If you have never been to visit a gynaecologist, then you may be surprised about the amount of detail we go into when asking what your periods are like for you. The reason for this is, despite the popular notion that a “normal” period comes every 28 days, there is a wide variation that can occur amongst women.
Periods for the first time
When you start to have periods for the first time, called menarche, it is common for periods to be very irregular. This may include periods which come anywhere from 2 weeks to a few months apart and periods which last anywhere from of few days of light spotting to heavy periods that last more than a week. The reasons why periods can be so irregular at this early stage include the ongoing development of the hormonal system between the brain and the ovaries and the responsiveness of the lining of the uterus to those hormones. This is also the time where environmental influences like stress, diet changes and heavy exercise are more likely to occur and may contribute to irregular periods.
When periods become life
Most women will start to have a more predictable cycle within 1-2 years of starting their periods. Whilst it is often considered “normal” at 28 days, few women have a perfect 28 day cycle, with the majority of women reporting a cycle between 26-30 days in length. Along with a more predictable cycle, the pattern of bleeding that occurs with each period also becomes a bit more regular. What is normal however can vary considerably with some women reporting only a few days of light bleeding whilst others report more than a week of heavy bleeding. In general, gynaecologists are interested in what is normal for you and if that has changed over time. The exception to this is when your periods are so heavy that you need to change your pad or tampon more than once per hour, if you are passing large clots (bigger than a golf ball), if the heaviness prevents you from doing normal activities like going to school or work, or if you become anaemic.
During reproductive life, your periods may also change. Common reasons for this include environmental influences like those mentioned above, the use of different contraceptive methods, and following on from any pregnancy, although occasionally there are underlying medical reasons that may cause abnormal uterine bleeding and as such you should consider seeing your GP if you have any significant change of periods or bleeding between your normal period.
When periods are no more
Similar to menarche, the menstrual cycle often becomes irregular both in length between periods and the heaviness of periods as you approach menopause. It is often referred to as peri-menopausal and you may start to develop symptoms of menopause (hot flushes, dryness of the skin and vagina, sleep disturbance or mood changes) during this time. The reason for this is the ovaries are starting to become less responsive to the reproductive hormones of the brain and are unable to release an egg (and therefore trigger a period) at the same rate as previously. Because of the way the eggs develop, this leads to a situation where periods can come close together, such as a week apart, or further away such as many months. In general, when periods are closer together they will be lighter and when there is a large gap between them they are likely to be heavier. If your cycle is the still the same but your periods are becoming progressively heavier, this may suggest an underlying medical condition and it would be recommended to attend your GP.
What could cause me to have abnormal periods?
There are two main symptoms women report to their gynaecologist – those where the periods have become heavier over time and those where their cycle has become very irregular. Heavy menstrual bleeding may be genetically acquired but when periods have become progressively heavier then it could be due to local changes in the uterus such as fibroids or adenomyosis or whole body changes such as thyroid disease or acquired blood clotting disorders. When periods are very irregular then we must consider causes where the ovaries don’t respond to reproductive hormones appropriately, including conditions such as polycystic ovarian syndrome (PCOS).
