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By Angela Hiatt

After experiencing menstruation for years, you probably have a pretty good idea of what your typical period is like. It might not be the same as your sister's or your best friend's — every period is certainly unique — but you know more or less what symptoms to expect, how heavy your flow will be and how many bags of chocolate-covered pretzels you need to keep on hand.

For most women, "normal" menstruation means that your period occurs every 28 days, plus or minus 7 days, and lasts for 3 to 7 days, said Erich Wyckoff, MD, assistant professor in the Department of Obstetrics and Gynecology at University of South Florida College of Medicine.

If you start to experience changes in your normal period, it's time to take note. Spotting between periods, variations in flow or severe pain can actually be signs of more serious problems. Read on to find out what symptoms to watch out for and when to call your doctor.

Abdominal Cramps or Lower Back Pain

What's normal: Because your uterus contracts to shed its lining during your period, it's normal to feel some discomfort in your abdomen or lower back at the beginning of your cycle.

However, Dr. Wyckoff warns that pain lasting longer than 24 hours without improvement, or pain that is unresponsive to traditional remedies (like over-the-counter pain relievers, rest or a hot water bottle) are generally signs that something is wrong.

"Abdominal pain associated with shortness of breath, tachycardia (elevated heart rate), dizziness and/or fever may also be a reason for concern," Dr. Wyckoff said.

Possible causes: Endometriosis, pelvic inflammatory disease (PID), ectopic pregnancy, uterine fibroids, ovarian cancer, endometrial cancer, premenstrual syndrome (PMS), use of a copper intrauterine device (IUD) or stress and anxiety.

Call your doctor if: the pain is sudden or severe, occurs at times other than menstruation, lasts daily for more than a week or is accompanied by a fever. Also call if you have symptoms of PID, endometriosis or fibroids.

Bleeding Between Periods

What's normal: Simply put, bleeding between your periods isn't normal. Bleeding during your cycle is your body's way of telling you that your reproductive system is working, so when you bleed outside of your normal period, it may raise a red flag.

If you are taking oral contraceptives and you miss a pill, your body gets confusing signals from your hormones that may cause spotting. Generally, if you are bleeding in between periods and there's not an obvious cause (such as forgetting to take the pill), you should contact your doctor for an exam.

Possible causes: Forgetting to take your birth control pill, use of blood thinners, use of an IUD, injury to the vaginal area, miscarriage or other pregnancy complications, PID, fibroids or ectopic pregnancy.

Call your doctor if: the bleeding is unexplained.

Absent or Lighter-Than-Normal Periods

What's normal: If your period suddenly becomes significantly lighter than usual or if it disappears entirely, you should investigate the cause. A good place to start is with a pregnancy test, either done at home or in your doctor's office.

Possible causes: Pregnancy, weight loss, weight gain, eating disorders, excessive exercise, stress or anxiety, hormonal imbalance, use of birth control pills or IUD, menopause, premature ovarian failure, thyroid disease or pituitary disease, polycystic ovarian syndrome (PCOS) or PID.

Call your doctor if: you previously menstruated, but have missed three or more periods in a row, or if you have any symptoms of PID or PCOS.

Longer or Heavier-Than-Normal Periods

What's normal: If your period soaks through a pad or tampon within an hour, that's considered heavy bleeding, said Dr. Wyckoff. Heavy loss of blood can reduce your iron content, leading to anemia and fatigue, so it's important to monitor your flow for changes in length and intensity.

Possible causes: PCOS, fibroids, endometrial cancer or cervical cancer.

Call your doctor if: you are bleeding heavily between periods, the bleeding is heavier and longer than usual, you have feelings of fullness or heaviness in your belly and you have not received regular pap smears. Also call if you have any symptoms of PCOS or fibroids. Dr. Wyckoff warns that passing large blood clots can also be indicative of a problem.

Severe PMS

What's normal: Premenstrual syndrome is suspected to affect up to 75 percent of women during childbearing years. A wide range of emotional and physical symptoms are encompassed in PMS; everything from bloating, clumsiness and diarrhea to edginess, irritability and fatigue.

If your symptoms are so severe that it prevents you from performing daily activities, and if you're feeling marked anger or persistent irritability, it may be a sign that you're suffering from more than PMS.

Possible causes: Premenstrual dysphoric disorder (PMDD).

Call your doctor if: you have any symptoms of PMDD.

The Bottom Line

Whether you are experiencing lower back pain, PMS or light periods, Dr. Wyckoff reminds you that there is "never a wrong time to call" your doctor with questions.

The most important action you can take to protect your health is to monitor your periods closely. Try MedHelp's free online menstrual cycle tracker or simply keep notes on a calendar. Pay close attention to the duration and strength of your flows, your moods and any pain — if any of your normal period traits falter, you will be the first to know.

Angela is a Montana-based freelance writer and social media editor.

Published October 10, 2011.

Reviewed by:

Wayne S. Blocker, MD
Board Certification:  Obstetrics & Gynecology
Licensure:  FL #ME0025645
Reviewed on: 10/3/18
Statistics have been verified

See also:

• 4 Telltale Signs of Endometriosis
• Know Your Symptoms: Track Your Menstrual Cycle
• Get answers to your questions in our gynecolgoy and women's health forum
• The Menstrual Cycle 101
• Endometriosis: Get the Facts