If your period is painful and heavy, you might be inclined to shrug it off and roll with the uteral punches. Let’s face it, the message we often get about periods is that it’s normal to be in pain. But Le’Nise Brothers, a nutritional therapist and author, disagrees and suggests some of the symptoms we accept as normal could be a sign of something more at play. And, crucially, those underlying issues might be reversible or manageable.

With millions of women missing out on school, sports and work because of their periods, getting to know your cycle can be life-changing. That’s why Brothers has spent her career trying to educate us on how to improve our menstrual health and when to seek medical support. Period pain, for example, is a complicated issue. While intense pain is always a warning sign, she points out that for women with conditions like adenomyosis or the 10% of women and girls living with endometriosis “their ‘normal’ is pain”.

But the key to having control over your cycle is knowing what ‘normal’ means to you. “We’re talking here about ‘biologically normal’ periods, but if you have medical issues, it’s important you’re working with a health professional and not sweeping symptoms under the rug,” she tells Strong Women. With that in mind, below are Brothers’ six green flags of period health – and the signs to watch out for that indicate things may be a little off-kilter. 

Healthy sign 1: your cycle is 21–35 days long

“From the first day of your period until the day before the next one starts, the length of the whole menstrual cycle should be between 21 and 35 days. Any shorter than that, and that’s something to look into. Any longer and again, we need to look into it,” says Brothers.

One study based on the data of 1.5 million users of the Flo period tracking app found that most menstrual cycles last around 29 days. So if it feels like you just had your period and you’re already bleeding again, it might be time to get it checked out. 

Red flag: short cycles, long cycles or no period at all

“Longer menstrual cycles are present in women with conditions like PCOS. We see really short cycles with perimenopause, in those with eating disorders or restricted eating and in people who over-exercise.” It’s important, Brothers says, that you talk to your GP or another healthcare professional if your periods stop altogether.

Healthy sign 2: your period lasts between three and seven days

“We want your period to be between three and seven days long,” says Brothers, “even if you don’t have a full flow for all the days.” Anything longer is classed as a heavy period and could be a sign of health conditions like pelvic inflammatory disease or PCOS. It’s worth knowing that 70% of women who live with PCOS are still undiagnosed.

Red flag: periods of two days or less

“Some people say they have a two-day period, and that’s normal for them, but if this is you, you’ll want it to be full flow both days. If you have full flow one day and the second day is quite scant, that’s something to look into as it can be a sign of low oestrogen,” says Brothers. Oestrogen deficiency can play a role in osteoporosis and bone density loss. 

Healthy sign 3: your blood is cranberry red

While you might see brownish blood at the start and end of your period, a sign of a healthy period is bright red blood the rest of the time. “Ideally, we’re looking for that cranberry red or maybe a little darker,” Brothers explains.”We want it to be a bright, light red most of the time.”

Coming off the contraceptive pill? You might have a brown bleed as a side effect. “A lot of people aren’t aware that this is not a true period; it’s a withdrawal bleed,” says Brothers.

Red flag: clots bigger than a 10p coin

Consistently brown blood might signpost low progesterone levels. Another giveaway? “Big blood clots are something to investigate,” says Brothers. While some small clotting is normal and can be a sign your body is trying to regulate your flow, if you see “clots bigger than a 10p coin or £2 coin, that can be a sign of something else. We see that with really heavy periods, fibroids and endometriosis.”

Healthy sign 4: life goes on as normal

Not everyone gets cramps but over 81% of women report some kind of pain during their period. So what’s the difference between healthy cramps and a warning sign? Pain should be mild and manageable.

“I was always told pain was a normal part of having your period,” says Brothers. “Cramps and aches are normal, but pain that disrupts your normal way of living, requires painkillers or leaves you bedbound is not. This should not be accepted as part of a normal period.” 

Red flag: you’re doubled over in pain

If you’re doubled over in pain, throwing up or fainting, you need to seek help. “That’s definitely not normal, and it’s something to look into,” says Brothers. That kind of agony could be a sign that you’re living with a condition like endometriosis, meiosis or fibroids.

Healthy sign 5: you’re changing products every two-to-three hours

Whether you’re a menstrual cup fan, a period pant aficionado or lifelong tampon user, pay attention to how long you leave it before swapping out products. “You should be changing your tampon at least every six hours,” explains Brothers. “But ideally, you should need to change every two to three hours.” It’s worth saying that different products hold different amounts of blood, so while changing a tampon or pad every three hours is totally normal, you may find that your cup only needs emptying every five or six hours (typically cups hold around three times the blood of a tampon). Period pants designed for heavy flows can hold up to 12 regular tampons’ worth of liquid.

Red flag: you are changing products more frequently

The red flag waves when we’re swapping out products too often. “If you have to change your product every one to two hours, that indicates a heavy flow,” says Brothers. Again, it’s worth getting checked out.

Healthy sign 6: your energy and mood is reasonably stable

Feeling a bit less energetic than usual is part and bloody parcel of having a period. Brothers calls this dip in energy a totally natural response to existing in a world running on “a masculine 24-hour cycle of peak energy in the morning and lower energies towards the end of the day”. A more hormone-sensitive cycle would be one that allows for energetic peaks and troughs from week to week.

But it’s not just our energy that changes, but also our mood: “It’s OK to feel a little flat, especially on day one or two when your oestrogen levels are at their lowest.”

Red flag: feeling exhausted and in a bad mood

“We have accepted the idea that we should feel totally exhausted during our period and that being in a bad mood is normal, but that isn’t right. If you’re feeling like you can’t get out of bed, that can be a sign of low iron levels. If you have a really heavy period, it might be a sign that your body isn’t managing energy throughout the rest of your cycle.”

The important thing is to pinpoint exactly what your issue is, so you can go to your GP armed with the specifics. Have a read of this guide to talking to your doctor about problematic periods. The language you use and the kind of data you bring to your appointment can make all the difference in terms of getting results.

Rather than saying: ‘I have really bad periods,’ Brothers recommends being more specific. “That could be like: ‘My period is really painful. On day one and day two, it stops me from going to work and from living my everyday life.’ This kind of language will help you get the support you need quickly.”

Images: Getty