It’s a question I’m asked frequently in the office…

Dr. McDonald, is it okay if I don’t have my period?

or…

My period is pretty heavy. Is this too much?

In this post, I’ll break down when it is okay to skip a period and when it is not. I will also make it clear if you are bleeding too much and need to have yourself evaluated and possibly treated.

Remember when your period started?

When many girls start having periods in adolescence, periods are often pretty irregular. It is not uncommon for a teenager to have a period every 1-3 months in an unpredictable pattern. While tracking periods on your cell may be helpful, sometimes periods jump out and yell a bloody “SURPRISE!” I absolutely remember getting up from my desk and having to wrap my sweater around my waist in middle school because my uterus was a bully!

Predictability can sometimes be achieved with exercise, maintaining a healthy weight, and sometimes with the aid of hormonal birth control.

When is it okay to skip my menstrual cycle, or my period?

A person who is NOT on hormonal birth control needs to see a menstrual flow, as in blood, every 1-2 months. Every 21-35 days is average, but at least every 45-60 days should be enough to keep the uterus safe.

If a person IS on certain types of hormonal birth control, as in some types of oral contraceptives, a patch, a shot, a ring, an implant containing a progestin, that person does NOT NEED to have a period. WHY? It is because some forms of hormonal birth control thin the uterine lining and don’t leave much blood to shed. You don’t NEED to bleed to be healthy. Menstrual blood only serves to refresh and prepare a fresh place for a pregnancy when you aren’t on birth control. If the pregnancy is being prevented, you don’t need to make a space in the uterus by shedding the lining.

Why don’t I need to bleed every month when I’m on birth control?

The analogy that I like to use is that it is like the difference between the house of a hoarder and a vacant house. If you are a hoarder you only bring stuff in your house and never take anything out. It gets crusty, dirty and cluttered. Even unsafe. That is what can happen in the uterus if you aren’t on birth control. You keep adding to the uterine lining and never let anything out, which increases risks for precancerous and cancerous changes in the uterus.

In contrast, the uterus of a person on certain types of hormonal birth control is one that is very cleaned out. The lining of the uterus is thin, so thin that nothing needs to come out. It is like a house that is vacant. Nothing comes out because nothing is in there. And THAT’S OKAY. Check with your doctor to see if you are on the type of birth control that can cause little or no period, just so that you are sure that your type is what I’m talking about.

How much bleeding is too much?

Now we’re talking about bleeding that is either too frequent or too high in volume.

If you bleed more frequently than every 21 days, that is too often. That includes spotting too. Spotting off of birth control could be normal, but it could be a sign of a polyp, fibroid, or cervical pre-cancer or cancer. While everything could be fine, you should absolutely check in with your doctor or healthcare provider to make sure everything is normal.

If you ARE on birth control, any of those aforementioned things could be a thing, or you could just be on the wrong form of birth control. You may need one that is more compatible with your body.

But what about the amount of blood?

Oh, that’s easy. Just don’t lose more than 80 ml of blood per menstrual period.

Just kidding. I wouldn’t leave you in the dark like that. The average blood loss during a period is 35 ml. The average regular tampon or pad takes 5 ml before it is soaked. So if during your entire period you use 7 tampons or pads, SOAKED ones, you’re about average. If you are soaking more than 16 regular pads or tampons during your cycle, you may be bleeding too much.

Let’s run through a scenario…

Day 1, you change a liner or minimally soaked tampon twice during the day. Day 2, you change a soaked tampon every 4 hours, like 3 times during the day and once at night. Day 3 you change a half soaked pad/tampon twice. Day 4 and 5, you are barely bleeding.

Total= about 6 total soaked tampons. Normal, no problem

Scenario #2: Day 1, you change a soaked tampon every 4 hours (3). Day 2, you change a soaked tampon AND pad (to catch overflow) every 2 hours (8), Day 3, same thing, oh and you messed up your bedsheets, which happens sometimes. Day 4, you can get away with a tampon every 3-4 hours. Day 5-7, same but every 5-6 hours.

Total= Okay, I lost count, but you hit 16 just on days 2 and 3, so you’re definitely over.

So what’s wrong with a heavy period?

Too much bleeding can cause anemia, which can affect your immune system, your energy and your overall health. AND, sometimes heavily bleeding can be a sign of structural abnormalities of the uterus or bleeding disorders, both of which can affect your overall health and reproduction.

Plus, who wants to be buying all of those pads and tampons. That’s too much blood for a Diva Cup or like product. And soiling clothing and sheets is just WRONG.

What can your doctor do about the heavy bleeding?

We can check you for hormonal, and structural causes. A thyroid problem, a polyp, a fibroid, a bleeding disorder… any of these things can cause heavy bleeding. We can treat or remove structural causes, or we can use hormonal or NON-hormonal medications to decrease blood loss. Tranexamic acid is an example of a non-hormonal medication that can slow bleeding.

In the end, it is important to know what is normal and to communicate concerns to your doctor or other healthcare provider. Comment below if you have general questions or want clarification of any of these concepts.

PERIOD

You already knew this article was going to end that way…

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