Understanding normal versus abnormal periods

Anna Baur, MD, is a board-certified obstetrician and gynecologist with Commonwealth OB/GYN Specialists in Richmond, Virginia. She is an expert in diagnosing and managing a wide range of obstetrical and gynecological conditions, including treatment options for abnormal periods.

What is considered a normal period?

A normal period, or menstrual cycle, occurs approximately every 28 days, and lasts about five to seven days. That being said, periods may be irregular in frequency and length for girls and women in different stages of their lives. Depending on their age and circumstances, abnormal periods have a number of different causes and potential solutions.

Dr. Baur explains, “A tween or teen who just started menstruating might have irregular periods for two or three years before they even out. A woman who recently gave birth might expect longer or heavier periods for several months, and it is very common for a woman in perimenopause to have less frequent periods.”

What is considered a normal versus abnormal period for a tween or teen?

While it is normal for tweens and teens to have irregularities in their menstrual cycle, there are some conditions that may call for medical intervention. If a period is so heavy or painful that it interferes with the ability to attend school, or if it regularly lasts longer than a week, a gynecologist can test hormone levels and provide solutions to help regulate estrogen and progesterone levels.

Hormone testing helps discern if there is an immature hypothalamic-pituitary-ovarian (HPO) axis, which connects the brain to the ovaries, causing the irregularities. More rarely, Von Willebrand disease (VWD), a hereditary blood clotting disorder, may be to blame. Treatment options for tweens or teens with heavy periods often include birth control pills or tranexamic acid (TXA) tablets to help improve blood clotting.

Likewise, if a girl has not started her period by the age of fourteen or fifteen, a consultation with a gynecologist will help determine if there is any cause for concern.

What is considered a normal versus abnormal period for a postpartum woman?

For women who recently gave birth and are breastfeeding, the absence of a period for several months, known as lactational amenorrhea, is common. Women typically have a period six to 12 weeks after birth if they are not breastfeeding or six to 12 weeks after weaning their baby.

The menstrual cycle often is heavier and longer after having a child. If it is extremely heavy, a gynecologist will check to ensure that a piece of the placenta was not retained in the uterus. In that case, a dilation and curettage (D&C) procedure may be necessary. Other solutions for postpartum women with heavy periods include regulating hormones with birth control pills, intrauterine devices (IUDs), or implantable birth control.

According to Dr. Baur, “It is important for women to understand that even while breastfeeding, they will ovulate before having their first postpartum period. Before having sexual intercourse, they should discuss birth control options with their gynecologist. It is usually recommended that women wait at least 12 months between pregnancies.”

What is considered a normal versus abnormal period for a perimenopausal woman?

In a normal menstrual cycle, ovulation is a key part of the body’s signal to have a period if a woman is not pregnant. In perimenopause, as the ovaries have fewer eggs to release, intermittently missing ovulation can lead to less frequent cycles. The average age of menopause is 51, but periods may begin to space out or become irregular for years prior. Menopause is officially diagnosed when a woman has not had a period for at least a year.

During perimenopause, the ovaries produce less estrogen and may not release an egg every month. The time between cycles may increase or decrease, the length of the period may be shorter or longer, and bleeding may be heavier or lighter. “Bleeding between cycles is more worrisome than cycles that are spread further apart,” says Dr. Baur. Potential causes of abnormal bleeding include the hormonal changes noted above, a possible pre-cancerous polyp in the uterine lining, or uterine cancer, among others. A simple ultrasound and a tissue biopsy from the lining of the uterus will help determine the cause of the bleeding and what, if any, course of action is needed.

What causes abnormal menstrual bleeding?

People at risk of abnormal periods are defined as:

• Having periods that last longer than seven days.
• Having to change a pad or tampon more than once every one to two hours.
• Feeling faint or dizzy during menstruation.
• Having a family history of blood clotting disorders.

The American College of Obstetricians and Gynecologists lists potential causes of abnormal menstrual bleeding as:

• Polycystic ovary syndrome (PCOS)
• Bleeding disorders
• Eating disorders or extreme exercise
• Sexually transmitted infections
• Uterine growths, like polyps
• Hormonal issues

Are there any risks with having abnormal periods?

While irregular periods may seem like nothing more than a nuisance, abnormal menstruation over the long-term should be taken seriously. It can result in iron-deficiency anemia and is associated with an increased risk of uterine cancer, type 2 diabetes, heart disease, and mental health conditions.

Those experiencing heavy or irregular periods should always consult with their gynecologist.

When should a person first visit the gynecologist?

The American College of Obstetricians and Gynecologists encourages a first visit to the gynecologist between the ages of 13 and 15, though it is completely acceptable to visit before then. Often, a first visit is only a verbal consultation. Pelvic examinations, external or internal, are only needed if specific concerns develop. Routine pelvic exams begin at age 21 and include pap testing for cervical cancer screening.

For those who are sexually active, a visit also may include testing for sexually-transmitted infections (STIs), most of which can be done with a simple urine test.

For more information or to make an appointment with Dr. Baur, call (804) 285-8806 or book online.