Period bleeding: What’s normal, what’s not?

Is it normal for this much blood to come out of me? When is a clot concerning? Do I really have to deal with this every month until menopause?!

Gynecologist Dr. Colleen Murphy of Novant Health Minimally Invasive GYN Surgery - SouthPark is here to answer the questions you might be too embarrassed to ask.

What’s “normal” period bleeding?

Every woman will have her own “normal,” but in general, normal frequency means that you have a period every 21 to 35 days, with five to seven days or less of bleeding.

Normal regularity means that you have your period once every month, without skipping periods.

Normal symptoms mean you can do all the things you want to do. Some degree of cramping is normal, but normal periods shouldn’t cause significant pain or dysfunction that interferes with school, work or daily activities.

Normal volume is going through 3 to 6 regular-sized pads or tampons a day or being able to change your menstrual cup or period underwear once a day, without soaking through these products.

When does bleeding become abnormal?

Here are some signs of abnormal bleeding:

• Bleeding longer than five to seven days in a month.
• Bleeding between periods.
• If you’re not getting a period at all, unless your ob-gyn has helped you stop it using birth control or surgery, or you’re newly postpartum or breastfeeding.
• Infrequent periods that aren’t on a predictable schedule.
• Passing blood clots the size of a quarter or larger.
• Regularly missing school, work or other activities due to period pain or excessive bleeding.

It can be tough to measure how much you're bleeding, so here are some practical benchmarks to indicate what’s abnormal:

• If you're having to use multiple products — like a super tampon plus a backup pad — and are still soaking through both every hour.
• If you have to wake up at night to change your product.
• If you’re filling up a menstrual cup or period underwear multiple times in one day.

If you have any of these signs of abnormal bleeding, it’s time to see your ob-gyn.

Is period bleeding ever an emergency?

If you feel dizzy or extremely fatigued, pass out, experience chest pain, or climb a flight of stairs and feel short of breath — head to the emergency room.

If you're wearing the largest size pad and soaking through two per hour for two consecutive hours — head to the emergency room.

And if you’re in menopause but start bleeding again, call your ob-gyn’s office and tell them what’s going on.

Are there life stages where abnormal bleeding is expected?

Teen girls who are newer to their period may have longer, irregular cycles of up to 45 days at first. They don’t need to be seen for this unless their bleeding is extremely heavy.

And women in their late 30s and 40s eventually start having irregular cycles as they enter perimenopause. This can look like a prolonged period or heavier flow at first; eventually, they’ll start skipping periods and go longer between cycles. I recommend seeing their ob-gyn when symptoms begin, so we can do a workup and talk about what to expect as they move closer to menopause.

How does abnormal bleeding affect women?

In addition to missing out on work, school and activities, it diminishes their well-being and they feel like they can’t live their life normally.

I hear patients say, “When I'm on my period, I just don't want to leave my house due to pain or bleeding. I lay in bed. I don’t go out because I’m worried I’m going to bleed through my clothing.” Or, “I have to carry around extra sets of clothes because I never know when bleeding will start.”

Women with long cycles feel like they don’t get a break: They bleed for two weeks, have two weeks off, and then it’s right back. That’s a huge impact on their quality of life.

And there’s sexual distress as well — due to pain or bleeding, women may feel lower sexual desire, and that can impact relationships.

It affects them physically, too: The leading cause of iron deficiency anemia in women is heavy menstrual bleeding. This makes them feel exhausted, dizzy, fatigued, short of breath and experience cognitive dysfunction. Treating it can require blood or iron transfusions — which means they have to take time away from their life to go to doctor visits and sit there for these infusions.

When should someone seek treatment for abnormal bleeding?

Many women don’t realize how abnormal their bleeding is. They’re used to it — they’ve bled that way since they were 11 years old, and their mom and sister had that kind of bleeding, and so they don’t realize that it’s not normal. A lot of times, they don’t seek treatment until someone diagnoses them with anemia or until life has become unbearable.

Don’t wait years for help. If your bleeding is interfering with your quality of life, tell your ob-gyn — there are so many things we can do to help.

What are some of the causes and treatments for abnormal bleeding?

Common causes for excessive bleeding are adenomyosis, a fibroid, a polyp, precancer or rarely, cancer — these are often due to structural issues within the uterus, and are typically treatable with an in-office procedure or surgery. Our patients are living a totally new life within weeks of their surgery.

Common causes for irregular bleeding are ovulatory dysfunction, polycystic ovary syndrome or a bleeding disorder, which we usually treat with nonhormonal medication or hormonal birth control, which can look like a pill, an intrauterine device (IUD), or an implant like Nexplanon.

Is it medically necessary to have a period?

Having a period is optional: Your ob-gyn has ways to stop it, like medication, surgery or an IUD, and there’s no reason you have to experience this every month if you’re comfortable with one of those options.

I hear women say all the time, “Isn’t it dangerous if I don’t have a period?” That’s a common misconception, rooted in some truth: If you’re not having a period and your ob-gyn isn’t helping you stop it, something is wrong. But if you’re seeing us and we’re managing that process of stopping it, it’s totally safe for you to not have a period.

Will it gross out my ob-gyn if I start talking about my period?

There’s no need to feel nervous about bringing it up: This is our job, this is what we are specifically trained to deal with, and these are stories we hear multiple times a day. A lot of women are dealing with this, even if they don’t necessarily talk to their friends about it.

Every woman deserves to feel heard, understood and empowered when it comes to her health — and that's exactly how I want my patients to feel. Our goal is to improve your quality of life, and nothing brings us more joy than to hear that we really helped you.