The taboo around periods and menstruation is still, sadly, a thing. Consider this: When was the last time you, a person with a uterus, loudly announced to your coworkers that you needed a tampon, thanked the person who gave you one, and then wagged it around in your hand en route to the bathroom? Chances are, you discreetly asked your work bestie for one and then rapidly shoved the package into your pocket. Once said menstrual product was in place, you probably tried to forget it—and the fact that you’re having your period—entirely.
But as Allison K. Rodgers, MD, an ob-gyn and endocrinologist with the Fertility Centers of Illinois, tells SELF, if you’re not thinking about your flow, you’re doing your health a huge disservice. “A period is like a fifth vital sign,” she explains. “If someone isn’t getting a period, or it's irregular or painful or heavy, it makes me wonder what’s wrong.”
Plus, as Dr. Rodgers points out, a lot of people don’t even realize they’re overlooking menstruation. “People are overextended with their jobs, families, and obligations. So many of my patients just don’t find it important enough to remember or just don’t realize the importance of a period.”
Here are six major health issues an absent, irregular, or extremely heavy or painful period can reveal (aside from the obvious).
1. You’re super stressed.
While nobody’s cycle looks exactly the same, a generally healthy person will bleed for two to seven days every 21 to 35 days. According to Dr. Rodgers, your period is like the final act of a symphony, one driven by “an orchestra of hormones released from the ovaries and pituitary glands.” Those hormones make your uterine walls thicker so it’s easier for an egg to implant itself and lead to a pregnancy. (We’ll call that the crescendo in this musical analogy.) When there’s no sperm to fertilize the egg, the uterine lining sheds, and voilà! There will be blood!
But, as Dr. Rodgers says, “If there’s something wrong, our body shuts off reproduction because it doesn’t feel like it’s healthy enough to support a pregnancy.”
“Reproduction in the animal world happens when the animal is safe and protected,” Lubna Pal, MD, a professor of obstetrics and gynecology at Yale, tells SELF. “What happens when you stress an animal? Their reproduction shuts down.” She notes that humans are no exception here—when you’re tense, you might feel the effects of that menstrually: Some research on people with uteruses in high-stress jobs found it can result in shorter (and sometimes longer), or completely absent, bleeding. Plus, as SELF has previously reported, stress can also cause sleep issues, bowel problems, hair loss, and an increased risk of heart disease, hypertension, type 2 diabetes, arthritis, and anxiety disorders.
2. You’re exercising too hard.
While anxiety and depression can absolutely stress you (and, by association, your ovaries) out, Dr. Rodgers notes that physical tension can have the same effect, particularly if you have rapidly lost weight or aren’t taking in enough calories. “If you are in a starvation state, you're trying to survive,” Dr. Rodgers says. “In an extreme weight loss situation, your body isn’t going to expend energy that it doesn’t have to to keep you alive. It knows you’re not healthy enough to carry a baby, so your reproductive system shuts off.”
- COVID-19 (Coronavirus)What Does Competing With COVID Do to an Athlete’s Body?
- Irritable Bowel Syndrome (IBS)Everything to Know About Hypnotherapy for IBS, Which Experts Say Is a Legit Treatment
While weight loss is a biggie for missed periods, overtraining can also play a role—all things that really serious athletes might be familiar with. Research has shown that people with uteruses who participate in team or competitive sports—particularly gymnastics—are more likely to have some type of menstrual problem. Naturally, a lot of the young, active folks that Dr. Pal treats tend to see this side effect as a benefit. If you are thinking “Fewer periods? Sign me up!“ keep in mind that halting menstruation entirely can cause problems on its own, including bone loss and cardiovascular disorders, as some studies have shown. “Yes, there’s a convenience, but you’re putting a tremendous amount of stress on the body,” says Dr. Pal.
3. You have a hormonal issue.
Speaking of athletes: When Oludara Adeeyo started missing her period for nearly six months at a time as a teen, her doctors told her she was perfectly fine—she was, after all, physically active. (Cue eye roll.) When she did finally bleed, she “would literally go through a box of extra-heavy period pads with wings in two days.” After doing some blood tests and an ultrasound, other docs diagnosed Adeeyo with polycystic ovarian syndrome (PCOS), a disorder that makes a person overproduce sex hormones called androgens.
Remember that “hormonal orchestra” Dr. Rodgers talked about earlier? When things aren’t in perfect harmony in that department, you start to see periods go awry, she says. “Some people with PCOS will ovulate every 35 to 40 days, and some not at all.” Important to note: PCOS isn’t life-threatening per se, but if you ask someone like Adeeyo, who’s dealt with its frustrating symptoms her whole life—including cystic acne and a weight that’s not normal for her—it can be really emotionally taxing.
4. You’ve got an underlying uterine problem.
Another disorder that can really impact menstruation, particularly the pain that comes with it, per Dr. Pal? Endometriosis, a chronic disease in which tissue similar to the inner lining of a uterus grows outside of it. It can result in infertility, excruciating pain, and bleeding in many parts of your body—even in rare cases, your belly button or eyes. “Painful periods are a hallmark symptom,” she explains. “And as endometriosis evolves, you can have pelvic discomfort not just when you’re about to get a period, but before periods start.”
Dr. Rodgers says that she sees patients with such severe cramping from endometriosis that they can barely do anything during the day, “They might also have pain with intercourse,” she notes.
You might also be dealing with uterine fibroids, which are noncancerous growths in the lining of the uterus. Again, out-of-whack tissue growth seems to factor in. “I think of them like big balls of muscle growing inside the uterus,” Dr. Rodgers says. More often than not, fibroids tend to be paired with heavy bleeding, Dr. Pal says, but “that depends on where the fibroid is, or how many there are.” As SELF previously reported, fibroids can cause you to bleed outside of your normal cycle too.
5. An injury or serious disease is present.
If blood appears in your panties at unexpected times—particularly after sex—there might be a more serious issue at play. “If you have penetrative intercourse and you bleed, you need to see a doctor—there’s really no reason someone should be bleeding then,” Dr. Rodgers says. The problem might be easily treatable (say, a sex toy caused some type of microtrauma), but there’s the possibility of serious stuff like an STI such as chlamydia or pelvic inflammatory disease (which is when a sexually transmitted germ moves from the vagina to the uterus, fallopian tubes, or ovaries) or even cervical cancer.
- COVID-19 (Coronavirus)What Does Competing With COVID Do to an Athlete’s Body?
- Irritable Bowel Syndrome (IBS)Everything to Know About Hypnotherapy for IBS, Which Experts Say Is a Legit Treatment
Granted, these issues aren’t *technically* related to your period—but it’s a prime example of why keeping tabs on your cycle could literally be lifesaving, which was the case for 39-year-old Aisha McClellan. She had always diligently tracked her health, including her menstruation. So when she once bled for 10 minutes straight after sex, she knew something was wrong. Though the docs misdiagnosed her with STIs at first, she ended up learning she had cervical cancer.
6. You’re entering a new phase in life.
If you’re in your 40s (although it could even be earlier or later in some cases) and your periods start getting few and far between (or even more frequent), don’t freak: There’s a chance you’re entering perimenopause. “As women get older, the cycles start to shorten from roughly every 28 days to every 21 days,” Dr. Pal notes.
Of course, wonky periods can be attributed to several things, but importantly, it means *something* is happening in your body that needs attention. And the sooner you can flag it to a medical professional, the better, Dr. Rodgers and Dr. Pal both agree. You might be able to nip an issue in the bud or get on a solid treatment path.
For you to know something is off, however, you have to have a good idea of how your cycle typically behaves. As for tracking, Dr. Rodgers says she gets why people might be hesitant to share their period info in a random app. “They're worried about being prosecuted for things that may happen,” she notes. “I think that there's a lot of care on many apps to keep that information private. That being said, I think you don't need to do anything fancy.” She recommends marking a calendar on your phone, or even a physical one in your bathroom, with info about the length of your cycle, what the bleeding was like on each day, and any other symptoms you might’ve experienced (say, cramps).
And don’t forget your Pap smear, which you should get every three to five years (depending on your age and risk factors) to check for cervical cancer. You should also check in with your ob-gyn regularly for well visits, which you need every year or as recommended by a doc, Dr. Rodgers says. Both tend to be solid ways to get ahead of gynecological problems. “I can’t tell you how many patients come in and tell me they don’t know how often they get a period, or when their last Pap was,” she says. So instead of worrying about what might be wrong with you, just make the appointment: It’s a great first step toward peace of mind.
Related:
