Periods
A period is the shedding of the lining of the womb, which repeats roughly once a month from the teenage years until the menopause.
On this page
- What an ordinary period looks like
- The first period: what to expect and when to see a doctor
- What to use during those days
- Period pain: the ordinary kind and the kind that is not
- The days before a period
- When the bleeding is too heavy
- A disrupted rhythm: late, missed and unpredictable periods
- Bleeding that cannot wait
- Online consultation
Medicines commonly prescribed for Periods
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 600 mgActive substance: ibuprofenManufacturer: Zambon S.A.U.Prescription required
A period is the shedding of the lining of the womb, which repeats roughly once a month from the teenage years until the menopause. It is not an illness and needs no treatment, but a period is the easiest place to notice that something in the body has shifted: the cycle slips, the bleeding becomes visibly heavier, the pain stops responding to what used to work. What follows is what counts as ordinary here, what is worth raising with a doctor without hurrying, and when waiting is not an option.
What an ordinary period looks like
The range of normal is wider than most people assume, and "what my friend gets" is a poor yardstick.
- Cycle length runs from the first day of one period to the first day of the next. It is usually 21 to 35 days; 28 is not a standard, simply the commonest figure.
- Length of bleeding is two to seven days, most often about five, with the first two days the heaviest.
- Amount. Measuring it precisely is impossible, so it is judged another way: how many pads get used, whether you have to get up at night, whether there are leaks.
- Colour. On heavy days the blood is bright red; on light days it may be pink or brown. A dark shade only means the blood took longer to come out.
- Clots about the size of a coin on heavy days are common and mean nothing in themselves.
The second half of the cycle is worth understanding too. Ovulation happens roughly 12 to 16 days before the next period, and sperm keep the ability to fertilise for several days. That is why calendar-based "safe days" are unreliable: ovulation only has to shift and the arithmetic stops working. A cycle-tracking app is handy as a diary, but it is not contraception.
The first period: what to expect and when to see a doctor
A first period usually arrives between the ages of ten and fifteen, and almost always about two years after the breasts start to develop. Before it, hair appears under the arms and on the pubic area, and a few months ahead of it a pale discharge shows on underwear. For the first year or two the cycle is often irregular, arriving after three weeks or after two months. That is normal behaviour for a system that has only just started up.
See a doctor if there are no periods by fifteen, if there are none by thirteen and no signs of puberty either, or if more than three years have passed since the breasts began to develop. The causes vary widely, from low weight and heavy sporting loads to thyroid disorders and differences in the anatomy of the reproductive organs, and almost all of them respond better the earlier they are looked into.
A teenager is best told about this in pieces and in advance, rather than in one solemn conversation after the fact, and it helps if pads are already in the school bag. Boys should know what periods are as well.
What to use during those days
Choosing a product is a matter of comfort, not of getting it right. Everything below is safe, including for someone whose periods have only just started.
- Pads stick to underwear and come in different absorbencies, including thin liners for the last days; washable reusable ones exist too.
- Tampons go into the vagina, with or without an applicator. A correctly placed tampon cannot be felt; if it is uncomfortable or sore, it has not gone in far enough. It cannot get lost inside you — the string always stays outside.
- Menstrual cups are made of silicone and collect the blood rather than absorbing it; they are washed and reused for years. They take some getting used to, but can be worn for longer at a stretch than a tampon.
- Period underwear is pants made of absorbent fabric with a leak-proof layer, washed and worn again.
Tampons and cups carry one rare but dangerous complication: toxic shock syndrome. Use the lowest absorbency that is enough for you, change a tampon every few hours, never leave one in for more than eight hours or overnight, and insert and remove it with clean hands. Take the tampon out at once and call an ambulance if, during a period, you suddenly develop a high temperature with vomiting or diarrhoea, a rash resembling sunburn, severe weakness or confusion. And if a tampon has been forgotten and you cannot get it out, there is nothing to be embarrassed about: a doctor will remove it in a minute.
Period pain: the ordinary kind and the kind that is not
The dragging pain of the first day or two comes from the womb contracting, and for most women it is moderate. Warmth on the lower abdomen and moving about both help, and among medicines, anti-inflammatory painkillers act on the very mechanism of that pain and work better taken from the start rather than once it has become unbearable.
These drugs have limits: they are not taken with a stomach ulcer or a bleed from the stomach, with serious kidney, liver or heart disease, or with asthma that has flared on similar medicines before, and they are combined cautiously with blood-thinning treatment. If any of that applies to you, talk the pain relief through with a doctor; the alternative is usually paracetamol. Aspirin is a poor choice for period pain: it makes bleeding heavier, and children and teenagers are not given it at all. Hormonal contraception noticeably reduces the pain for many women, and that is a legitimate reason to discuss it.
Pain stops being ordinary if it forces you to miss work or school, does not settle with painkillers, starts a week before the period and carries on afterwards, spreads into the lower back and the rectum, or comes with pain during sex, when opening the bowels or when passing urine. Endometriosis, in which tissue resembling the womb lining grows outside it, often lies behind that picture; for many women years pass between the first complaints and the diagnosis, simply because the pain gets put down to "that time of the month". Adenomyosis causes much the same. Sudden one-sided pain in mid-cycle is usually ovulation, but if it is severe and has not eased within a day it needs to be seen.
The days before a period
A week to ten days before the bleeding, sex hormone levels change, and some women feel it in the body and in the mood. This is premenstrual syndrome: bloating, tender breasts, food cravings, spots, headache, irritability, tearfulness, exhaustion. Its distinguishing feature is that all of it lifts once the period starts and disappears entirely in the first half of the cycle.
Regular sleep, movement and cutting back on alcohol and caffeine over those days all help. If the symptoms wreck relationships or work — particularly sharp mood swings, anxiety and hopelessness — this may be premenstrual dysphoric disorder, and it is treated with a plan a doctor puts together, not by waiting for it to be grown out of.
Menstrual migraine is a story of its own. Attacks begin a couple of days before the period or in its first days, tend to be worse than usual attacks, and often come with nausea and an inability to tolerate light. Both things matter: getting the treatment right, and taking the migraine into account when choosing contraception, since combined pills are usually avoided in migraine with visual aura.
When the bleeding is too heavy
A period counts as heavy not by millilitres but by how far it intrudes on life: you have to change a pad or tampon more often than every two hours, use two products at once, get up in the night or drop plans for fear of leaking; clots come away that are bigger than a coin; the period leaves you noticeably weak afterwards.
Continuous blood loss drains the body's iron stores, and it is often that, rather than the period itself, that explains the tiredness, the breathlessness on stairs, the pallor, the brittle nails and the odd urge to chew ice. It is sorted out simply, with a full blood count and a ferritin level.
The causes vary: fibroids, adenomyosis, polyps, a thickened womb lining, a copper coil, an underactive thyroid, or blood-thinning medication. One pointer is worth remembering separately: if periods have been heavy since the very first one and you also bruise easily, get frequent nosebleeds, bleed for a long time from cuts, or had a significant bleed after a tooth extraction or childbirth, clotting needs to be checked. Inherited bleeding disorders go unrecognised in women for decades, and yet they change both the treatment and the preparation for any operation.
Assessment usually includes an examination, blood tests and an ultrasound scan. Tranexamic acid taken on the bleeding days helps, as do anti-inflammatory painkillers and hormonal options — the most effective of which is the hormone-releasing intrauterine system — while fibroids and polyps sometimes call for a procedure.
A disrupted rhythm: late, missed and unpredictable periods
The first thing ruled out when a sexually active woman's period is late is pregnancy, and it is ruled out with a test rather than by reasoning. A test done too early can come back negative, so if the period still has not come it is repeated a few days later.
If there is no pregnancy, other causes are looked for: sudden weight loss or being underweight, heavy physical training, prolonged stress, polycystic ovary syndrome, thyroid disease, a raised prolactin level, a recent change or stopping of contraception, serious illness. The ovaries running down before the age of forty is checked for separately: it is uncommon, but important not to miss, because those women need hormonal support to protect their bones and blood vessels.
See a doctor if there have been no periods for three cycles in a row with a negative pregnancy test, if the cycle has suddenly become irregular for no clear reason, or if periods have become much lighter or, conversely, barely stop.
Somewhere between forty-five and fifty-five the cycle naturally begins to change: periods come further apart or closer together, the amount swings, and hot flushes and night sweats join in. This is the perimenopause, and it not uncommonly lasts several years. One important detail: while periods continue at all, however infrequent, pregnancy remains possible. And another: a period can be deliberately delayed for a trip or a competition, but how it is done depends on which contraception you take, so it is arranged with a doctor in good time rather than two days beforehand.
Bleeding that cannot wait
Some bleeding has nothing to do with the cycle, and it is always shown to a doctor, even if it happens once and is slight:
- bleeding between periods;
- bleeding after sex;
- any bleeding after the menopause, that is, a year or more after the last period.
The causes are more often harmless — an infection, a polyp, changes on the cervix, a missed pill — but a pre-cancerous change or a cancer of the cervix or the body of the womb can lie behind them, and this is precisely the case where checking early changes the outcome. It is also a good moment to recall whether you have had cervical screening; the intervals and the method are set by your country's national programme. A normal result from an earlier screen does not remove the need to investigate new bleeding.
Call an ambulance — in Spain, Italy, Portugal, Poland and Ukraine the single number is 112 — if:
- blood soaks right through a pad or tampon every hour for two hours or more;
- you become dizzy or your vision darkens, you faint, your heart races, you break into a cold sweat or become breathless;
- a late period is followed by sudden one-sided pain low in the abdomen, especially with shoulder-tip pain, weakness or bleeding — an ectopic pregnancy can present this way;
- during a period the temperature shoots up with a rash, vomiting and confusion while a tampon or cup is in place.
Online consultation
Heavy bleeding and sudden severe abdominal pain are not sorted out online: those need an examination and tests the same day. Almost everything else, though, is well suited to a conversation from home and often comes sooner than a waiting list. A doctor can help you work out whether your cycle falls within normal limits or is due to be investigated; explain the blood count, the ferritin and the scan; adjust pain relief if the usual medicines do not suit your stomach or your asthma; go through what to do about heavy periods; help you choose contraception with your migraine, your blood pressure and your plans for pregnancy in mind; explain how to delay a period for a trip. Reasons of their own to write in: a late period with a negative test, periods that have stopped before the age of forty, and any bleeding between cycles or after the menopause — those are not for putting off, but for working out who to see and how quickly.
This material is for information only and does not replace medical advice.
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Online doctors for Periods
Discuss your symptoms and possible next steps for Periods with a doctor online.
