Real talk: Menstruation can be exceptionally unpleasant (period farts, bloating and cramps, we're looking at you). So, if your flow visits more frequently — say, a period twice a month — you might be freaking out a bit. After all, no one wants to deal with double the trouble.
Still, you might also be worried about whether bleeding bimonthly is a cause for concern. So, is it normal to have your period twice a month?
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Well, it depends. Sometimes, shedding your uterine lining twice in one month is NBD, while other times, it can indicate a more serious health issue.
"Anytime your period changes significantly, especially if it is heavier, lasts much longer or results in large blood clots or pain," you should talk to your doctor, says Angela Marshall, MD, a board-certified internist and the CEO of Comprehensive Women's Health. These can all be signs of an underlying medical condition.
Likewise, "whenever anyone is experiencing symptoms associated with menstruation that are impacting their lives in a serious way, whether it is frequency of periods, length of periods, pain, irritability or mood," don't just grin and bear it, says Nisha Verma, MD, a complex family planning specialist and the Darney-Landy Fellow at the American College of Obstetricians and Gynecologists. Period-related problems shouldn't diminish your quality of life.
We spoke with experts to understand why you get your period twice a month and when you should see a doctor.
If you have to change your tampon or pad after less than two hours or you pass blood clots that are quarter-sized or bigger, visit your doctor to avoid complications like anemia, according to the Centers for Disease Control and Prevention.
1. You Have a Short Menstrual Cycle
Indeed, you can get your period twice in a month. And for some people, a bimonthly flow is totally typical.
Here's why: "A normal menstrual period may last between 21 and 35 days, so many [people] with normal menses may still have more than one period per month," Dr. Verma says.
In other words, if you have a shorter cycle, you can bleed twice in the span of 30 days.
Your bimonthly menses may be a byproduct of perimenopause, the time of transition to menopause that marks the end of your reproductive years.
During perimenopause, "as the ovaries start to decline in estrogen production, they stop the ovulation process, which results in what we call anovulatory cycles," Dr. Marshall says, meaning you don't ovulate (or release an egg from your ovaries).
But as ovulation becomes more erratic, your periods can become irregular. "When the hormone levels fall, it disrupts this entire process," and this can confuse your uterus about when it should shed its lining, Dr. Marshall says. Sometimes, the result is a more frequent flow.
Per the Mayo Clinic, other signs of perimenopause include:
- Hot flashes and sleep problems
- Mood changes
- Vaginal and bladder problems
- Decreasing fertility
- Changes in sexual function
- Loss of bone
- Changing cholesterol levels
3. Uterine Fibroids
Uterine fibroids — benign tumors that grow in and on your uterus — can sometimes cause bleeding.
Fibroid statistics show these growths can vary in size from 1 millimeter to 20 centimeters (that's as large as a watermelon) and are very common — between 40 and 80 percent of people assigned female at birth (AFAB) have fibroids, according to the Cleveland Clinic.
While most fibroids don't cause symptoms, larger growths can bring things like bleeding. "At times, this bleeding can be very heavy, and it can occur both with the cycle and at periods (no pun intended) that are outside of the normal menstrual cycle," Dr. Marshall says. In other words, this excess bleeding can make it appear that you're getting your period twice a month.
According to the Cleveland Clinic, other symptoms may include:
Talk to your doctor about the best way to treat your fibroids, which may include taking over-the-counter pain medicine, birth control or other hormonal therapies, per the Cleveland Clinic.
4. Thyroid Issues
Your thyroid could be to blame for your bimonthly bleeding.
That's because your thyroid plays a pivotal role in your menstrual cycle, so if it produces too much or too little thyroid hormone, your periods may become abnormally light, heavy or irregular, according to the Office on Women's Health.
Put another way, "thyroid problems can cause issues with the hormonal synchrony that triggers ovulation and uterine lining shedding," Dr. Marshall says.
And if your hormones become unbalanced, a bimonthly menses may occur.
Getting your period twice a month can be a side effect of endometriosis, a condition where the uterine lining tissue grows in other parts of the body (besides the inside of the uterus), Dr. Marshall says.
"This tissue can occasionally cause period disruption, pain and heavy bleeding," she explains.
Endometriosis affects as many as 10 percent of people AFAB between the ages of 25 and 40, according to Johns Hopkins Medicine.
In addition to an abnormal menstrual flow, this condition can also cause the following symptoms:
- Pain during intercourse or tampon insertion
- Excessive menstrual cramps in the abdomen or lower back
- Painful urination during periods
- Painful bowel movements during periods
- Other gastrointestinal problems, such as diarrhea, constipation and/or nausea
Talk to your doctor to determine the best way to manage excessive menstruation from endometriosis, including treatments like over-the-counter pain medicine, birth control, hormonal therapy or surgery, per Johns Hopkins Medicine.
6. Skipping Birth Control
Forget to take your birth control pill? This can mess with your monthly menses.
"Imperfect use of birth control can cause more-frequent periods or bleeding between periods," Dr. Verma says.
That's because it can "disrupt the hormonal synchrony that controls ovulation and the menstrual cycle," Dr. Marshall says.
7. Weight Gain
Putting on a few pounds can perturb your period, too.
"Weight gain, and, in particular, changes in body fat, can cause a disruption in the reproductive hormones, which are mostly fat soluble," Dr. Marshall says. So, an increase in body fat can upset your hormonal balance, bringing about an irregular period.
Stress can also be the source of your twice-monthly menses.
Indeed, "stress-related hormones can disrupt reproductive hormones, resulting in period changes," Dr. Marshall says. "Cortisol is one of the main hormones that can alter the hormonal balance necessary for normal menstrual cycle and blood flow."
9. Polycystic Ovary Syndrome
Period problems may also be produced by polycystic ovary syndrome (PCOS), a condition characterized by the imbalance of reproductive hormones.
Some people with PCOS may have multiple periods in a month due to hormonal imbalances that interfere with ovulation, Dr. Marshall says.
Per the Office on Women's Health, other signs of PCOS may involve:
- Facial hair growth
- Acne on the face, chest and upper back
- Thinning hair or hair loss on the scalp
- Weight gain or difficulty losing weight
- Darkening of skin, particularly along neck creases, in the groin and underneath breasts
- Skin tags
PCOS statistics show the condition is fairly common, affecting one in 10 people AFAB in their reproductive years, according to the Office on Women's Health.
10. Bleeding Disorders
Your bimonthly menstrual cycle can also be a sign of a more serious bleeding disorder such as hemophilia.
Bleeding disorders — a set of conditions defined by problems with the body's blood clotting process — can cause abnormal or heavy menstrual bleeding, Dr. Verma says. People with bleeding disorders may also experience easy bruising and frequent nosebleeds, she adds.
According to the National Library of Medicine, other symptoms associated with bleeding disorders may be:
- Bleeding into joints or muscles
- Excessive bleeding with surgical procedures
- Umbilical cord bleeding after birth
Bleeding twice in a month can occur during pregnancy. Spotting — which is light bleeding that's not enough to fill a panty liner — is normal, particularly during the first trimester, according to the Cleveland Clinic.
Heavier bleeding, however, can sometimes be a sign of pregnancy complications or underlying health issues like a molar or ectopic pregnancy, hematoma, cervical polyps or a miscarriage, per the Cleveland Clinic.
If you experience heavy bleeding during pregnancy, call your doctor to determine if there is a problem, per the Cleveland Clinic.
12. Endometrial Cancer
Abnormal vaginal bleeding can sometimes be a symptom of cancer. For instance, 90 percent of people with endometrial cancer experience atypical bleeding, like changes in your period, bleeding between periods or bleeding after menopause, according to the American Cancer Society (ACS).
Similarly, unusual bleeding — like bleeding after sex or after menopause — can be a sign of vaginal cancer, per the Mayo Clinic. However, this is a rare cancer, so it's always best to visit your doctor and rule out more common causes of vaginal bleeding first.
Per the ACS and Mayo Clinic, other symptoms to look out for include:
- Unprompted weight loss
- Pelvic pain
- Feeling a lump or mass
Is Blood Loss a Concern?
In some instances, a bimonthly period may produce potential complications related to excessive blood loss. The thing is, losing too much blood can cause a damaging domino effect in your body.
For example, "if a person experiences too much bleeding, it can result in a low blood count (otherwise known as anemia), which can be serious if not treated," Dr. Marshall says. So, when your period comes twice a month, keep an eye out for other signs of anemia such as pale skin, weakness and fatigue.
If you suspect you have period-related anemia, speak with your doctor, who can perform bloodwork to properly assess and diagnose the condition.
In severe cases, "sometimes a blood transfusion is needed," Dr. Marshall says. "More often, though, iron and vitamin supplementation are necessary for several months to restore the red blood cell level." But always check with your doctor before and while taking iron supplements, as too much iron can cause other problems.
Also, keep in mind "there's a difference between chronic abnormal bleeding and a sudden, severe case of uterine bleeding," Dr. Verma says. The latter can be acutely dangerous.
If your menstrual cycle leads to abrupt, heavy bleeding (for example, needing to change tampons or pads every two hours or less) along with chest pain, dizziness or shortness of breath, something serious might be up, and you should seek emergency care immediately to treat any possible complications from blood loss or change in blood pressure, Dr. Verma says.
Once you're in stable condition, your health care team will work to identify the cause of the bleeding, including any underlying health problems.
Talk to your doctor before trying any supplement, as the FDA doesn't require these products to be proven safe or effective before they're sold, so there’s no guarantee that any supplement you take is safe, contains the ingredients it says it does or produces the effects it claims.
- Mayo Clinic: “Perimenopause”
- Cleveland Clinic: “Uterine Fibroids”
- Office on Women’s Health: “Thyroid disease”
- Johns Hopkins Medicine: “Endometriosis”
- Office on Women’s Health: “Polycystic ovary syndrome”
- National Library of Medicine: “Bleeding disorders”
- U.S. Food and Drug Administration: “FDA 101: Dietary Supplements”
- Centers for Disease Control and Prevention: "Heavy Menstrual Bleeding"
- Cleveland Clinic: "Bleeding During Pregnancy"
- American Cancer Society: "Signs and Symptoms of Endometrial Cancer"
- Mayo Clinic: "Vaginal cancer"
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Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.