Menstrual Cycle Red Flags: When Period Symptoms Mean You Should See a Doctor

What counts as heavy menstrual bleeding, and when is it considered a red flag?

Katie Bernardoni, MD: Heavy menstrual bleeding could be considered any of the following:

• Soaking through a pad or tampon every hour for more than two hours in a row. This kind of rapid blood loss is more than a typical period.
• Bleeding so heavily that you feel lightheaded, dizzy or have even passed out. These symptoms can be a sign that your body is losing more blood than it can comfortably manage.
• Noticing that the bleeding is affecting your daily life. If the amount of bleeding makes it difficult to work, exercise, attend social events or function emotionally, it is worth a conversation with your provider.
• Having menstrual cycles that last more than seven days on a regular basis. Long cycles can sometimes signal an underlying issue.
   

Are large blood clots during my period normal or a sign I should see a doctor?

Katie Bernardoni, MD: Passing clots occasionally, especially on your heaviest flow days, can be completely normal. The size of the clots themselves is not always a reason to worry. What is important to pay attention to is what is happening along with them.

How do I know if my irregular periods are a sign of a bigger issue?

Katie Bernardoni, MD: A period that is a few days early or late once in a while usually is not cause for concern. But if you have had:

• No period at all for more than three months
• A consistently irregular or unpredictable bleeding pattern for three months or longer

that is a good reason to schedule an evaluation.

When is severe menstrual pain more than normal cramping?

Katie Bernardoni, MD: Most women experience some level of cramping, but pain should not stop you in your tracks every month. If your cramps:

• Do not improve with over the counter medications like NSAIDs or acetaminophen
• Are not relieved by heat or rest
• Interfere with your ability to go to work, school or participate in daily activities

then the pain may be more than typical menstrual discomfort. Conditions like endometriosis, fibroids or adenomyosis can cause severe pain, and they are treatable once identified.

What does bleeding between periods mean, and when should I get checked?

Katie Bernardoni, MD: Some women experience a small amount of spotting around the time of ovulation and this can be completely normal. However, if you are having bleeding between periods for more than three months in a row it is important to get evaluated. Persistent spotting or bleeding outside of your regular cycle can be related to hormonal changes, structural changes in the uterus or other causes like endometrial abnormalities. We can help identify what is going on and recommend appropriate treatment.

What symptoms during my period could be signs of a bleeding disorder?

Katie Bernardoni, MD: One of the biggest signs is soaking through a pad or more every hour for longer than two hours. Bleeding disorders are not common, but they can go undiagnosed for years because many women assume heavy bleeding is simply normal for them

When should I talk to a doctor about abnormal period symptoms?

Katie Bernardoni, MD:  You should reach out any time your menstrual symptoms are persistent, concerning or impacting your quality of life. If something does not feel normal for your body, whether it is bleeding, pain, timing or how your cycle is affecting your mood or energy, your doctor wants to hear about it. You do not need to wait for symptoms to become severe before seeking help. Many period related conditions are very treatable and you deserve to feel your best.
 

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