Your monthly friend, your Aunt Flo, your “gift” — your menstrual period, in other words — is, for many,a sign of a regular, healthy reproductive system. And it’s important that you know what “normal” looks like for you, so that you can identify a pattern if your period begins to shift. But what period symptoms should you particularly watch for? Everything from consistency and clots to cramps and accompanying pain may provide a clue to underlying health conditions that you need to address.
1| Large Clots or Gray Tissue
This, according to the data scientists at Clue, may be a sign that you’re not actually experiencing a period at all. Significant clots and the presence of gray-colored tissue can indicate that you’re experiencing a miscarriage. “When a miscarriage occurs very early in pregnancy (for example, less than or equal to two weeks after an expected period),” the scientists tell Bustle, “it can be difficult to tell the difference between a normal menstrual period and miscarriage, especially if a person occasionally or regularly experiences heavy or painful periods.”
But, they add, “the later into a pregnancy a miscarriage occurs, the more it will differ from a menstrual period. Bleeding from later miscarriage will contain fetal tissue, and blood clots will likely be larger than during normal menstrual periods. The tissue will likely look different from menstrual blood in color (ex. gray), consistency/texture, and shape.”
2| Serious Pain From Pelvis To Shoulders
If your period or a period-like bleed is accompanied by severe pain from your pelvis to your shoulders, along with abnormal bleeding, the Clue scientists say, you need to seek medical help immediately. “These could be signs of an ectopic pregnancy (when a fertilized egg attaches and grows somewhere other than the uterus, most commonly in the fallopian tube),” they explain. “Ectopic pregnancies are life-threatening and should be treated as medical emergencies.” The phenomenon is rare, but it needs to be treated immediately using either drugs or surgery to remove the ectopic pregnancy from the body.
3| Cramping Out Of Nowhere
“Symptoms of both menstrual periods and miscarriage can include heavy bleeding, pain, and cramping,” note the Clue scientists. Outside of that possibility, though, particular types of unexpected cramps can signify different health issues. A sharp pain on one side, for instance, might indicate that you have an ovarian torsion, an extremely painful condition that involves the ovary’s blood flow being cut off. Seriously agonizing cramps may also indicate that you’ve developed fibroids in or around your uterus, creating more pressure on the lining and more problems as the uterus contracts to attempt to dispel its waste.
4| Fever, Dizziness & Fainting
You should not be feeling feverish or miserably ill while you’re on your period. That is not normal, and it could indicate an infection, like pelvic inflammatory disease, which is often contracted via sexually transmitted illnesses and involves infections of the reproductive organs. It can also be a sign of the rare condition known as toxic shock syndrome, which can be associated with tampon use and needs immediate medical attention. Whatever’s happening, a fever of more than 102 degrees while on your period needs a GP or emergency room visit ASAP.
5| Heavy bleeding
Menorrhagia is heavy or long-lasting menstrual bleeding. According to the Centers for Disease Control and Prevention (CDC), people have heavy bleeding if they:
- have a period that lasts longer than 7 days
- bleed through a pad or tampon within 2 hours
- need to change a pad or tampon during the night
- pass blood clots larger than a quarter, or another large coin
Heavy bleeding could indicate a hormone imbalance or a health condition that affects the uterus.
Spotting, or any vaginal bleeding between periods, could indicate a condition such as:
- benign uterine cysts
- cervical cysts
- pelvic inflammatory disease
- changes to hormone levels, such as during puberty, perimenopause, and menopause
- endometriosis, a condition that causes the tissue that forms the uterine lining to also grow in other areas
In rare cases, vaginal bleeding between periods or after menopause could be a sign of uterine, cervical, or ovarian cancer.
7| Skipped periods
Stress, excessive exercise, and some forms of birth control can all disrupt the menstrual cycle and cause a missed period. If the cause is temporary, a person’s period may return as usual the next month.
Pregnancy causes periods to stop, and they may not resume until the woman finishes breastfeeding.
The medical term for the absence of periods before menopause is amenorrhea. The Office on Women’s Health (OWH) explain that a person may have amenorrhea if:
- they miss more than three periods in a row
- they have not had a period by the age of 15
The OWH note that some other causes of amenorrhea can include:
- eating disorders, such as anorexia nervosa
- extreme weight gain or loss
- severe, long-term stress
- polycystic ovary syndrome (PCOS)
8| Breast Tenderness
Mild breast tenderness can be expected during a period.
However, a person should consult a doctor if breast tenderness:
- is severe
- occurs at other times of the menstrual cycle
- accompanies any other symptoms, such as a lump in the breast or changes in the nipple or the skin of the breast
Some have an upset stomach or diarrhea around or during their periods.
This can be due to the release of chemicals called prostaglandins from the uterus, which can cause diarrhea, nausea, and lightheadedness.
If diarrhea is severe or an unusual period symptom, speak to a doctor.
Some clotting is a regular feature of menstrual bleeding, particularly on days with a heavier flow. Clots smaller than a quarter can often be expected, particularly at the beginning of a period.
If a person notices clots that are larger or appear more frequently than usual, it could indicate an underlying health issue, such as:
- adenomyosis, in which the uterine lining grows through the wall of the uterus
Also, if a woman who is pregnant, or suspects pregnancy, passes clots, this could indicate pregnancy loss, or miscarriage. If this happens, it is important to see a doctor right away.
11| Unusual consistency
The consistency of a period may change from the beginning to the end of the period, with a heavier flow to start with, which then gets lighter towards the end of the period.
If people experience abnormal menstrual blood consistency, which is different from their usual consistency, they should see their doctor.
Pink, watery menstrual blood or unusually thick blood could indicate an underlying condition, such as menorrhagia.
The medical term for pain during periods is dysmenorrhea, and cramping is often a cause of this pain.
Mild cramping in the abdomen can be an uncomfortable but expected part of the menstrual cycle.
Extreme or unusual cramping could be severe dysmenorrhea, and indicate an underlying condition such as:
13| Period not stopping
The duration of bleeding can vary from person to person, ranging from about 2–7 days. For each person, it should be fairly consistent from month to month.
If the duration of a period changes from month to month, or if the menstrual cycle becomes unusually long or short, this can signal an underlying health issue, and it is a good idea to speak with a doctor.
14| Significant mood changes
After ovulation and before the start of a period, many women experience a combination of physical and emotional symptoms. These, collectively, are known as premenstrual syndrome (PMS).
The OWH note that changes in levels of the hormones estrogen and progesterone can cause low mood, which is a common PMS feature.
However, severe changes in mood, which may keep a person from daily activities, could be a sign of premenstrual dysphoric disorder. People with this issue often benefit from a combination of lifestyle changes and medications.
It is also important to note that any mood changes related to regular hormonal shifts can worsen symptoms of existing mental health conditions.
15| Irregular periods
Typically, a menstrual cycle is 28 days long, but can vary from person to person. A regular menstrual cycle may be 24–38 days long.
An irregular period is one that occurs more frequently or less often than usual.
Irregular periods can point to an underlying condition, such as:
- premature ovarian failure
- thyroid problems
Don’t be shy about seeing a gynecologist or a mammologist (actually, it’s recommended that you see them 1-2 times a year) and discussing everything you’re worried about with them. There are no awkward questions when it comes to health.