Women don’t have enough information about their bodies — that’s just a fact.
Speaking of facts, where do you draw the line between those actual truths and the rampant myths that exist in the realm of women’s, menstrual, and reproductive health? It’s tough, especially since we’ve been brought up to believe these issues aren’t up for discussion in social settings. The shame associated with that idea leaves us both wondering if what we’re experiencing is “normal” and afraid to voice concerns when it comes to the realities of our bodies. Of course, it also doesn’t help that social media and the Internet in general are so full of misinformation.
Take periods, for example: While understanding your menstrual health is so important, many of us don’t really know what’s normal and what could potentially be a red flag.
That’s why we enlisted Dr. Taniqua Miller, Board-certified OB-GYN, and midlife expert at HerMD to break it all down.
We presented Dr. Miller with different ideas about menstrual health and asked her to clarify whether these ideas are myths or facts (and of course, since menstrual health is complex, some fall somewhere in between). Have you believed any common period myths? Read more to find out.
Myth or fact? Periods can last over a week
Myth…sort of.
“Can they be as long as seven days and be considered normal? Absolutely,” says Dr. Miller. “But, if you’re having bleeding [for] more than seven days, it should warrant an evaluation. Sometimes having heavy bleeding, if it’s going on for a long time, can predispose a person to iron deficiency anemia, so it’s good to check in with a provider.”
If your periods are typically shorter than a week, but you experience a one-off seven-day period, that’s typically not a cause for concern and is likely a fluke.
If you haven’t gotten your period by 16, something may be wrong
Fact — the operative word being “may”.
“Sixteen would be a good age for evaluation [if you haven’t started your period],” says Dr Miller. “We know that if the menstrual bleeding doesn’t start by age 16, there can be several different causes for that.”
Structural or hormonal issues could be to blame, according to Dr. Miller. Of course, there may be no underlying cause, but 16 is the age at which someone should consider seeking out an evaluation.
“That person should see their pediatrician, who will likely refer them to a gynecologist or a reproductive endocrinologist,” says Dr. Miller.
If you get your period at an early age, you’ll experience fertility issues
Myth.
“We see menstrual cycles start as early as age nine,” says Dr. Miller, who adds that there’s no evidence that entering puberty at that age influences fertility.
“If we actually see precocious puberty, so we’re seeing puberty changes [like the growth of pubic hair] in children as young as four, five, six, then we do want to delay that type of puberty because that can long-term consequences to overall growth. There are medications we [can use to halt that process],” Dr. Miller adds. “But if we have someone on the young side, like nine or 10, I don’t think there’s a clear relationship. I think that myth comes about because we think there’s a finite number of eggs and so if you start earlier, you will likely end earlier, but there really isn’t a lot of evidence for that.”
If you have regular periods, you will probably get pregnant easily in your 20s and early 30s
This one’s tricky — while it’s technically a fact that most people with regular cycles get pregnant within a few months of trying in their 20s and early 30s, some will experience infertility even if their cycles are regular.
“If you’re having regular menstrual bleeding with a predictable cycle, then the average couple trying to achieve pregnancy with purposeful, timed intercourse has about a 20 percent chance each month,” says Dr. Miller. “By the end of six months, you’re probably going to have achieved pregnancy. [But] even with normal menstrual cycles and timed intercourse, you still have about 10 percent of people at that year mark who are not achieving pregnancy in a year, [which is] what we define as infertility.”
If you have irregular periods, you’re more likely to experience infertility
Fact.
“If you have a history of irregular menstrual cycles, there are a lot of different categories of this. We see this in patients who have a diagnosis of polycystic ovarian syndrome — they’re not having menses because they’re not reliably ovulating each month. Or we see it in patients who may have what we call constitutional delays in menses — that may be related to diet, that may be relatable to levels of stress, so their cycles may be irregular. It’s very hard to time intercourse for pregnancy because ovulation is so sporadic or erratic,” says Dr. Miller.
With that being said, “Those patients who have irregular menses, while they may have more difficulty achieving pregnancy on their own because they have already been identified because their menses are so irregular, they tend to be offered interventions sooner,” says Dr. Miller.
If your cycles are not approximately 28 days, you should talk to a doctor
Myth.
“Cycle lengths vary and what’s considered normal is anywhere between 21 and 35 days,” says Dr. Miller. “You can get a lot of variability in your cycle length.”
Cycles that vary by a day or two each month are still considered regular
Fact.
According to Dr. Miller, slight variations are totally expected.
Some degree of period pain is to be expected
Fact — but…
There’s a lot going on in the body when you menstruate — your uterine lining is literally shedding and leaving your body.
“If you can imagine, some degree of cramping may be experienced during the menstrual cycle — usually, it can be mediated by a heating pad or [over-the-counter pain relievers],” says Dr. Miller.
But the caveat is…
Debilitating period pain is to be expected
Myth.
“You should still be able to function in your daily life with minimal interruption,” says Dr. Miller. “Menstrual pain to the point that it’s disrupting activities of daily life or quality of life should be evaluated because there are options for treatment.”
Very heavy bleeding is a red flag
Fact.
“One of the ways to better understand heavy bleeding is by understanding the quantity of bleeding. Believe it or not, normal bleeding is considered 30 mL of bleeding [think of about] two tablespoons. That is considered normal,” says Dr. Miller. “Heavy bleeding is anything over 80 mL — it doesn’t take a lot to be considered heavy bleeding.”
Heavy bleeding may indicate structural issues within the uterus such as fibroids, polyps, abnormalities to the lining, or another disorder.
“We have stories of people having a menstrual cup in and also wearing a menstrual pad — that is something that should be evaluated,” says Dr. Miller. “Truthfully, there are a lot of treatments to help with the amount of bleeding. Really for a lot of people, that heavy bleeding is super destructive. I have patients who have planned their lives around their bleeding. They don’t wear white around certain times of the month because they’re worried about bleeding…that’s not what we want for our patients.”
Very light bleeding is a red flag
This is a tricky one.
“If I have someone who tells me that they have light bleeding, I always ask them how many pads they’re changing,” says Dr. Miller. “If they’re changing what sounds like about 30 mL of bleeding, that’s actually normal. You have some that just may have lower levels of menstrual bleeding, and that’s not an issue. What becomes an issue is if there’s a change in the pattern of bleeding.”
Someone who had D&C for pregnancy termination, for example, and is experiencing lighter bleeding afterward, could potentially have scarring in the uterus.
Cravings are normal during your period
Maybe?
“I’m going to say…yes?,” says Dr. Miller. “I don’t know why.”
True or false, consider this your sign to honor those cravings.
Menstrual migraines are normal
Fact — sort of. Normal may not be the right word, but there’s an explanation for those monthly migraines.
“Menstrual migraines are related to the withdrawal of estrogen when there’s no pregnancy. I don’t know if I would say normal, [but] it is explained by the withdrawal of hormones, but can be very debilitating,” says Dr. Miller. “If it’s disruptive to that person’s life, it can be evaluated and treated.”
You should track your period even if you are not trying to conceive
Fact…if it’s important to you.
“That depends on what your goals are,” says Dr. Miller. “If you want to understand [things like mood changes or migraines as they relate to your cycle], then I think checking your cycle for knowledge and a better understanding of your body is a positive. But would I say you have to have an app or a calendar where you’re marking off [the dates of your cycle] if that’s not a goal of yours? Not necessarily.”
Ovulation always happens 14 days before your next period begins
Fact.
“The luteal phase is constant. The first half of your cycle will vary pretty widely [but] the second half of your cycle, which is that luteal phase is always about 14 days.”
Ovulation pain is normal
Fact.
“Actually, there’s a term for it: It’s called mittelschmerz. You may in fact feel ovulation — it’s actually not the egg traveling, but the distention of the follicle that’s causing that discomfort. So yes, there are some people that say ‘I feel a little twinge of pain in the middle of the cycle, I think I’m ovulating’ and that is very much true,” says Dr. Miller.
But again, severe pain warrants attention.
“What becomes more worrisome is if that pain goes from just like ‘oh I notice it’ to being pretty uncomfortable,” adds Dr. Miller. “The reason for that is sometimes it can cause a large cyst on the ovary after ovulation, those cysts could rupture [or] twist on themselves. If the pain is not just for a day or two and causing significant pain, that should be investigated.”
Zara Hanawalt is a freelance journalist and mom of twins. She's written for outlets like Parents, Marie Claire, Elle, Cosmopolitan, Motherly, and many others. In her (admittedly limited!) free time, she enjoys cooking, reading, trying new restaurants, and traveling with her family.