The Truth About Abnormal Periods

11.25.2020 — Dr. Sherry A. Ross

Every woman’s period is different. Getting to know our bodies is one thing, but familiarizing yourself with your cycle is vital for a myriad of reasons. The main reason being that it’s absolutely necessary to know if your period is normal, to begin with. Certain period symptoms can be hinting at larger health issues and some that need to be addressed ASAP. And then of course there are remedies for treating those uncomfortable PMS symptoms, whether it be at-home or traditional medicine (you know, Frenshe believes there’s a time and place for everything). Ahead, we’ll take a deep dive into everything you need to know about periods and went to address those symptoms you’ve been so curious about!

Normal vs. Abnormal

Most girls will start their menstrual periods around 11 to 14 years old.  You would think once this rite of passage into” teenhood “starts it should come every month, right?  In a perfect world, periods come every 28 days, last 2-3 days and cramps don’t exist, but this may not be your story.  A menstrual period or cycle is counted from the first day of bleeding in one month to the first day of bleeding in the next month or whenever you get that next period.  Irregular periods can be the norm for many lasting a couple of years after your menstrual cycles officially begin.  It may take a few years for your period to become regular.

What’s typical with a menstrual cycle:

  • Age of onset 11-12 ranging from 8 to 14
  • Average frequency 32 days but 21-45 days is considered normal
  • Length 2-7 days
  • Normal blood flow requires 3-6 pads or tampons per day

How to identify an abnormal period:

It can be confusing during your teen years when your periods are coming every 3 to 6 months or once a year.  If you notice that your periods are coming frequently, less than 21 days, or infrequently, greater than 45 days, you should contact your health care provider to discuss reasons why this might be happening.  When your periods come less often they tend to be heavier, last longer, and with more painful cramping.

“When your periods come less often they tend to be heavier, last longer, and with more painful cramping.”

Reasons for irregular periods:

  • Thyroid and other hormonal disorders
  • Peri-menopause and Menopause
  • Polycystic Ovarian Syndrome (PCOS)
  • Excessive Exercising
  • Sudden Weight Changes
  • Physical or Emotional stress
  • Illnesses
  • Pregnancy
  • Sexually Transmitted  Infections (STIs)

You can download a period tracker on your smartphone or use a calendar to keep track of your periods.

No matter what your mom or girlfriends tell you, having monthly periods tells us that you are hormonally balanced.  Whether you call it “Aunt Flo”, “Strings Attached” or “Sharks are Circling”, regular periods are best for you both, physically and emotionally.

Treating Your Menstrual Cycle

In general, a healthy and regular diet doesn’t necessarily affect or regulate your periods. There are dietary and lifestyle changes that will put you in charge of your period instead of your period taking charge of you.

  1. Eat healthy foods including fresh fruits and veggies, proteins-fish, chicken- and complex carbohydrates such as whole grains and brown rice to prevent bloating.
  2. Eat foods that are natural diuretics to reduce bloating and swelling such as celery, cucumbers, watermelon, tomatoes, asparagus, lemon juice, garlic, melon & lettuce.
  3. Exercise is often helpful for many PMS symptoms and cramps experienced during the menstrual cycle.  The feel-good and mood-boosting endorphins and serotonin help ease the pain and stress experienced during certain times of the month.  Walking, jogging, Pilates, yoga, and swimming are excellent choices.
  4. Green tea is a great natural diuretic and can serve as a comforting beverage.
  5. Calcium-rich foods and supplements reduce muscles from cramping.  Ideally, 1,000mg/day of calcium works best.  Dairy products (cheese, yogurt, and milk), sunflower seeds, spinach, soybeans, kale, figs, almonds, sesame seeds, and tofu are excellent sources of calcium.
  6. Drinking water, warm or hot, helps relax the uterine muscles.
  7. Vitamins such as calcium, vitamin E, D, thiamine, magnesium, and omega 3-fish oil may also be helpful in relieving the period bloat and swelling.

Foods and beverages to avoid:

  1. Limit your alcohol consumption during this sensitive time during your menstrual cycle since it makes bloating symptoms worse.
  2. Avoid foods that are classic causes of bloating including beans, broccoli, Brussels sprouts, cabbage, and cauliflower. Other dietary culprits include rich and fatty foods, whole grains, apples, peaches, pears, lettuce, onions, Dietary rituals including many “B” and C vegetables are classic causes of gas and bloating and include beans, broccoli, Brussels sprouts, cabbage, and cauliflower.
  3. Avoid foods high in sodium that contribute to bloating and weight gain such as Chinese and other salty ethnic foods.

Other remedies:

Your grandma’s hot water bottle when applied to the lower abdominal area helps relax tense muscles associated with cramping. Heat is a well-known treatment option for mild cramps. Heat works by relaxing the muscles of the uterus which increases the blood flow and ultimately helps ease the pain.

Acupuncture has long been used for painful medical problems including menstrual cramping and irregular periods. Even though scientific research is limited it’s thought to work by activating your body’s own self-healing mechanism.

CBD is the active ingredient in marijuana that helps make your body feel good, relaxes muscles in the pelvis, and distracts your brain from feeling the pain associated with menstrual cramps.  There are many ways to use CBD products including bath salts, tampons, suppositories, infused chocolates, body balms, and tinctures and they all seem to be effective for mild and moderate cramps. They are safe and harmless products.

NSAID works great for period cramps. The feeling of pain is caused by increased levels of prostaglandins which makes the uterus contract.  NSAID’s block the action of prostaglandins which decrease the pain brought on by period cramps.

Biofeedback is also helpful in treating period cramps. This is a mind-body technique that involves using visual or auditory feedback to gain control over certain bodily functions, such as blood flow.

Massaging muscles and pressure points may help reduce pain, tension, and stress associated with cramping. It doesn’t have a direct effect on uterine muscles but it certainly relaxing and pleasurable. Aromatherapy massage does help with mild menstrual cramps. Lavender oil has been studied to show an anti-inflammatory effect that helps treats mild cramping.

Oral contraception or “the pill” is not only great birth control but makes your menstrual blood less heavy which minimizes your cramps each month.

The progesterone IUD makes your blood flow less or nonexistent also reducing uterine cramping.

Hormonal birth control shortens the length, amount, and flow of period bleeding and relieves menstrual cramps. 

When things become worrisome

Blood is a form of liquid but can turn solid and appear as a clot in certain conditions. If your blood flow is heavy and leaves the uterus quickly blood clots are not usually created.  But if you have a heavy flow and blood leaves the uterus slowly, blood clots develop. Blood clots are not uncommon during a period.  They tend to be dark or bright red in color and come in irregular shapes and sizes. Small clots the size of raisins are usually nothing to worry about and can happen during a heavy blood flow.

Larger and thicker blood clots, greater than the size of a quarter, are reasons to be concerned. Blood clots can develop during a period but are not considered normal if persistent.  Causes of blood clots can be due to a hormonal imbalance, uterine fibroids, uterine polyps, or an abnormal pregnancy. Seeing your healthcare provider who can check your blood for medical conditions and getting a pelvic Ultrasound will be helpful in determining a potential explanation.

Regulating your period if it stops:

There are many reasons a period can just stop on its own if you are not taking the birth control pill or using a progesterone IUD for contraception as a known side effect.  The most common hormonal issues associated with irregular periods where it may stop completely include pregnancy, polycystic ovary syndrome, and thyroid dysfunction—too much or too little.  Other hormonal causes include Cushing’s disease, poor control of diabetes mellitus, premature ovarian failure, and congenital adrenal hyperplasia.

When a women’s period stops the first step is to try and figure out the cause by checking blood tests. Once this is done, it’s often easy to jump-start a period by inducing it with the hormone progesterone.

Working with a health care provider is important when new period changes occur.

Causes of abnormally heavy periods:

Causes of blood clots can be due to a hormonal imbalance, uterine fibroids, uterine polyps, or an abnormal pregnancy. Seeing your healthcare provider who can check your blood for medical conditions and getting a pelvic Ultrasound will be helpful in determining a potential explanation.

When cramps hint at something better

Your uterus is basically one big muscle (the shape of a pear) which starts to contract, causes cramping, that helps the lining of the uterus shed.   This shedding will be your 4 to 6 days of uterine bleeding and is called your menstrual cycle or “period”.  Period cramping can be felt in the lower back or belly.  Cramps tend to be more intense during the first day or two of a period.

Every woman experienced cramps differently.  If you are having heavy periods with large blood clots you will probably experience more intense cramping.  Some women may have light bleeding but still have severe cramps.  Blood flow and volume don’t always correlate with how significant the cramping will be.

For many of us, cramps can be completely debilitating and stop us from doing our daily routine.  For others, cramps are noticeable but not disruptive.  Cramps can be a normal part of the period cycle.

A constant, low-grade pain that is bearable could represent mild cramping that doesn’t respond to typical treatment include a ruptured cyst, a bladder infection, sexually transmitted infections, pregnancy, or endometriosis. All reasons to be worked up by a healthcare provider.

If period cramps don’t respond to typical treatment remedies including ibuprofen, nonsteroidal anti-inflammatory medications, acupuncture, biofeedback, or the birth control pill.

I would be concerned endometriosis was the cause of the pain which doesn’t always respond to traditional treatments.

Changes in bowel movements with periods:

Gastrointestinal havoc is common during your menstrual cycle.  Bloating, nausea, diarrhea, or constipation are the most frequent intestinal symptoms.  The most common bowel change is diarrhea.  It’s thought to be caused by the release of certain chemicals, primarily prostaglandins, and progesterone.  Prostaglandins are also responsible for the cramps experienced during your period.  These disruptive prostaglandins make the intestines and uterus contract causing diarrhea and menstrual cramps the first 3 days of your period. An increase in the hormone progesterone causes bloating, diarrhea, and constipation.

The best way to treat these disruptive symptoms includes eating a healthy, fiber-rich, and colorful diet, exercising regularly, and avoiding caffeine, sugar, salt, dairy, spicy foods, and alcohol.  Adding a probiotic made especially for women helps balance and control the healthy bacteria needed to improve annoying gastrointestinal symptoms. It’s also important to manage stress through relaxing techniques such as mindfulness, yoga, and Tai Chi.   

Everyone experiences that time of the month differently.  Hormonal changes can be more troublesome to some women and not others. A healthy lifestyle and dietary behaviors will definitely control some of these less common and unusual symptoms.

Minimizing PMS Symptoms

Emotional changes including depression, mood swings, irritability, and anxiety are common and normal symptoms associated with PMS. When these emotional changes become disruptive with work or your personal life, the diagnosis of Premenstrual Dysphoric Disorder (PMD) is made.  Medications that treat depression and anxiety are often given to women suffering from this debilitating diagnosis.

It’s best to avoid foods that cause excessive bloating 1 to 2 weeks before your period.  During this time, hormonal changes cause bloating, diarrhea, and constipation so it’s best to avoid foods and beverages that make these symptoms worse.

Dietary rituals including many “B” and C vegetables are classic causes of gas and bloating and include beans, broccoli, Brussels sprouts, cabbage, and cauliflower. Other dietary culprits include rich and fatty foods, whole grains, apples, peaches, pears, lettuce, onions, sugar-free foods containing sorbitol, mannitol, and xylitol are directly associated with this frustrating symptom.  Lactose intolerance commonly affects women and is a frequent cause of bloating. Other lifestyle behaviors include drinking carbonated beverages, overeating, eating too fast, lack of exercise, and drinking alcohol all contributes to bloating.

Foods high in sodium make you contribute to water retention, weight gain and bloating.  These symptoms also increase your risk of depression during this vulnerable time of the month.

When you try without the success of dietary other lifestyle changes, there are scientifically studied herbs that help you get your life back on track.  Herbs including Chasteberry, Passion Flower extract, Royal Jelly, Ashwagandha, and Chromium have been found to combat the most disturbing symptoms including bloating, water retention, mood swings, anxiety, depression, night sweats, and cramps.

Feminine Products

Tampons are a favorite feminine hygiene product. It’s important to get into the routine of regularly changing your tampon to prevent unwanted odors, infections, and any concerns with Toxic Shock Syndrome. Tampons should be changed every 4 to 8 hours.  A tampon should never be left inside the vagina for more than 8 hours.  Women should be in the habit of changing their tampons on a regular basis regardless of how heavy or light their period blood flow.

Sanitary pads should also be changed regularly or every 2 to 4 hours depending on the amount of menstrual bleeding and pad absorption. Once the pad is full or saturated with blood you should change it to a new one. You should feel comfortable and clean when using them during the day and night. Using pads specially made for overnight use, are helpful in making sure you don’t wake up in a bloody mess.

Make sure your choice of tampon purchased is an FDA approved brand with the desired style of applicators that may make insertion easier for the user. Anything put inside the vagina has an expiration date, even tampons, so pay attention.

A menstrual cup is also a natural and environmentally friendly way to collect menstrual blood. Women love the menstrual cup since it can be more comfortable than using a tampon or pad, it saves a lot of money than using tampons and pads, it is great for nighttime blood collecting and can be worn for up to 12 hours.

If you are not vagina friendly you may not be the best candidate for a menstrual cup. If you have irregular periods and are not sure when your period is coming it may be harder to use a menstrual cup.

There are some downsides to using the menstrual cup in that it will make you more prone to yeast, bacterial, and urinary tract infections if left in too long or not properly cleaned.  It’s important that you shop around and see which brand and size is the right fit for your vagina.

Besides bacterial and yeast infections, other concerns about using a menstrual cup include removal can be messy, it may dislodge an IUD and could cause vaginal irritation.

Dr. Sherry A. Ross is a Women’s Health Expert, Lady Parts Co-Host, Author of she-ology the she-quel and founder of she-ology hormonal supplements for women.

Dr. Sherry A. Ross