You’d think that after getting your period month after month for a decade or two, you’d know it intimately well. And yet, there are still things about our own menstrual cycles that elude us. Part of the problem is that no one ever really talks about periods, which makes it harder to know what’s normal and what’s not. So we often cobble together information from our friends and some Google searches, but that can still leave some gaps in our knowledge about our own bodies.
Considering that, on average, women have about 450 periods in their lifetime, according to the Association of Reproductive Health Professionals, it’s worth getting to know your cycle and how it works. So we tapped top experts to address some common period myths and misconceptions.
Let’s clear up some confusion, shall we?
For some reason, there’s a lot of confusion surrounding what exactly counts as the first day of a woman’s menstrual cycle. The good news: Pinpointing when your cycle officially starts is simple: “The first day of your cycle is the first day you start bleeding,” Leah Millheiser, M.D., clinical assistant professor of obstetrics and gynecology and director of the Female Sexual Medicine Program at Stanford University Medical Center, tells SELF. “That is cycle day one.” (This video shows your entire menstrual cycle in two minutes.)
In general, women with regular cycles who are not on hormonal contraceptives (since you don’t ovulate while on most types of oral contraceptives) ovulate between day 10 and day 14 of their cycle. As we’ve already established, day one is the first day that you bleed, so you can do the easy math from there.
That said, “women are not machines, so it can vary,” Fahimeh Sasan, D.O., an assistant professor of obstetrics, gynecology, and reproductive science at Icahn School of Medicine at Mount Sinai, tells SELF. “You may not ovulate exactly on the 10th day every single month. That’s why when women are trying to conceive we don’t tell them to only have sex on days 10 through 14. Instead, have sex three to four times per week [around the ovulation period] because sometimes it can vary.”
That’s the number that’s often touted as “normal” because a 28-day cycle is the average—meaning, 28 days from the first day of your period to the first day of your next period. But there’s actually a range when it comes to what’s considered a normal, healthy menstrual cycle: anywhere from 21 days to 35 days in adults (and 21 to 45 days in teens), per the U.S. Department of Health and Human Services. So anything that falls within that span is A-OK.
Also, most periods last three to five days, notes Millheiser, but as little as two days and up to seven days is also considered normal. If your periods are consistently longer than seven days, though, you should get checked out by a gynecologist. Longer bleeding days can be a sign of fibroids, uterine polyps, or adenomyosis, which is when endometrial tissue grows into the muscular wall of the uterus and can cause painful, heavy periods, according to the Mayo Clinic. “That’s certainly something we want to treat,” says Sasan.
Yes, it can be a little disconcerting if your period tends to show up like clockwork and then there’s a slight delay, but your cycle isn’t set in stone. “Everyone assumes that if their period is exactly 28 days for the last 10 years and now it’s every 30 days that something is wrong,” says Millheiser. But you’re probably fine: “Period cycles fluctuate, depending on the environment, diet, stressors, and hormonal changes,” she explains.
Although pregnancy is the most likely reason why a period is MIA if you’re sexually active, high levels of stress—such as a big breakup, getting laid off, or moving—can also suppress reproductive hormones, causing secondary amenorrhea. In fact, a 2014 study of more than 370 couples that was published in the journal Human Reproduction found that psychological stress makes it harder to get pregnant.
In addition, low body weight, because of major weight loss, anorexia, or exercising rigorously (think: marathon running), can affect the hypothalamus, which helps regulate a woman’s menstrual cycle, leading to skipped periods, notes Millheiser.
While one missed period followed by your cycle going back on track is nothing to worry about, if you’re missing more than one period in a row, see your doctor. (The exception: If you’re adjusting your contraception to purposefully miss your period—more on that below.) missed periods signal that there’s likely a health issue at play, such as polycystic ovarian syndrome (PCOS), which is a hormonal imbalance—namely, high levels of androgens, a male hormone—that causes irregular cycles, such as only getting your period three or four times a year, or no periods at all. PCOS affects one in 10 women of childbearing age, according to the U.S. Department of Health and Human Services. Here’s some information on how to know if you have PCOS, endometriosis, or both that may be helpful.
If you’re over 40 and you’re skipping two to three periods in a row followed by a heavy period (thanks to a uterine lining that’s been building up for months)—especially if that’s joined by mood swings, night sweats or hot flashes—you’re experiencing the telltale signs of perimenopause, notes Millheiser.
But don’t panic thinking you’re going into full-blown menopause right away. “Perimenopause can go on for one to five years—you’re not going to go into menopause tomorrow,” Millheiser notes. “Menopause is one full year without a period.”
And more young women are doing just that. A 2013 study published in the journal Conception found that many college-age women are choosing to skip their periods by taking the hormonal pills in the pack back-to-back (and skipping the sugar pills) or using other hormonal contraceptives like the vaginal ring continuously. Of the more than 1,300 women in the study using combined hormonal contraception currently or recently, about 17 percent deviated from package instructions to alter their scheduled periods. Half of these women said they delayed or skipped their period for convenience’s sake.
“Is it safe for you to not have your period [by choice]? Absolutely,” says Millheiser. “The progesterone in your birth control pills is keeping the uterine lining thin. Often women will choose to have their periods two to three times per year.” If you have a health condition that affects your reproductive system, such as PCOS or endometriosis, check with your ob/gyn before you decide to skip periods.
Keep in mind that if you do continuous birth control pills, except some breakthrough bleeding eventually. The spotting is caused by hormonal fluctuations that cause some of the uterine lining to slough off, notes Millheiser.
One of the most persistent period myths is that it’s impossible to get pregnant while you’re menstruating. It’s not common, but getting pregnant while on your period can definitely happen. Sperm can last in the cervical mucous and uterus for up to five days. If a woman has a short menstrual cycle, such as 24 days, and has unprotected sex on the last day of her period and ovulates three days later, it’s possible for the egg and sperm to meet, resulting in a pregnancy. The chances are slim, notes Millheiser, but is a possibility. This is especially true if a woman’s cycle is short and her period lasts six or seven days. Adds Sasan: “It’s very unlikely for a woman who is actively menstruating to get pregnant. However, with every rule there’s an exception, and women should not use their period as a form of contraception.”
Another risk is thinking you’re on your period while you’re actually ovulating. Here’s why: In some cases, when a woman is spotting during her cycle, that can be mistaken for a period when it can actually be a sign of ovulation. “It’s very common for a woman to spot during ovulation,” notes Millheiser. “One day—typically mid-cycle—a woman might notice a couple of drops of light red or dark brown spotting, not usually bleeding. It’s just hormonal changes during ovulation—it causes this little shedding. It’s nothing concerning. In fact, for women trying to get pregnant, it’s a really good sign that you can get pregnant now.” So some women might mistake the spotting for their actual period and, thinking they can’t get pregnant during their period, have unprotected sex when they’re actually at their most fertile. The misconception can lead to a pregnancy outcome.
When you’re having your period, hormones called prostaglandins cause the uterus to contract to help shed the uterine lining. As almost anyone with a period knows, those contractions can be uncomfortable and even downright painful. Over-the-counter pain relievers, as well as birth control pills, can help. “For some women, being on birth control pills can help make periods less painful,” says Sasan, because birth control pills reduce the amount of prostaglandins produced by the body. “Even in someone who is not using it for contraception purposes, we often prescribe it since it can be used specially for dysmenorrhea, which is painful periods.”
If your periods are predictable and your doctor gives you the green light, Sasan recommends taking an anti-inflammatory prophylactically the day before you expect your period. That way, the medication is already in your system. “Unless there are contraindications, start taking Advil or Motrin the day before every six hours,” she says. “Most people report painful periods for the first day or two, so continue to take the medication every six hours or for however many painful days you typically experience.” Sasan recommends Advil and Motrin since they’re anti-inflammatory and suggests taking the meds with food so they don’t upset your stomach.
But if your periods are very painful and nothing seems to help (or they weren’t painful and now are), don’t dismiss it, says Sasan. “No one should put up with pain,” she says. “If you’re in pain, you should definitely talk to your doctor and have a thorough exam.” In some cases, painful periods can be a sign of a cyst, fibroids, or endometriosis that should be evaluated and treated by a doctor.
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