How serious is serious? Here’s an OB-GYN’s take on when to call your doctor.

When it comes to taking care of your health, asking questions never hurts. But is it always worth a visit to your doctor? We’re asking experts to weigh in on your burning questions—from feminine to general health and everything in between—so you can get advice from a pro before you go. The doctor will see you now.

Each woman has her own “normal” period, from typical PMS symptoms to cycle lengths. But how do you know when your “normal” isn't actually normal? We asked Dr. A. Nicky Hjort, M.D., OB-GYN, for her take on when a period problem merits a visit to your provider over a Google search and a shrug.

According to Dr. Hjort, “These concerns are acutely urgent, potentially serious, even life-threatening kind of problems.” Irregular period problems fall into three categories: a lack of periods, heavy or irregular bleeding, and painful periods.

01. Missed Periods

Q. Is a lack of periods really that serious?

A missed period (“amenorrhea”) is as important as the other two categories. When you go in for a consultation, your doctor will ask about your history before doing a pregnancy test and exam.

In women of reproductive age, pregnancy is the “first thing that must be considered,” Dr. Hjort says. The next is a “hormonal imbalance, either in the brain, the ovaries, or the uterus itself.” For women who are not on medication that suppresses or regulates their cycles (like hormonal birth control), amenorrhea can be very serious. “Alternating presentation of no period, followed by heavy, dangerous, irregular bleeding,” Dr. Hjort notes, is a “condition that can, over time, increase a woman’s risk for developing cancer of the uterus.” Thyroid dysfunction, a condition that can be diagnosed as early as your teenage years, can also present as cycle irregularity.

Dr. Hjort says women who are experiencing light, short, irregular periods, mood swings, or cycles that are too short or too long (shorter than twenty-one days or longer than forty-five days) may want to call their doctor but don’t need to pick up the phone this minute. If the length of time between cycles is getting progressively longer to the point that some months you don't have a period, you should see your doctor for an evaluation.

02. Really Heavy Flow

Q. My bleeding is heavier than most. How heavy is too heavy?

Dr. Hjort advises that if you “soak a tampon with super or a maxi pad with super-plus capacity in less than an hour for several hours in a row,” your flow is dangerously heavy and you should see a doctor right away. Medically termed “menorrhagia,” Dr. Hjort likens it to turning a faucet on in the body. If your doctor can’t see you in the next few minutes, she says you should get to the emergency room ASAP.

Heavy bleeding may merit getting admitted to the hospital, a blood transfusion, medicinal treatment, and possibly some acute surgical intervention. This situation could result in “severe anemia, which can, when drastic enough, be the cause of multi-organ failure, including heart and lung failure, and kidney failure and death,” Dr. Hjort warns. “In a situation where bleeding is that heavy, the sooner we can intervene the better.” 

Often simple interventions like hormonal medications via IV can stave off the bleeding. Acute heavy bleeding can also be symptomatic of cancer in serious situations—in which case time is crucial for survival, Dr. Hjort says.

If your flow isn't quite that heavy, but you do have more than two days of heavy flow, check in with your doctor to see if your situation may be symptomatic of a related issue.

03. Noteworthy Menstrual Pain

Q. Isn’t it normal to experience pain with your cycle?

Cramps, headaches, low-grade discomfort—all of these are par for the course with your period. Some period pain is normal, Dr. Hjort says, but an intensely painful period—called “dysmenorrhea”—can be a sign of infection or other serious conditions, like endometriosis. Dr. Hjort also notes that “pain associated with a fever, whether it’s associated with the menstrual cycle or not,” may be a symptom of a “serious bladder or uterine infection or sexually transmitted infections.”

When you see a doctor to address dysmenorrhea, you can expect “a good physical examination, including an internal pelvic exam,” Dr. Hjort says. You doctor may also recommend tests for pregnancy, blood counts, hormone levels, and, depending on your situation, an ultrasound to look for anatomic causes, like masses in the uterus or the ovaries.

We can learn a lot about the status of our overall health from our cycles. So when your period is sending out an SOS, don’t hesitate to get the help you need from a health care practitioner who will take your concerns seriously. Your reproductive health—and your life—may depend on it.

Photo Credit: Erich McVey