Severe Period Symptoms You Shouldn’t Ignore

Sure, periods make it possible for women to become pregnant and have babies. But let’s face it—they can be a real pain in the butt. And while almost every woman experiences side effects like bloating and cramps, symptoms that are intense or interfere with daily life could mean something has gone awry.

We spoke to OBGYN Jennifer Wilson, MD, of Swedish Medical Center in Littleton, Colorado, to learn the three severe symptoms you’ll want to watch for, along with which health conditions they hint at and how your OBGYN will diagnose you.

Medically reviewed in December 2019.

So, how do you know what’s normal and what’s not?

Your periods should be predictable, but they may not occur at the same time every month, says Dr. Wilson. What's more, periods vary from woman to woman, and as you go through different stages of your life, they may change. “Teenagers often have irregular periods as their reproductive system matures," says Wilson. "Women of childbearing age should have predictable, regular menses, while those in their 40s may experience menstrual changes as their ovaries prepare for menopause, which usually occurs around age 51.” Occasionally, an irregular period may signify a more serious problem, like Cushing’s disease. Things like genetics, weight and stress levels can all affect your period, too.

Most normal periods last from 2 to 7 days, and will usually be 21 to 35 days apart. And cramps, bloating and bowel changes are common during your period.

Wilson recommends keeping track of your period: its length, your symptoms and any mood swings. “If there are changes preventing you from living your life normally, remember that there are safe and effective therapies available for most problems.” 

It’s normal to bleed for up to eight days during your period. It's not normal to see it in your panties or on toilet tissue between periods. On one hand, unusual bleeding could be a sign you're experiencing an irregular menstrual cycle. On the other hand, it could indicate a miscarriage, uterine fibroids—tumors that grow in the uterine wall—or cervical polyps, which develop on the lower section of the uterus. In rare cases, spotting or irregular bleeding can be a sign of uterine cancer.

Based on your age and symptoms, your gyno may perform one or more of the following tests to determine the source of the bleeding:

• Ultrasound
• Hysteroscopy
• Endometrial biopsy
• Magnetic resonance imaging (MRI)
• Computer tomography (CT)

Depending on the cause, treatment may involve medication, surgical procedures, or some combination of the two. 

Heavy menstrual bleeding is not only annoying, but could be a sign of something more serious. When is bleeding considered heavy? When it does one or more of the following:

• Lasts longer than seven days
• Soaks through numerous pads or tampons in an hour
• Is accompanied by blood clots bigger than a quarter

Heavy periods could be a sign of many different health conditions, but—like spotting—uterine fibroids and cervical polyps are some of the most common causes. Uterine adenomyosis—a disorder in which the endometrial tissue typically lining the uterus actually grows along the wall of the uterus—and polycystic ovary syndrome (PCOS) can also cause you to bleed heavily. So can a hormonal imbalance that causes problems in the ovaries. In more extreme cases, intense bleeding could be an early sign of endometrial cancer. If caught early, treatment for this type of cancer is very effective.

Blood loss from severe menstrual bleeding can also result in iron deficiency anemia, a health condition that means your blood doesn’t carry enough oxygen through your body.

Head to the gyno if you're bleeding heavily. A pelvic exam, ultrasound, hysteroscopy or biopsy can determine what’s going on. Hormonal birth control options can help improve symptoms if the bleeding is a result of ovulation issues, or fibroids or endometriosis, a condition in which uterine tissue grows outside the uterus. 

Alas, menstrual cramping is just part of getting your period. But painful periods, otherwise known as dysmenorrhea, can't always be chalked up to run-of-the-mill menstruation.

Primary dysmenorrhea is normal menstrual pain probably caused by an increase in activity by the uterus-produced hormone prostaglandin. The condition causes you to feel pain in your abdomen, back or thighs, especially during the first one or two days of your period. As your period continues, your uterine lining sheds and the pain should decrease.

Secondary dysmenorrhea is not a disease on its own, but is set off by health conditions like endometriosis, fibroids and adenomyosis. It could also mean you have pelvic inflammatory disease (PID), a uterine infection that can extend to other reproductive organs. Secondary dysmenorrhea causes menstrual pain in your hips, low back, inner thighs and abdomen even before your period starts. Most of the time, it gets worse as your period continues, and may not go away after your period ends.

In addition to these symptoms, see your gyno if you have sudden, extreme pain along with foul-smelling vaginal discharge or fever—or you’re more than a week late. Pain that occurs before your period or comes after your period has ended is also a sign you need to visit your doctor. He or she will do a pelvic exam and talk through your menstrual cycle and symptoms. From there, an ultrasound or laparoscopy may be ordered to look inside your pelvic area. Treatment will depend on whether or not there are underlying health issues, but anti-inflammatory medications and certain birth control methods can help relieve cramping.