That time of the month again? Periods are a part of life for many years for most women. They can, unfortunately, have a negative impact on your quality of life with cramps, bloating, breast tenderness, mood changes and irregular bleeding.

During your lifetime, your menstrual cycle and periods change and evolve due to normal age-related hormonal changes and other factors such as stress, lifestyle, medications and certain medical conditions. But what is normal and what should you be concerned about?

Here are some common terms used to describe menstrual periods:

• Menarche: The age when an adolescent girl begins to have her period.
• Amenorrhea: When a women does not have a period for 6 months or more. Primary amenorrhea is when an adolescent never begins having a period, and secondary amenorrhea is when a women stops having periods.
• Oligomenorrhea: When a woman has infrequent periods that occur at intervals greater than every 35 days and up to every 6 months.
• Dysmenorrhea: When a woman experiences painful periods.
• Perimenopause: This is a period of time leading up to menopause that may last for a few months to a few years. During perimenopause, a woman does not ovulate regularly and she has irregular cycles that may occur monthly to every few months. She may also experience some periodic symptoms of menopause such as hot flashes.
• Menopause: When a woman’s ovaries stop ovulating and producing adequate hormones leading to no periods for more than a year. Menopause may be accompanied by hot flashes, vaginal dryness and other symptoms

Your period tends to change through the decades. Here is what you may experience:

Adolescence

Although there’s no way to pinpoint when a girl will get her first menstrual period, the median age in this country and worldwide is between 12-13 years and typically happens about 1.5-3 years after breasts start to develop. One factor that can impact menarche is a young girl’s body mass index (BMI) which is calculated by a ratio of her weight and height (weight in kilograms (kg) divided by her height in meters squared). If a young girl has not had her first period by age 15 or within three years of breast development, she should be evaluated by a physician.

Menstruation may be irregular at first, with as many as 6 months passing between periods. Most cycles are in the range of 21-45 days, although shorter or longer cycles may occur. By the third year, most menstrual cycles are that of a typical adult woman: 21-34 days long (28 days on average), and each period lasting for 2-7 days.

Teens/20s

Once you enter your 20s, your period will likely become more consistent as you begin to ovulate more regularly. You may start to experience more symptoms, like PMS, cramps and breast tenderness. 

This is also the time that many women decide to begin birth control pills or other forms of contraception. Contraception may change your periods by making them shorter, lighter and more regular with less bleeding, cramping, and reduced PMS symptoms. Different contraception options will impact your menstrual cycle and period differently. Your physician should discuss these different changes with you when deciding on a contraception option. In addition, you should be aware of the menstrual side effects that each form of contraception may have.

30s

Your menstrual cycle should be pretty predictable and consistent in this decade. Some benign conditions can appear in your 30s, including fibroids and polyps of the endometrium or cervix. Sometimes, these conditions can make your period heavier and cause painful cramps or you may experience intermenstrual bleeding. 

During your reproductive lifetime (teens through 40s) your cycle can also change after you have a baby. Your period usually won’t return until 6 weeks after delivery, and if you’re breastfeeding it may not return until you stop even if you breastfeed for a year or more. Some women experience heavier, longer or more painful periods, and for others, their periods improve after having a baby.

40s

Beginning in your 40s, the amount of estrogen produced by the ovaries may begin to fluctuate and you may not ovulate as regularly. These are the years leading up to menopause, called perimenopause. Perimenopause can last from a few months to more than 10 years prior to your last menstrual period.

The most common symptom of perimenopause is a change in your menstrual cycle. You may have periods that are longer, shorter, heavier or lighter than usual, or you may begin to skip periods. You may also experience hot flashes, sleep issues, vaginal dryness, urinary issues and emotional changes.

50s

Most women will experience menopause in their 50s. The average age of menopause is 51 and a normal range is between ages 45-55. A good indicator of when you may begin menopause is when your mother did.

Other factors that can impact age of menopause include the number of babies you have (women with more babies tend to have later menopause), tobacco users may have menopause earlier and ethnicity can impact age of menopause. African American and Hispanic women tend to have earlier menopause than Caucasian women. If you experience bleeding after menopause, let your doctor know right away. It could be a sign of something serious like uterine cancer.

Your period is a good indicator of what’s going on with your body and your overall health. Although your menstrual cycle can change over time, alert you doctor if you notice any of these potentially serious symptoms:

• Pelvic pain/abdominal discomfort. Constant pain could signal uterine fibroids or endometriosis. Sharp pelvic pain may be a sign of an infection, a ruptured ovarian cyst, or an ectopic pregnancy.
• Bleeding between periods. Occasional spotting happens, but let your doctor know if mid-month spotting keeps occurring, lasts for days, or is heavy and painful. It could signal an injury to the vagina, a miscarriage, or even cancer.
• Heavy periods/missed periods. Let your doctor know of any unusual changes to your cycle, such as unusually heavy periods (e.g., having to change your pad/tampon every hour), or bleeding that lasts longer than a week. Irregular or missed periods can be normal at times but may indicate a medical condition that needs to be addressed.
• Postmenopausal bleeding. If you start bleeding after menopause you should consult your physician as this can be a symptom of gynecologic cancer such as cervical or endometrial cancer.

Your menstrual cycle can tell you a lot about your overall health. Pay attention to what’s normal for you. If at any time you experience any unusual symptoms or sudden changes to your cycle, let your doctor know.

All women who are sexually active and/or who are over 21 should see their gynecologist yearly for routine checkups and screenings. Find an OB-GYN.

Jeffrey Fitzer, M.D., is an obstetrician and gynecologist at Elmhurst Clinic. Read his profile and schedule an appointment online.

Learn more about women’s health at Edward-Elmhurst Health.

Related blogs:

Puberty: What’s normal, what’s not?

Hot flashes anyone? Answers to your questions about menopause