How to Tell If Your Irregular Periods Are a Sign of a Bigger Health Issue

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When is an irregular period a potential warning sign of a bigger health issue?

There is one pretty glaring medical issue that can interrupt your period: pregnancy. If you’ve had unprotected sex, or PIV intercourse in general, and your period is late or missing, you should take a pregnancy test to rule that out completely. If you can’t tie your irregular period to pregnancy or any recent life events, medication changes, or lifestyle habits, something else could be at play, health-wise.

AnnaMaria Maples, MD, an ob-gyn at Emory University School of Medicine inAtlanta, tells SELF that three or more months of irregular menstrual bleeding is a red flag that could indicate a bigger health issue, like a hormonal imbalance. 

“It’s important to have regular exposure to progesterone and estrogen,” Dr. Maples says. Ordinarily, that exposure would come from your own body’s production of those hormones. “Naturally, ovaries make these hormones and, together, they impact the menstrual cycle.” 

The specific way that your period is irregular can also tell you something about what the potential cause could be. “If you’re skipping many months between periods, that can sometimes be a sign of PCOS, or polycystic ovary syndrome,” says Dr. Kossl. “For those patients, sometimes when they’re skipping months, when their periods actually do come, they can be heavy or prolonged.” Dr. Kossl also notes that PCOS can be tough to diagnose, and that people with the condition often experience other symptoms outside of irregular periods. If you’re experiencing frequent ovarian cysts, hair growth that feels outside of your norm, acne, rapid weight fluctuations, prediabetes, or difficulty getting pregnant on top of an irregular period, consider talking to a doctor about getting tested for PCOS, which could mean undergoing a pelvic exam, some blood tests, and/or an ultrasound, per the Mayo Clinic.

Dr. Cron says that debilitating menstrual pain also often indicates a bigger issue. She points to endometriosis—a condition that Lena Dunham, Halsey, and Padma Lakshmi have all spoken about living with—as a particularly excruciating cause of menstrual irregularity, as well as other symptoms, like pain during sex, fertility issues, stomach problems, and persistent fatigue, among others.

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When should I see a doctor about my irregular periods, and what should I say during the appointment? 

According to Dr. Kossl, if your period is causing you significant discomfort of any kind—or you just feel like something is off—you should discuss that with a medical professional. “If anybody’s experiencing changes to their periods that are resulting in bothersome symptoms, that’s always worth addressing,” she says. “That doesn’t necessarily mean that there’s something wrong or abnormal, but that’s what we’re here for as providers. People shouldn’t have quality of life issues secondary to menstrual periods.”

If a visit to the doctor is an emergencies-only situation for you, the symptoms that can come with issues like PCOS and endometriosis are big signs that it’s time to talk to a health care provider. That means if you’re experiencing lots of pain (especially during sex), persistent fatigue, fertility issues, adult acne, or hair growth that feels abnormal for you, and irregular periods, that’s your signal to make an appointment if you can.

So is nonstop bleeding—according to the Centers for Disease Control and Prevention, you should see a doctor if you are passing period blood clots that are the size of a quarter or larger, or bleeding through a pad or tampon in less than two hours. “In that case, we would do evaluations to see if there’s anything structural in the uterus, such as fibroids or polyps,” Dr. Kossl says. “For [people] who might be a little bit closer to menopausal range, we’d also be looking at some safety checks to make sure that we’re not seeing any precancerous or cancerous tissue that is presenting with abnormal bleeding.”