancy. A rare possibility is that you have a pituitary tumor (usually benign).

Your doctor will likely order a urine test to check for pregnancy, along with a series of blood test to check hormone levels. If you have high levels of prolactin, which is released by the pituitary gland, an MRI or CT scan can confirm or rule out obvious tumours.
Treatments, if you’re in perimenopause, going on the pill might regulate your cycle. If you have a pituitary tumour, your doctor may treat it with drugs that suppress prolactin or, in rare cases, recommend surgery.

If you have long intervals between bleeding, you regularly go longer than 35 days between periods.

It probably is polycystic ovarian syndrome (PCOS), a disorder that affects up to 7 per cent of pre-menopausal women. It occurs when the ovaries make excess testosterone, so you ovulate irregularly or not at all. Other signs are acne, excessive facial or body hair growth and weight gain. In addition, women with PCOS produce too much insulin, putting them at higher risk of diabetes, heart attack and stroke.

Sometimes, the case is a thyroid abnormality or hyperprolactinemia, where the pituitary gland releases excessive prolactin (the hormone that stimulates breast milk production).

Your doctor will likely do blood tests for hormone levels, (thyroid hormone, oestrogen, progesterone, testosterone and prolactin) and fasting glucose (blood-sugar) levels. If PCOS is suspected, you may need an ultrasound to look for ovarian cysts.

Treatments, oral contraceptives can normalize your periods and minimize other symptoms in women with PCOS. Losing weight, exercising regularly and possibly taking an insulin-sensitizing drug (like metformin) can also help manage the condition. If excess prolactin is the problem, taking a medication (such as bromocriptine) can suppress the hormone’s production.

If you have a frequent bleeding, your period arrives every 20 days or more often or lasts longer than a week.

It probably is a thyroid abnormality, fibroids or an anovulatory problem (where you bleed but don’t ovulate), possibly triggered by PCOS. Inflammation of the cervix or uterus, both of which can be prompted by a bacterial infection, is another possible cause.

Your doctor will likely do a pelvic exam, order blood tests to see if you’re ovulating and check your testosterone and thyroid levels.

Treatments, thyroid medication if necessary. Losing weight or beginning to take oral contraceptives can help PCOS and will usually lead to a more regular cycle in a few months. Antibiotics will cure a bacterial infection.

If you have a spotting between periods, you are bleeding lightly and intermittently between periods.

It probably is the result of skipping a dose of your birth-control pill or not taking it at the same time every day. Another possibility is that you’re taking a medication that decreases the pill’s effectiveness (the list is long; check with your doctor before going on a new drug). Not on the pill? In addition, some women have breakthrough bleeding mid-cycle when ovulation occurs. Light spotting in the week before your period could signal a luteal phase defect, meaning that your progesterone levels are too low during the second half of your cycle. If bleeding only occurs after sex, it could be an infection, cervical polyps or warts or cervical cancer.

Your doctor will likely do a pelvic exam to look for polyps and a Pap smear to test for cervical abnormalities, including warts. She also may test you for other sexually transmitted diseases. An endometrial biopsy may detect a luteal phase defect. To get a closer look at your cervix, she may perform a colposcopy (a visual inspection of the cervix with a small viewing instrument).

Treatments, a quick, outpatient surgical procedure can remove polyps; antibiotics can clear up some STDs. If you have pre-cancer of cervix, treatment depends on how far it has progressed. Your doctor might watch it, freeze it or remove the outer area of the cervix with a cone biopsy, which can be done with a laser. A luteal phase defect can be treated with vaginal progesterone or fertility drugs.