That Your Hypothalamus Is Unhappy

What's happening: You skipped a period.

What it could mean: When your cycle is off, it's usually a sign that something else is off, too, and your brain is delaying ovulation until your health returns to normal. The timing of your menstrual cycle is set by the hypothalamus, the regulatory center in the brain that tells the ovaries what to do, says Daniela Carusi, MD, director of General Gynecology at Brigham and Women's Hospital in Boston. The hypothalamus is super-sensitive to factors that can impair general brain function (even in very mild ways), like sleep deprivation, stress, illness, an unusual fluctuation in hormones, extreme exercise (which the brain can interpret as stress), unusually high or low temperatures or drug use. Very often, Carusi says, when your health gets back on track, your cycle does, too.

What to do: If you skip two periods, bring this up with your gynecologist, so she can help you figure out what's going on.

The Spots That Can Be an Important Red Flag

What's happening: You notice random spotting.

What it could mean: Irregular bleeding that occurs in the middle of your cycle, with no PMS in sight, is often unrelated to your period, Carusi says.

What to do: Tell your gynecologist so that she can investigate. The cause may be random and benign, says Carusi, but your doctor will still want to rule out conditions like cervical or uterine polyps, fibroids, an infection or a precursor to cancer.

That Something Isn't Right

What's happening: Your cramps are so intense that you need to call in sick or cancel plans, and OTC meds can't help.

What it could mean: Severe cramps can be a sign of endometriosis, which can affect your fertility if left unchecked. But endometriosis is treatable when caught early, so don't assume that horrible cramps are just something you need to endure (something Carusi hears a lot from young patients).

What to do: Complain as loudly as you want—in front of a professional. Also let your doctor know if you have easy periods that turn painful, which could be due to fibroids or other conditions in the uterus. (As for moderately miserable periods that become more bearable over time: Carusi says that can be a perk of getting older.)

That You're Having a Pseudo-Period, and It Means This...

What's happening: You have a surprise, irregular period with no bloating, no breast tenderness, no change in appetite. The only PMS symptom you experience is a frantic need to buy tampons.

What it could mean: You're probably not ovulating, says Carusi. If you have an irregular cycle and are also overweight or obese, there's a chance you could be pre-diabetic. Insulin resistance has a direct effect on the ovaries, says Carusi.

What to do: Your doctor may refer you to a weight loss specialist, or may talk to you about cutting back on sugary and processed foods. For these patients, getting weight under control is an imperative—especially if they plan on getting pregnant.

That You've Got an Extra Reason to Exercise, Eat Right, Limit Alcohol and Do Self Breast Exams

What's happening: You've had your period since you were in elementary school.

What it could mean: The more periods you've had over the course of your life, the more years you've had active hormones in your body. This can put you at a slightly higher risk for breast cancer, says Carusi. We don't know exactly what's causing this connection, but it may be related to diet or environmental influences (the synthetic estrogen in the environment that affects fertility could be affecting puberty, too, she says)—factors that affect the hormones early and can present themselves as disease later in life.

What to do: In addition to doing what you can to lower your cancer risk, make sure your gynecologist is aware of your menstrual history as well as your family history of breast and other cancers.

That You're...Completely Normal

What's happening: Your period is two days early this month.

What it could mean: Nothing at all! Carusi says that tracking apps have made women—especially those trying to conceive—hyper-alert to small changes in their menstrual cycle. She spends a lot of time reassuring patients who think that ovulating 48 hours early means their "wacky hormone levels" will keep them from getting pregnant. Very few women ovulate at the exact same time every month, even if their cycle is almost always 28 days long, and ovulating a week early or a week late is still considered "normal," Carusi says.

What to do: Keep in mind that about 80 percent of women who have sex regularly get pregnant within a year.


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