As a woman, you get to know your typical period—how long it lasts, how heavy it is, how you feel before and during.
If you notice a change to your cycle, you might wonder what’s going on and if you should call your doctor. Is it a normal variation or something that needs attention?
UNC Health OB-GYN Michael D. Evers, MD, shares five reasons you might notice changes in your menstrual cycle.
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You’re pregnant or postpartum.
Of course, if your periods abruptly stop, the first question to consider is whether you could be pregnant.
Or maybe you’ve recently had a baby and are wondering when your period is coming back and what it’s going to be like. If you’re not breastfeeding, it should return within a month or so; if you are breastfeeding, it’s anyone’s guess. You won’t want to rely on breastfeeding as a form of contraception.
“Breastfeeding and pumping six to eight times a day usually suppresses the menstrual cycle, but for some, cycles do return within eight weeks,” Dr. Evers says. “This is why IUDs and other contraception methods can be wonderful if you’re breastfeeding and do not want to be pregnant again right away, as you could get pregnant at that first ovulation.”
When your period returns, it might be different than before.
“Some people go from lighter to heavier periods, some go the other way,” Dr. Evers says. “Sometimes periods become less painful after someone delivers a baby. Some people may not notice any change.”
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You’re getting older.
The last few years of menstruating, or perimenopause, can be unpredictable.
“It’s really all over the map,” Dr. Evers says. “For some, periods get lighter and start to space out a little bit; for others, it gets heavier and more intense, with more fatigue, hot flashes and night sweats.”
Your healthcare provider can help you with these transitions and any bothersome symptoms, such as cramping, heavy bleeding or hot flashes.
“If you’re not feeling right, or if your cycle is affecting your ability to go out and function, we can help you feel better,” Dr. Evers says. “You don’t have to prove your toughness.”
If you experience any bleeding after menopause, defined as having no periods for one year, contact your healthcare provider right away. It could be a sign of uterine cancer.
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You’re on contraception or another medication.
Many medications can affect the menstrual cycle, including antidepressants, blood thinners, steroids, antipsychotics, cancer medications and nonsteroidal anti-inflammatory drugs (NSAIDs). You might miss a period, notice changes in your flow or have some bleeding between periods.
Some birth control methods, including pills, rings, patches and shots, use hormones to prevent ovulation (the process of an ovary releasing an egg), and those hormones can affect other parts of your cycle. They may lessen your experience of cramps or the heaviness of your flow, or your period may stop altogether. Your provider may recommend one if you’re experiencing painful, long or heavy periods.
“If you’re having pain or heavy bleeding with a period, you should be evaluated,” Dr. Evers says. “Your cycle should not control you. If you’re having days where you can only wear black or don’t leave the house without an extra change of clothes, you don’t have to endure that.”
Talk to your provider if you’re noticing any concerning changes after starting a new medication.
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You have a medical condition.
Many medical conditions can cause your period to stop, be infrequent or feel more painful.
Sometimes the issue is in your uterus: With endometriosis, the endometrial tissue grows outside the uterus, causing pain; fibroids are noncancerous growths in the uterus that can cause heavy bleeding and pelvic pain depending on their location in the uterus.
Other times, the process is disrupted by hormonal conditions. People with polyendocrine metabolic ovarian syndrome, formerly known as polycystic ovary syndrome, have irregular menstrual cycles along with other hormonal and metabolic symptoms, such as acne, excess facial or body hair and difficulty managing weight. Both an overactive and an underactive thyroid can cause changes.
Unmanaged diabetes or autoimmune disorders also can affect your period.
Even short-term illness, like the flu or COVID-19, can make your period seem a little different.
Talk to your doctor about painful and missed periods.
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You’re stressed or have had a significant change in weight.
Your overall health affects the health of your menstrual cycle.
“Stress can change or even shut down ovulation,” Dr. Evers says. “Buying a home, having major changes in your relationship, having a very sick child or family member—they could all shut the cycle down for a while.”
Your stress also could be changing your eating habits, and significant changes in weight can affect your period. Weight loss or being underweight can cause irregular cycles or cause your period to stop entirely; sudden weight gain or obesity can cause irregular cycles.
People who are extremely active because they participate in endurance events or competitive sports may also experience period changes. Because these changes can be a sign of relative energy deficiency in sport (REDs), also known as the female athlete triad, you may need to work with a dietitian to be sure that your diet supports your training goals and your body.
Fortunately, healthy habits like regular exercise, a balanced diet and managing stress all can help, and your provider is available to help, too, if you let them know it’s an issue.
“This shouldn’t be a big, black box that you feel like you can’t discuss,” Dr. Evers says. “Menstrual bleeding is something half the population has. This is a human experience we can make a little easier.”
Talk to your provider if you’re concerned about your menstrual cycle. Need a doctor? Find one near you.