It’s bad enough dealing with your period once a month—the cramps, the mood swings, the potentially ruined underwear… But twice?
As it turns out, a more frequent period isn’t all that abnormal. “The average cycle should occur every 21 to 35 days and last anywhere from two to seven days,” explains Lakeisha Richardson, an M.D. and ob-gyn based in Greenville, Mississippi. If you’re on the shorter end of that spectrum, that math could easily translate into getting your period twice in one month. And about 40 to 60 percent of women will have some irregular periods throughout their life, she says.
“Since most women know their cycles, they will also usually recognize if something is off,” adds Alyssa Dweck, an ob-gyn and author of The Complete A to Z for Your V. In most cases, the reason will be benign, so there’s no need to worry, says Richardson. And while dealing with a period that goes away and comes back is frustrating on it’s own, it can also make you fear something’s not right with your lady parts.
“Irregular bleeding can have different implications depending on age, medical history, and family history,” says Dweck, “so it’s important to seek ob-gyn guidance if you have persistent, recurrent, or worrisome bleeding habits.” Your doctor can help identify the cause and treatment, typically with just a pelvic exam, vaginal and cervical cultures, and a pelvic ultrasound, says Richardson.
So before you freak out about the unfairness of double the period time, consider what might be going on:
1. YOU FORGOT TO TAKE YOUR BIRTH CONTROL
Duh, right? “Missing birth control pills or forgetting your Deposit-Provera shot will always cause irregular bleeding,” says Richardson. “Anytime you fail to take a birth control method correctly, you will bleed because you have an abrupt withdrawal of hormones.” This kind of bleeding, though, is not an emergency. “
If you resume your birth control by following the instructions, the bleeding will subside, she says. Just make sure to use a backup method of birth control to prevent pregnancy until your next period.
We know, we know: Pregnancy means missed periods. But “believe it or not, some women will bleed irregularly if they are pregnant,” says Dweck. Spotting during pregnancy is very common, especially in the first trimester, and can occur for a number of reasons, including after heavy exercise or sex, or due to polyps—“benign lesions that can grow inside the uterus or on the cervix, which are usually associated or locate near blood vessels and can bleed spontaneously,” says Richardson.
Obviously, this cause for getting your period twice in one month can be ruled out with a simple pregnancy test.
This is what every woman should know about pregnancy tests:
3. YOU HAVE POLYPS OR FIBROIDS
Uterine issues like polyps or fibroids—benign tumors that can grow in the uterus—are very common and may be related to hormonal issues. “Uterine polyps can cause bleeding in between periods,” says Dweck, especially if they are touched, like during sex, and “fibroids can cause pain, back pain, abdominal bloating, anemia, pain with intercourse, and spontaneous bleeding because they’re not associated with the menstrual cycle,” explains Richardson.
Head to your ob-gyn for an ultrasound with saline infusion, a uterine biopsy, or a hysteroscopy (a telescope that looks into the uterus). “Removal of the growths is usually curative and ensures that there are no other causes of irregular bleeding,” she says.
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4. YOU HAVE A VAGINAL OR CERVICAL INFECTION
Vaginal and cervical infections are incredibly annoying for a number of reasons, not least of all that they can cause bleeding outside of your period. “Inflammation or infection of the cervix with bacteria such as bacterial vaginosis or trichimonas can cause irregular bleeding,” says Richardson.
“Infections should be treated immediately, because research has shown that sexually transmitted disease such as trichomoniasis increases your risk of contracting HIV and other STDs,” she says.
5. YOU HAVE THYROID ISSUES
An underactive or overactive thyroid gland can cause irregular menses. “The thyroid gland is regulated by hormones produced and regulated in the same area of the brain—the pituitary and hypothalamus—as the hormones that control menstruation and ovulation,” explains Dweck. “When one is off, the other might be affected.”
This is diagnosed with a blood test and typically treated with medication.
6. YOU HAVE PCOS
Polycystic ovarian syndrome is a hormone imbalance that affects between eight and 20 percent of women, according to the National Institutes of Health. “It’s a result of less frequent ovulation or the lack of ovulation, leading to an imbalance of estrogen, progesterone, and testosterone,” Dweck explains. “One of many symptoms includes irregular bleeding.”
Other commonly associated symptoms include acne, difficulty maintaining weight, hair growth in places typical to men (like the upper lip or chin), and fertility issues, she says. If you think there’s a chance you have PCOS, schedule an appointment with your doc to be evaluated.
7. YOU HAVE CANCEROUS OR PRECANCEROUS CELLS
When found in either the uterus and cervix, precancerous and cancerous cells can cause irregular bleeding. “Suffice it to say, a tumor growing on the cervix or uterus can bleed erratically,” says Dweck. One study even found that irregular periods are more likely to lead to ovarian cancer, so early detection is key.
These are diagnosed with an ultrasound and uterine biopsy, and a pap smear and cervix biopsies, respectively, so if you’ve ruled out other causes, get to an ob-gyn STAT.