Written by Michelle Fletcher, M.D.,a gynecologist with the University of Miami Health System
When you got your first period, hopefully, someone you trust helped you make sense of pads, tampons, cramps, and mood swings.
But they probably didn’t explain how your menstrual cycle will change throughout your life. As you age, the length of your cycle, number of days of bleeding and spotting, amount of bleeding, and PMS symptoms can change as hormones flow in different ways. As women, our menstrual cycle is one of our health vital signs. It can be a signal that everything is going well or a warning when something may be off in our bodies.
When menstruation begins
When a pre-teen or teenager starts menstruating, this is the right time to start seeing a gynecologist. At this age, speaking with or getting examined by a doctor can be uncomfortable. But, understanding what a gynecologist can do for you (or your child) and breaking that barrier can improve your health and wellbeing. These are great visits for young patients and their parents/caregivers to attend together. I like to open the floor for any questions a young patient has about her changing body. This encourages the conversation and allows her to feel comfortable talking about her body with her parent or caregiver and a physician. She can gain a better understanding of what to expect and what to speak up about.
When our cycles are first starting, it can be expected for periods to be irregular or without a clear pattern. Cycles can be anywhere from 21 to 45 days, and it may take several years for it to find a regular pattern (four to five years in some girls). During this time, bleeding for up to seven days is also normal.
In your 20s
As we get into our 20s, we can expect a little more stability with our cycles. You should be seeing your period every 28 to 35 days, and bleeding can decrease slightly, with most women having four to six days of bleeding. Mild PMS symptoms are also typical and may increase or be more noticeable during this time. Most women experience mild emotional or physical symptoms leading up to their period (such as bloating, breast tenderness/pain, headaches, feeling tired, food cravings, and others). These symptoms should be mild and not disruptive of your daily life. If your symptoms affect your social or economic life, talk to your gynecologist about your ways to alleviate them.
In your 30s
In your 30s, your menstrual cycle should remain stable and predictable. The cycle length should be consistent, as should the amount of bleeding. During these years of our life, we are more likely to start having children. Pregnancy and childbirth can affect your period in many ways, and it’s common for menstrual flow to change after having a baby. Also, during these years, we are more likely to use some form of birth control. The various therapies we use for birth control can affect and change our periods in many ways. To gain a clear understanding of what to expect, discuss these side effects with your gynecologist before starting any method of birth control.
In your 40s
Throughout your 40s, you may start to experience more irregularities in your cycle and the length of bleeding. Changes in women’s estrogen levels occur during this time. This stage before menopause is called “perimenopause” and can last for a few months or up to 10 years. During this time, you can have irregular periods, changes in your mood, issues with sleep, hot flushes, and night sweats. If you feel these symptoms are affecting your daily life, discuss them with your gynecologist.
After age 40, it can be normal to enter menopause at any time, although the average age for most women in the U.S. is around 51. Once you have seen no bleeding for over one year, you have officially entered menopause. Once this occurs, it is imperative to notify your doctor if you ever see bleeding again, as that is not normal. Symptoms, including night sweats, irritability, hot flushes, and vaginal dryness, may persist once you have entered menopause. Thankfully, many treatments can help this transition. So, speak with your doctor if you’re seeking relief.
How your lifestyle affects your period
Our bodies and menstrual cycles are quite sensitive to everything we do—including the food we eat, how hard we exercise, and physical and emotional stress. It’s important to try to live a healthy and balanced lifestyle to keep things flowing normally.
If you see significant changes in your weight (gain or loss), this can cause your hormone levels to fluctuate and affect your ovulation and period. Similarly, if you exercise very frequently and do not consume enough calories to match what you’re burning, this can also affect your cycle.
When to see a gynecologist
If you’re experiencing period-related concerns, such as intense menstrual cramping, irregular periods, missed periods without pregnancy, severe mood swings or depression tied to your cycle, or very heavy periods—speak with your gynecologist. That is what we’re here for!
We have many interventions that can help with everything from making cycles more regular and decreasing bleeding to helping with mood symptoms. There is no reason to be suffering every month.
You should see your doctor if you are experiencing cycles that are not 28 to 35 days, bleeding for more than seven days, bleeding that you feel is so heavy it is affecting your daily life or no bleeding at all. Sometimes, we put off our health to care for our children and family members. But, we should always take a moment to check in with ourselves to ensure we’re doing okay. Your periods are a part of your life, but they should not disrupt your life and keep you from doing everything you want to do.
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