12 Things Every Woman Should Know About Her Period
What to know about your period
The average woman can expect to get her period approximately 450 times in her lifetime. But even though you've probably got the hang of your cycle by now, chances are that some menstrual mysteries remain unsolved. Maybe your cycle is super long or short, or it's irregular, or it comes with side effects like PMS—and you wonder if what you experience each month is normal. Or maybe new issues have cropped up, like really awful cramps or a heavier flow, and you're not sure if you need to tell your ob-gyn what's going on.
The fact is, it's important to pay attention to what's normal and what isn't during your cycle because changes can provide clues to your overall health, says Taraneh Shirazian, MD, assistant professor of obstetrics and gynecology at NYU Langone Medical Center. We asked Dr. Shirazian and other experts to decode puzzling period symptoms, surprising (and potentially scary) side effects, and other crucial pieces of period intel that every woman needs to know.
It's okay to skip your period—really
If you occasionally hack your birth control to avoid your period (say, during a vacation), you're not alone. And fortunately, it's safe. "The idea of having a menstrual period every month is an outdated mind-set," says Adam R. Jacobs, MD, medical director of the division of family planning at the Mount Sinai Health System in New York City.
When you use hormonal contraception continuously, "the endometrial lining is thinned, which means you don't need a period to get rid of it," explains Dr. Jacobs. If you're on the pill, talk to your MD about skipping the placebo pills and immediately starting a new pack. On the ring? Ask about replacing it with a new one right away instead of waiting a week. You may also want to discuss types of birth control that are designed to reduce the frequency of your period.
The pill isn't the only option for heavy periods
From 10% to 30% of women deal with heavy menstrual bleeding, or menorrhagia—a condition that's often accompanied by painful cramps and, if left untreated, can lead to anemia.
While many women turn to birth control pills for relief, there may be a better option out there: the Mirena IUD. A 2013 U.K. study published in The New England Journal of Medicine found that it was more effective at relieving menorrhagia than oral contraceptives and nonhormonal antibleeding drugs. The Mirena IUD releases a small amount of progestin, which thickens the cervical mucus, making it harder for sperm to reach an egg. It also makes the uterine lining much thinner, decreasing bleeding. Another hormonal IUD on the market, called Skyla, has similar effects.
Other hormonal contraceptives, such as the ring and the birth control shot, can also be used to manage a woman’s flow, says Ana Cepin, MD, an ob-gyn at New York-Presbyterian at Columbia University Irving Medical Center. These birth control options will not only make your period lighter but also shorter, she adds.
You (probably) don't need organic tampons
If you're prone to irritation down there, organic tampons might be a better choice, says Monica Svets, an ob-gyn in Cleveland, Ohio, because they're free of fragrances and dyes. But otherwise, you don't need to splurge on the organic kind. According to the FDA, tampons have been tested and found to contain only trace amounts of chemicals (if any), and the risk of adverse health effects from such tiny amounts is negligible.
Menstrual cups and period panties are eco-friendly options
The average American woman goes through more than 10,000 pads or tampons during her lifetime. Luckily, we now have options that are better for Mother Nature.
Menstrual cups are made of flexible silicon and sit in the vaginal canal to collect (instead of absorb) menstrual blood. Most cups can stay in for up to 12 hours, and reusable versions can be kept for years, significantly reducing the amount of waste you'd have if you used a disposable product. The cup is reusable because you empty and wash it before reinserting, which might not sound as appealing as tossing it in the trash, but it's a lot more eco-friendly.
Like the cup, period panties are reusable after washing, meaning they have a smaller environmental footprint than disposable products. Depending on the brand (Thinx, Mobibodi, and Dear Kate are popular ones), period panties can hold up to three times the amount of blood one tampon can absorb. If you’re not into pads, these panties are still useful for backup coverage. Wear them with a menstrual cup or tampon to stop worrying about leakage.
Your periods may get worse during perimenopause
Before they stop altogether when you reach menopause (the average age is 52), your periods will likely get longer and heavier, suggests a 2014 University of Michigan study. When researchers tracked more than 1,300 women between the ages of 42 and 52, they found that 91% reported their period occasionally lasted at least 10 days, 88% reported frequent spotting, and nearly 78% recorded at least three days of heavy flow.
"It's really disconcerting for women whose periods were regular and predictable in their 30s to find them suddenly going haywire in their 40s," says Dr. Jacobs. The good news: If you're suffering from bad cramping or anemia, or you just want a shorter, less heavy flow, hormonal contraceptives should help.
Natural PMS remedies may help
Sick of popping pain relievers? Here are three research-backed, non-drug treatments to try.
Acupuncture: This ancient practice appears to reduce physical symptoms (including headaches, cramps, backaches, breast pain, and bloating) by as much as 50%, according to a study review. Doctors aren't sure exactly how it works, but one theory is that it releases endorphins, feel-good chemicals that help dull pain, says Dr. Shirazian.
Chaste tree: The same 2014 review found that taking chaste tree extract (between 20 and 40 milligrams a day) improved both physical and psychological PMS symptoms by more than 50%. In another study, it was about as effective as the antidepressant fluoxetine (marketed under the brand name Prozac or Sarafem).
Yoga: In one study, researchers found that women who did yoga twice a week at work for 50 minutes reported improvements in symptoms such as bloating, sore breasts, cramps, and cold sweats. Yoga may help by releasing endorphins or by relieving stress, says Dr. Shirazian.
Yep, you can get pregnant if you have sex during your period
It’s very unlikely you’ll get pregnant while on your period, but it is possible. Though women typically ovulate about 14 days after the start of their period, some can ovulate unpredictably, says Felice Gersh, MD, ob-gyn and founder/director of the Integrative Medical Practice of Irvine, California.
Sperm can live inside your reproductive tract for up to seven days, Dr. Gersh explains. So if you have sex on the last day of a seven-day period, and your partner’s sperm is hardy enough to stay alive inside of you for another seven days, suddenly it’s been 14 days since the start of your period—and you could ovulate and then conceive.
Bottom line: If you don't want a baby, always use birth control...no matter what time of the month it is.
You probably lose a lot less blood than you think
It only feels like you’re gushing a torrent of blood each month. The truth is, the average woman only loses only about three to six tablespoons.
If you think your flow is a lot heavier than that, Dr. Gersh suggests keeping track of how often you have to change your tampon or pad. If you have to change it more than once every few hours, "that’s probably excessive,” she says, and is something to discuss with your ob-gyn. Losing too much blood puts you at risk of anemia, which can in turn cause fatigue, dizziness, and cold hands and feet, among other symptoms.
Cramps that get more painful can be a sign of something serious
Many women get cramps during their period; they're caused by contractions in the uterus that help shed the uterine lining. The pain these contractions cause can range from mild discomfort to serious agony. Over the counter anti-inflammatory pain meds can help (especially if you take them before your cramps get super awful), as can old-school remedies like a heating pad and massaging your lower abdomen.
If you don’t usually get cramps or the pain is no big deal—and then suddenly it feels like someone is tying your uterus in a knot every month, that’s cause for concern, Dr. Cepin says. When cramps materialize out of the blue or intensify, it could be due to a more serious condition, such as uterine fibroids, benign growths in the uterus. It could also be a sign of endometriosis, when uterine tissue grows outside the uterus.
Seek treatment if your cramps are significantly inhibiting your life or if they’re progressively getting to the point where they might, so doctors can diagnose what’s going on and take steps to ease the aching.
Period tracking apps help you stay on top of your cycle
If you have an irregular flow (and you probably do, since few women have periods that operate on a strict 28-day schedule), the digital age is making your life easier Apps like Clue, Eve, and Flo Period & Ovulation Tracker keep tabs on your cycle to alert you when your period is due.
These apps can be especially helpful if PMS hits you hard in the days before your period actually arrives. By tracking when your PMS symptoms hit each month, you’ll know exactly when to expect the bloating, mood swings, pre-period cramps, or other body issues—so you can take steps to minimize their impact. “If you’re trying to figure out a cause and effect, it’s certainly nice to have a record so you can track things over time and see if there does seem to be a causality,” Dr. Gersh says.
Period sex has many benefits—and one potential drawback
Period sex has lots of advantages; it can cut down on pain from cramping (or at least distract you from it), and the extra lubrication can make penetration feel even better. Just remember to use a condom if you aren't sure of your partner's STI status, because your odds of contracting a sexually transmitted infection are higher at this time of the month.
“The microbial population of the vagina will be different during a menstrual period than it will be during a different time in the cycle,” Dr. Gersh says. Translation: the acidity of your vagina during shark week is at a point where it’s easier for microbes to get into your system. Also, cervical mucus might be decreased, so you don’t have that layer of protection keeping bugs out.
Your partner is also at higher risk of getting an STI from you. “Blood is a vehicle that transmits infections,” Dr. Gersh says. Get it on during your period when you're carrying something, and your flow could end up giving it to your partner.
Spotting between periods isn't always a bad sign
Depending where you are in your cycle, levels of estrogen and progesterone change, and sometimes that can result in spotting—aka, a small amount of bleeding, say enough to stain your underwear or a pantyliner. This between-periods bleeding might be annoying, but it’s nothing to worry about, says Dr. Gersh.
However, other causes of spotting can be a concern. Cervical cancer, uterine cancer, uterine polyps, and other serious conditions can also trigger abnormal bleeding, she adds.
So how can you tell if your spotting warrants a conversation with your doctor? If you’re spotting because of normal changes in hormone levels, the bleeding will likely happen at the same time each month, Dr. Gersh says. That's why it’s useful to keep track of your symptoms on an app or calendar. If you have that data available, your doctor can determine if the bleeding is occurring during a point in your cycle when hormones are in flux.
If you’ve never had spotting before, it happens randomly, or it goes on all month long, it’s time to tell your doctor. “It’s never normal; it doesn’t mean that it’s something terrible,” Dr. Gersh says. “It could be that a woman has a hormonal imbalance, but it always requires a comprehensive evaluation if a woman has random spotting.”