Medically reviewed by Dr. Jessica Shepherd
Half the world's population get a period, but the stigma surrounding menstruation leaves many people feeling too ashamed or uncomfortable to talk freely about periods. As a result, symptoms like heavy bleeding may go undiscussed and undiagnosed, potentially causing serious health problems. How can we know what's "normal" if we're too embarrassed to ask?
Understanding that it can be difficult to talk about your menstrual cycle with your best friends — much less a medical professional — we reached out to Dr. Jessica Shepherd, an OB-GYN and women's health expert who is a member of HealthyWomen's Women's Health Advisory Council, with some questions to ask your healthcare provider (HCP) about periods.
What is “normal” bleeding? Is everybody’s “normal” bleeding different?
The average menstrual period lasts around five to seven days and varies in flow. It's usually heavier on days two and three, and then gets lighter over the next few days. It's important to note that everyone's "normal" is a little bit different, though — even if your period only lasts for a couple days every month, it still falls within the normal range.
What causes some girls to develop their period later than others?
This can depend on circumstances like a family history of late periods, too little or too much body fat or a hormonal imbalance. Race may also be a factor — a review of several studies found that white girls tended to start their periods later than Black girls, for example. Certain medical conditions, including polycystic ovary syndrome (PCOS) and problems with the pituitary gland, are also associated with delayed periods.
How can I know if my period is too heavy? When should I contact my HCP?
If bleeding interferes with your daily activities, you find yourself needing to change tampons and/or pads every hour, or your period causes you significant pain, you should contact your HCP. You may be experiencing heavy uterine bleeding (HUB) or another health problem that is causing you to bleed excessively.
What health conditions are related to heavy periods?
Uterine fibroids, endometriosis, obesity and thyroid issues are some of the conditions linked to heavy periods. If you have been diagnosed with any of these conditions and are concerned about heavy bleeding, you should share your concerns with your HCP.
What lifestyle factors or behaviors affect my period?
Some of the lifestyle factors that can affect your period are a lack of physical activity, intense exercise, smoking and drinking alcohol. Both obesity and low body fat are also linked to changes in the menstrual cycle, as is stress. Women who experience chronic or long-term stress may have more severe premenstrual syndrome (PMS) symptoms or irregular periods.
Are there any lifestyle changes I can make to help maintain a healthy, normal period?
Eating healthily and maintaining a body weight that's healthy for you may help regulate your cycle. If your weight is normal but you don't always eat as well as you should, changing the way you eat or taking supplements can fill in nutritional gaps that contribute to period issues. Low levels of vitamin D, for example, have been linked to menstrual disorders.
If your level of physical activity — whether too low or too high — is throwing your cycle out of whack, you'll want to tweak your fitness routine. Finding balance when it comes to exercise may help balance your hormones and regulate your cycle.
Why does your cycle evolve as you age? And what are some changes to expect as I enter perimenopause?
Your hormones regulate your cycle, so the hormonal changes that happen throughout your life can affect your period. This is especially true when you enter perimenopause and begin to experience changes related to the disruption of hormone production.
While lower estrogen levels are responsible for symptoms like night sweats, the decrease in progesterone that happens when women stop ovulating can lead to issues like erratic periods or heavy bleeding. Perimenopause, which typically lasts around four years, can also intensify PMS symptoms like mood swings, anxiety and rage.
Are there certain apps or digital tools that are useful for pelvic health and menstruation?
Period-tracking apps can be very useful for helping you tune into what's going on with your menstrual cycle. Over time, they offer you an opportunity to identify your "normal" when it comes to your period.
Most apps let you track the dates of your period as well as your symptoms, giving you a chance to recognize patterns and plan accordingly. For example, if you know that you often feel nauseated and exhausted around the same time every month, you may not want to schedule anything too taxing at that time.
How can we start — and normalize — the conversation about periods?
It's essential to start the conversation early, well before a girl gets her first period. We should try to shed any feelings of shame that may have been instilled in us by our parents, guardians, teachers or family members, and speak without embarrassment, even if we're feeling a bit nervous or awkward.
When we're open in explaining menstruation and reproductive health, and in answering any questions kids might have, we can foster a healthy dialogue and help to end the stigma surrounding periods.
Why should we be educating boys, along with girls, about periods?
Boys who don't understand the menstrual cycle grow up to be men who don't understand the menstrual cycle, and people tend to feel uncomfortable with things they don't understand. Given that half the world menstruates, it's important that the other half have at least a basic grasp of this normal, healthy biological process.
This resource was created with support from Myovant Sciences.