Tracking Red Flags in Your Menstrual Cycle

The menstrual cycle is an important indicator of a woman’s reproductive and overall health. Most women assume that period changes are normal, especially during stress, weight fluctuations, or hormonal shifts. However, the body often sends early warning signs through the menstrual cycle. Recognizing these red flags can help diagnose conditions like thyroid disorders, PCOS, fibroids, endometriosis, clotting disorders, infections, and even certain cancers at an early stage.

In India, many women tolerate discomfort due to shyness, family normalization, or lack of awareness. Understanding what is normal and what needs attention empowers women to seek timely treatment.

A normal menstrual cycle typically has the following features:

• Cycle length between 21 to 35 days

• Bleeding lasting 2 to 7 days

• Mild to moderate cramps

• Total blood loss around 30 to 80 mL per cycle

• Predictable pattern month to month

The cycle may vary slightly in teenagers, postpartum, during breastfeeding, and near menopause. However, extreme irregularities or sudden changes need evaluation.

Missing periods or having cycles longer than 35 days is a warning sign. Irregular menstruation may indicate:

• Polycystic Ovary Syndrome (PCOS)

• Thyroid imbalance (hypothyroidism or hyperthyroidism)

• High prolactin levels

• Eating disorders or severe dieting

• Chronic stress

• Premature ovarian insufficiency

• Pregnancy

If periods are absent for more than three months without pregnancy, medical consultation is essential. Long-term irregular cycles may increase the risk of endometrial thickening.

Heavy menstrual bleeding, also known as menorrhagia, can interfere with daily activities. Warning signs include:

• Needing to change pads every 1–2 hours

• Passing large clots

• Soaking through clothes or bedding

• Bleeding longer than 7 days

• Symptoms of anemia such as fatigue or dizziness

Possible causes include:

• Uterine fibroids

• Endometriosis

• Thyroid disorders

• Adenomyosis

• Copper IUD side effects

• Bleeding or clotting disorders

• Rarely, endometrial cancer

Heavy bleeding should not be ignored, especially in women over 40 or those with a family history of uterine cancer.

Mild discomfort is normal during menstruation, but pain that limits daily activities is not. Severe period pain may be due to:

• Endometriosis

• Adenomyosis

• Pelvic inflammatory disease (PID)

• Fibroids

• Ovarian cysts

If pain begins suddenly, worsens over time, or persists outside the period, it requires medical evaluation. Pain accompanied by fever, nausea, or fainting needs urgent care.

Spotting or bleeding between cycles is medically called intermenstrual bleeding. It may occur due to:

• Hormonal imbalance

• Thyroid issues

• Cervical polyps

• STIs or pelvic infections

• Pregnancy complications

• Endometrial hyperplasia

• Certain medications, including emergency contraception

Postmenopausal bleeding is always abnormal and must be evaluated immediately.

Cycles shorter than 21 days or longer than 35 days suggest hormonal disturbances. Common causes include:

• PCOS

• Thyroid dysfunction

• Perimenopause

• Excessive exercise

• Low body weight

Tracking periods for a few months helps identify patterns needing medical attention.

Even if your cycle was always regular, a sudden shift in:

• Flow

• Color

• Duration

• Pain level

• Frequency

may indicate an underlying problem. Sudden changes after age 35 especially require evaluation.

Premenstrual Syndrome (PMS) is common, but intense emotional or physical symptoms affecting daily life may indicate Premenstrual Dysphoric Disorder (PMDD).

Red flags include:

• Severe mood swings

• Depression or anxiety before periods

• Anger, irritability, or hopelessness

• Difficulty functioning socially or professionally

Hormonal and neurotransmitter changes contribute to PMDD, and treatment options are available.

Discharge is a normal part of the menstrual cycle. However, concerning signs include:

• Foul smell

• Green, yellow, or cottage cheese-like discharge

• Itching or burning

• Pelvic pain

• Pain during urination or intercourse

These may indicate bacterial vaginosis, yeast infection, or STIs. Immediate evaluation prevents complications.

Bleeding 12 months after the last natural period is abnormal. Possible causes include:

• Endometrial hyperplasia

• Polyps

• Hormone therapy

• Early uterine or ovarian cancer

Postmenopausal bleeding always requires medical evaluation.

This may indicate:

• Iron-deficiency anemia from heavy bleeding

• Thyroid disorders

• Heart or metabolic illnesses

• Severe pain response

Evaluation is important to prevent long-term health risks.

During the first two to three years after menarche, irregular cycles may be normal. However, red flags include:

• Absence of periods for more than 90 days

• Heavy bleeding affecting school attendance

• Severe pain

• Excess facial hair, acne, or rapid weight gain

These may indicate PCOS, thyroid issues, or bleeding disorders.

Seek medical help if you experience:

• Cycles outside the 21–35 day range

• Heavy bleeding requiring frequent pad changes

• Pain interfering with normal activities

• Bleeding after intercourse

• Missed periods without pregnancy

• Pelvic pain, fever, or foul discharge

• Postmenopausal bleeding

Early diagnosis improves treatment outcomes.

Depending on symptoms, healthcare professionals may suggest:

• Pelvic ultrasound

• CBC and iron studies

• Thyroid function tests

• Blood sugar and insulin levels

• Hormonal profile (FSH, LH, prolactin, androgens)

• Pap smear or HPV testing

• Endometrial biopsy in selected cases

These tests help identify structural, hormonal, or metabolic causes.

While some menstrual red flags require medical treatment, healthy habits support menstrual health:

• Balanced diet rich in iron and fiber

• Regular physical activity

• Adequate sleep

• Stress management

• Maintaining a healthy weight

• Avoiding smoking and excessive alcohol

Keeping a menstrual diary or using a period-tracking app helps detect changes early.

Common reasons include:

• Belief that pain is normal

• Cultural shame around menstruation

• Lack of awareness

• Fear of diagnosis

• Limited access to gynecologic care

Awareness and open conversations can change this.

Your menstrual cycle is a natural monthly health report. While minor variations are normal, persistent or sudden changes should never be ignored. Heavy bleeding, severe pain, irregular cycles, spotting, missed periods, and postmenopausal bleeding are major red flags. Timely medical evaluation helps detect hormonal disorders, infections, fibroids, endometriosis, thyroid problems, and, in rare cases, cancer. Listening to your body, tracking your cycle, and seeking professional care ensures long-term reproductive and overall health. Women deserve safe, informed, and stigma-free healthcare.