For many women, the only times we receive much education about our periods are at puberty and menopause. You might assume that after the teenage years, your period should be on a regular cycle, unchanged until menopause, but this isn't true. Along with the menstrual cycle disruptions of pregnancy, birth control pills, and illnesses, you may have very different periods through the different decades of your reproductive years.
The 20s: Typically, by the time you reach your 20s, the hormonal chaos that accompanies puberty has mostly subsided, and your hormone levels are as balanced as they will ever be. There is no one "right" menstrual cycle, but the average time between one period and the next for a woman in her 20s is 32 days. Periods may be very predictable-like clockwork, even-especially if you are using birth control pills.
This doesn't mean, however, that you should necessarily be concerned if your periods are irregular. A woman's menstrual cycle is a complex interaction between her reproductive system; hormones produced in the pituitary glands, hypothalamus and thyroid; and the environment. Stress, diet, and the amount of sleep and exercise you get all influence your cycle, too.
When should you be concerned? Generally, these are signs that you should see a health care provider:
Severe PMS: If you are bothered by physical changes or changes in your mood consistently each month, see a health care provider to rule out underlying causes, such as clinical depression, uterine fibroids, or endometriosis.
Painful periods: Some discomfort is normal, but if the pain is severe, consistent, and not relieved by an over-the-counter medication such as ibuprofen, see a health care provider to rule out an infection, scar tissue, or another underlying cause.
Missed, or infrequent, periods: If you are sexually active, have a pregnancy test done first. An occasional missed period, even if you aren't pregnant, shouldn't be a concern. They can be caused by too much exercise, stress, and certain medications. If you have gone more than 3 months without a period and are not pregnant, see a health care provider to rule out a hormone imbalance, ovarian cysts, or certain hypothalamus or pituitary conditions.
Unusually heavy periods: If a pregnancy is possible, an unusually heavy period could be a sign of miscarriage. If you consistently have heavy periods, your health care provider may want to rule out endometrial cancer or an underlying thyroid or blood-clotting disorder.
These conditions are all treatable. Don't be afraid to see your health care provider if you feel there is something unusual or wrong about the way your body functions.
The 30s: As you transition from your 20s to your 30s, and especially by the age of 35, your body begins to produce less estrogen. You may find that your menstrual cycle has shortened, from an average of 32 to 28 days. You may also notice shorter or irregular periods, increased symptoms of PMS, a heavier menstrual flow, or a combination of these changes. These hormone fluctuations are sometimes referred to as perimenopause, which simply means "the time around menopause."
As our estrogen levels begin to decline, our fertility begins to decline as well. We may experience some of the changes associated with menopause, including the thinning and drying of vaginal tissue, breast tenderness, an increased buildup of body fat around the waistline, hot flashes, and night sweats. A woman may experience these changes for up to fifteen years before her last menstrual period. For some women, these body changes will be more severe during perimenopause than during menopause itself. In fact, seven to eleven percent of women in their late 30s will stop having periods.
If you are severely bothered by the hormone fluctuations and the body changes associated with them, you might first consider lifestyle changes to ease the symptoms. Eating well, getting moderate exercise, reducing your stress level, and getting adequate rest may make the symptoms more manageable. If lifestyle changes don't solve the problem, you may want to see your health care provider and find out whether hormone therapy, either in the form of birth control pills to help regulate hormones or estrogen replacement therapy, is appropriate for you.
For some women, the perimenopausal years may mean changes in heart health. If you experience any heart symptoms, including skipped beats or moments of rapid heart fluttering, see your health care provider immediately to rule out an underlying heart problem. After you have had these heart symptoms checked out by your doctor, you may find that some heart symptoms become a consistent part of your cycle. Know your own body and what is normal for you.
The 40s: Women typically experience the body changes of perimenopause six to ten years before our menstrual periods stop. For most of us, this means we'll experience perimenopause by our late 40s. Depending on family history and other factors, you may also stop having periods in your 40s. The average woman will experience shorter cycles. In contrast to what many of us experience in our 30s, you may also have lighter menstrual flows. Ovulation occurs less frequently than it did in your 20s and 30s, and fertility continues to decline.
If you haven't already learned what to expect from your body during and after menopause, now is the time to educate yourself. If possible, talk to your mother, grandmother, and aunts about their experiences. Even if lifestyle changes worked well for you in your thirties, you may now want to talk to your health care provider about hormone replacement therapy.
Remember, too, that for many women, the transition from the menstrual to the post-menopausal years is a relief and has many positive aspects. Our bodies will change; this is inevitable. Suffering, physically or emotionally, because of these changes is not inevitable.
Women of any age should keep track of when our periods begin and end each month, and be aware of changes in our bodies' rhythms. This way, when we do notice something unusual or bothersome, we'll be better prepared to discuss the changes with our health care providers.