Your frequently asked questions about your period answered by Bird&Be’s Chief Medical Advisor Dr. Dan Nayot.
What causes period-like spotting in the middle of my cycle?
Most women don’t experience this, but some do. We’re not sure of the exact cause of spotting right around ovulation, but it isn’t necessarily considered abnormal and could just be from the drop of estrogen which is part of the normal ovulation physiology. It can also be common with those who are trying to conceive, and therefore having sex around the time of ovulation, which may cause minor trauma to the cervix resulting in spotting or bleeding. There can be other causes of inter-cycle bleeding including polyps or fibroids within the uterus. Check in with your doctor if you’re concerned.
My period has changed since coming off hormonal birth control—is this normal?
The pill is a combination of estrogen and progesterone (which thins the uterine lining). When you’re on hormonal birth control pills, your lining is very thin because you’re on progesterone every day—and if your lining is very thin, you don’t have that much to shed, and your periods are lighter. It’s not unexpected that your natural-cycle periods are different from periods while on the pill, since in the natural cycles your lining thickens in the follicular phase (estrogen only) and progesterone is around only after ovulation, so you have more endometrial tissue to shed. Learn more about what constitutes a normal period.
My period has changed since my miscarriage—is this normal?
The key is to document any possible changes in your menstrual cycle and flow. Having a record of what your periods used to be like and what they currently are, will give you a good indication if things have really changed or not. Certainly, things can change after a miscarriage. What we, as doctors, worry about is a miscarriage that may have developed into uterine infection or a surgery performed for the miscarriage (like a D+C, dilatation and curettage) that has caused scarring in the uterus. If you’ve noticed a big change in your periods before and after miscarriage, this is a good conversation to have with your doctor. It doesn’t necessarily mean something is off, but it is worth investigating.
Why is my period short? (Or long?)
The length of your period is important. The first thing you need to do, is accurately document it. It’s very common to get a day or two of spotting before your period—and if you count your period with the first day of spotting it can feel quite long. Most clinicians identify the start of a period as the first day of full flow (not those spotting days). If you’re finding your period is very short, it might mean that there is less lining to shed and could be an indication that your endometrium is thin (and if you're trying to get pregnant a thicker lining is better). If your period is long, it might mean you have lots to shed, and have a thick lining. There are other reasons, including structural issues in the uterus (polyps, fibroids or adenomyosis) or things that may impact how your blood is clotting (for example blood thinner medications can contribute to heavier and longer periods). Always chat with your doctor if you’re concerned.
Can you get pregnant on your period?
It depends on your definition of the term period. If we’re talking specifically about menstruation as a withdrawal bleed (endometrial shedding after a drop in progesterone), then the answer is no. But if we’re talking about any form of vaginal bleeding, then the answer is yes. For example, you can often get implantation bleeding around the same time you are expecting your period, and this can often be mistaken for menstruation.
Can you be pregnant and have a period?
If we are using the term period to describe vaginal bleeding, then yes—in the first trimester vaginal bleeding is very common. (And importantly, it doesn’t always mean you’re going to miscarry.) If we are referring specifically to menstruation as withdrawal bleeding due to the drop in progesterone, then no.
Why do I get cramps on my period?
Think of your period as two steps. Step one: you’re shedding your lining—it detaches. Your endometrium must then come out of the uterus so, step two is cramping (uterine contractions)—and your uterus is one big muscle. It’s a smooth muscle which means you can’t control it (like your bowels) and is unlike skeletal muscle that you can control (like your biceps). It pushes the shed endometrium out the cervix and through the vagina. Cramping is part of the menstrual process. Cramping is painful, but pain is complex and subjective, so everyone experiences it differently. From a doctor’s perspective, if the cramping isn’t impacting your daily routines (missing work, requiring very strong pain killers) then it’s considered normal. But it’s more important to ask yourself how it impacts you. There are many interventions your doctor can suggest to decrease menstrual cramping, so it’s worth a discussion with your clinician to find a solution to help reduce pain.