The 4 Most Common Period Problems

What's normal, what's not and when to see a doctor
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The 4 Most Common Period Problems

What’s normal, what’s not and when to see a doctor

-Rachel Grumman

An unhappy woman sitting on her bed

Whether you dread your period or embrace it as part of being a woman, your menstrual cycle can throw you a curve ball now and then thanks to, among other things, breakthrough bleeding and painful cramps. We talked to an expert to help you figure out what’s going on:

Spotting. Although ruining your favorite pair of underwear thanks to spotting is annoying, you can at least rest assured that “the vast majority of times spotting is benign,” says Mary Jane Minkin, M.D., a board certified obstetrician-gynecologist and a clinical professor at Yale University School of Medicine. Breakthrough bleeding (another name for spotting) can occur for a variety of reasons: very low-dose birth control pills (the lower the dose, the higher the risk of spotting); not taking the Pill at your usual time (which causes a dip in hormone levels but not pregnancy protection); ovulation (usually around 14 days pre-period); polyps (small benign growths) in the lining of the uterus; and uterine fibroids (non-cancerous tumors in the uterine lining). In some cases, spotting can be a sign of cervical or uterine cancer.

What to do: If spotting happens once or twice and goes away, it’s most likely nothing to worry about, but if the breakthrough bleeding is persistent, tell your gynecologist and have a pelvic exam. If your low-dose birth control pill is to blame, your doctor can bump you up to a slightly higher-dose Pill. To check for polyps and fibroids and rule out cancer, your doctor may take a closer look by doing a Pap smear and a transvaginal ultrasound (a slender wand is inserted through the vagina to send out sound waves and create an image) or a hysteroscope (a thin, flexible, lighted telescope). If needed, your doctor may also take a tissue sample to test for any abnormalities.

Read Could It Be More Than PMS?

Heavy periods. Having a heavy period is relative – what seems like normal bleeding to one woman can feel like a flood to another – but if you’re soaking through a heavy-duty tampon in a hour or if you have to use a tampon and a pad together, then you genuinely have a heavy flow, says Dr. Minkin. The culprits include a hormonal imbalance, a lack of ovulation, uterine fibroids, polyps or endometriosis (a painful condition in which uterine tissue grows on other organs in the body.) In rare cases, heavy bleeding can be a sign of ovarian, cervical or uterine cancer.

What to do: Your doctor should take a blood sample to check for anemia and do a pelvic exam and a Pap smear to rule out cancerous changes. He or she may also do a transvaginal ultrasound to get a better look of the uterus and take a tissue sample. The progestin in oral contraceptives as well as in the Mirena IUD, which recently received FDA approval for heavy bleeding, can help control your flow. If you need polyps or fibroids removed, your doctor can go over your options.

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