For many of us, getting our periods is such an across-the-board miserable experience that we have a hard time categorizing any period symptoms as unusual. Spend enough years dealing with horrid-yet-"normal" period symptoms, like cramps and exhaustion that leave you laid up in bed for the day, and you'll start believing that any symptom short of your uterus jumping out of your body and delivering a monologue from Twelfth Night is "normal." But "abnormal" period symptoms do exist — and they're signs that your reproductive system is not doing business as usual. They shouldn't be blown off or chalked up to bad luck. As much as you may want to forget about your period's existence the second it is over, if you're experiencing any of the seven symptoms listed below, you should discuss them with your doctor.
While few period symptoms are pleasant — what's up, period diarrhea — most "healthy" period symptoms, like cramps and diarrhea, are caused by prostaglandins, a hormone-like compound our bodies use to signal to our uteruses that it's time to slough off lining. How do uteruses shed lining, when they don't have opposable thumbs, or even access to any kind of basic home improvement materials? They contract. An overabundance of contraction-inducing prostaglandins can lead your uterus to cramp too strongly; the compounds can also travel through the bloodstream to neighboring organs with smooth muscles (like the bowels), causing them to contract, as well. Prostaglandins are also why we sometimes feel nauseous during our periods! Ugh. Great job, prostaglanjerks.
But the issues below signal that something else is going on besides prostaglandins run amok. So if any of the symptoms below sound familiar — like "staring down my calendar and feeling increasing dread as my period draws near" familiar — talk to your doctor.
1. Extremely Heavy Bleeding
Obviously, you know your own flow better than anyone else. But know that in a "normal" period, you'll lose two or three tablespoons worth of blood in total. And a flow that exceeds that amount by a lot can be a sign of problems.
How can you tell if your bleeding is something to be concerned about? Since most of us don't spend our periods with a measuring cup clenched between our thighs, let's discuss this in terms of pads and tampons. According to the Center for Disease Control, if you're soaking through a tampon or pad an hour for more than one hour, you have to wake up in the middle of the night to change your menstrual product, or you get your period for more than seven days straight, you're experiencing abnormal bleeding. A very heavy flow can be a sign of uterine fibroids, thyroid or hormonal disorders, Pelvic Inflammatory Disease, a faulty IUD, or sometimes, even cancer — so getting checked out by a doctor is key.
2. Intense Cramping
Again, cramps can often seem like just another terrible fringe benefit of having a uterus. But if you regularly experience cramps so bad that you have to miss work or school, or that don't seem to be relieved at all by over-the-counter painkillers, you may be dealing with something more serious.
Extremely painful periods can be a symptom of endometriosis, a disorder where uterine lining grows on other areas of your body outside your uterus, including ovaries, fallopian tubes, or even bowels. Painful cramps are usually just one of several symptoms people with endometriosis endure, according to the Mayo Clinic — they often also experience pain during physical intimacy, painful bowel movements, and irregular, non-cycle bleeding. So if this sounds like your symptoms, make a doctor's appointment.
Super-painful periods aren't exclusively a sign of endometriosis, though — the Mayo Clinic reports that they can also be a sign of uterine fibroids, benign growths inside the uterus that can cause pain and discomfort.
The good news is that there are often treatments, from medications to surgery, that can lessen (if not eliminate) your period pain. So don't just feel like you have to white-knuckle it through another month; a medical professional can help you learn more about your options.
Much of the time, spotting — extremely light bleeding, which often occurs between periods — occurs due to being on a low-dose birth control pill or just the hormonal flux of ovulation. However, sometimes spotting can be a sign of uterine or cervical polyps (which are benign, but may cause bleeding after physical intimacy, as well), or pregnancy. In rare cases, it can also be a symptom of cervical or uterine cancer.
So while spotting is likely nothing to be worried about, you may want to bring it up to your doctor so you can figure out what's up. They can help you make sure it's not a sign of any scary health issues, and also recommend some new birth control pills or methods — so that you can feel protected from both accidental pregnancy and accidentally ruining yet another pair of underpants.
4. Large Blood Clots
The occasional tiny blood clot during your period is nothing to get worried about — sometimes, during a particularly heavy flow, the anticoagulants in your body can't keep up with your flow, which leads to small, harmless clots.
However, passing blood clots the size of a quarter or larger during your period can be a sign of a real problem. According to the CDC, large blood clots during your period can be a sign of everything from uterine fibroids, to thyroid disorders, to certain types of cancer. They can also be a sign of miscarriage, ectopic pregnancy or that your body is having a difficult time adjusting to your new IUD.
In short: if you're seeing blood clots on your pad on the regular, you shouldn't have to deal with it on your own. Make an appointment with your OB/GYN, and remember to make note of any other symptoms you're having (unusually heavy periods, etc).
5. Severe Lower Back Pain
Many of us experience some lower back aches during our periods — which is, yet again, a problem caused by prostaglandins (ugh, can't these losers get another hobby besides ruining our lives?). Prostaglandins can cause back pain when they make the uterus to contract too forcefully — this can cut off oxygen supply to some surrounding muscles. Which can end in you lying on your bedroom floor, clutching your heating pad as if it were the last life vest on the Titanic and demanding that someone bring you some waffles.
All of that is, tragically, within the realm of normal. However, it you deal with incapacitating back pain during your period — the kind that keeps you from going to work or class — it can be a sign of endometriosis. Endometriosis sufferers don't only experience back pain while they're menstruating; it can also turn up throughout the month, sometimes paired with abdominal or pelvic pain.
If you're worried you might have endometriosis, you don't have to deal with it on your own — according to the Mayo Clinic, there are a wide variety of treatments available, from surgery to acupuncture. You can get tested for endometriosis by your own gynecologist, or at Planned Parenthood, and develop a plan of action from there.
Intense back pain during your period isn't just a sign of endometriosis, though — per the Mayo Clinic, it can also be a sign of fibroids. So no matter what, be sure to get checked out by a medical professional.
6. Painful Bowel Movements
This is a rarer one, but still serious — if you're experiencing pain while pooping during your period, the Mayo Clinic says it can be a sign of endometriosis. Endometriosis can cause uterine lining to grow on the rectum, appendix, or small bowels. If this happens, it can lead to pain while moving your bowels, and can also cause constipation or frequent diarrhea.
This form of endometriosis is often mistaken for Irritable Bowel Syndrome, or occurs alongside IBS, which can make getting a correct diagnosis confusing or complicated. That's why it's so important to talk to your doctor — and, if you think you've gotten an incomplete or incorrect diagnosis, to seek out a second opinion.
7. Any Major Changes In Your Symptoms
Our periods are so unique — they're like snowflakes! Painful, bloody snowflakes that ruin your jeans and make you spend one day a month swaddled in blankets, watching 20- year-old episodes of The X-Files! That's why the biggest symptom that something is up with your reproductive health (or your health in general) can be when your period symptoms suddenly change.
If your periods used to be very short but now they're very long, get it checked out. If your periods used to be very heavy, but now they're suddenly light, get it checked out. If you went your whole life without really having cramps, but now they're so bad, you have to spend one day a month in bed — tell your gynecologist. It might just be a totally harmless change related to aging or hormonal levels. But it could also be a sign of a major health issue that you're not dealing with it.
So if anything's unusual, go talk to a doctor. You have nothing to lose (except your future painful, awkward, unpleasant periods).
This post was originally published on April 24, 2016. It was updated on June 6, 2019.
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