5 Red flags with your periods

Women most often are unaware of when to consult a gynecologist regarding abnormalities of their menstrual cycles. Having a sound knowledge of what is normal in a period/ menstrual cycle will help one consult a doctor at the earliest when they notice changes in their periods.

What is a normal period/ menstrual cycle?

1. Normal cycle:
Bleeding once in 21-35 days is considered normal.
So, it’s ok if you don’t have a 28-30 day cycle as long as you're bleeding once in 21-35 days
2. Normal duration of bleeding:
A normal period lasts for 2-7 days; the first 2-3 days tend to be heavy, with most women changing about 3 pads or having to empty menstrual cups 2-3 times a day.
A normal period is often not associated with clots.
3. Pain during periods:
Mild pain during periods that does not incapacitate you or prevent you from doing your normal work, or pain that does not require medication, is normal.
4. Vaginal discharge:
Excessive clear sticky discharge noted before your period and around the mid- cycle at the time of ovulation is considered normal as long as it’s clear, not associated with itching or foul smell.

What are the red flags with a period that warrant immediate attention?

1. Heavy bleeding:

Bleeding that lasts longer than 7 days, or heavy flow causing a woman to change more pads/ cups than usual, or bleeding that is associated with the passage of clots, needs immediate evaluation by a gynecologist.
The causes of heavy bleeding could be:
Hormonal or endocrine abnormalities
Non-cancerous growths in the uterus, like fibroids and Adenomyosis
Infection
Cancers of the uterus or cervix
Heavy bleeding, if not cared for immediately, can cause anemia, leading to extreme fatigue, palpitations, and heart failure.
An early evaluation helps in diagnosing the problem and initiating prompt treatment, leading to better outcomes.

2. Bleeding in between periods/ Inter menstrual bleeding:

Any amount of bleeding or spotting that occurs after the completion of your period needs further evaluation.
A woman may notice some spotting/ bleeding in the mid-cycle at the time of ovulation that lasts a day or 2, which could be normal.
However, bleeding on and off in between 2 periods needs prompt evaluation.

3. Bleeding after intercourse:

Any amount of bleeding/ spotting noticed after intercourse is considered abnormal and needs to be looked at in order to rule out abnormalities of the cervix and, more importantly, cervical cancer.
Your gynecologist will examine you to look for changes or abnormal growths in the cervix and do a Pap smear to rule out cervical cancer.

4. Pain during periods:

Pain during or around a menstrual cycle that is severe, requiring medication, and incapacitating a woman from doing her normal chores requires further evaluation.
The causes of pain or dysmenorrhea are many; the most common being endometriosis, especially in a woman finding it difficult to conceive, fibroid uterus, Adenomyosis, and pelvic infection.
In women over 40, pain during periods with or without other bleeding abnormalities needs to be evaluated to rule out uterine cancer and its precursors.
Young girls often experience severe pain during periods despite a normal ultrasound. This is often self-limiting; however, medication to relieve the pain will help them continue with their normal activities and studies.
Physical activity/ exercise is known to reduce dysmenorrhea( period pain) and is recommended during periods, along with the other days of the month.

5. Abnormal discharge

Any vaginal discharge that is foul smelling, excessive, associated with itching, curdy- white, yellow, or greenish in colour needs prompt evaluation to rule out vaginal or uterine infections and cancers.

Women are fortunate to have telltale signs such as bleeding abnormalities and abnormal vaginal discharge in the early stages of cervical and uterine cancer. This often leads to an early diagnosis of these conditions and is associated with better survival.

Hence, it’s imperative that these red flags are taken seriously and evaluated at the earliest!

(This is an authored article by Dr. Preeti Prabhakhar Shetty.)