Because vaginas are pretty clever, you know…
Even when everything is working like clockwork, your period is a pretty weird and wonderful time of the month. While you might presume vaginal itching, blood clots and taking more poos than normal (yes, really) are cause for concern, even some of the seemingly strangest symptoms are all just part and parcel of your period.
We spoke to London-based gynaecologist Dr Anita Mitra, aka Instagram’s no-nonsense Gynae Geek, to get the lowdown on what’s normal down below and what warrants a trip to the doctor’s office.
1. Itching is a rite of passage
Not only is vaginal itching normal, but it's actually very common. "It happens due to a fluctuation in the ‘vaginal microbiome’, bacteria that resides healthily in your vagina," says Dr Anita. "The change in hormones and presence of blood result in a slight change in the bacterial population and yeasts (which cause thrush), both of which can cause itching."
Some find that tampons make itching worse, but this varies from person to person. "While there are a lot of scare stories about tampons containing awful chemicals that can cause irritation or worse – and that organic tamponsare better – there’s no firm evidence to back this up."
"One of the most important things you absolutely should not do is douche or use feminine hygiene washes, because this can make the itching worse," she adds. "They wash away the good bacteria, meaning yeasts and bacteria that you don't want are able to grow even more, so it becomes a vicious circle." FYI, some odour is normal – blood itself has a distinct smell – but douching will make period blood smell worse.
2. Your vagina’s pH level changes
"The vagina’s low pH helps protect you from growth of the type of bacteria that cause bacterial vaginosis, bacterial STIs such as chlamydia and gonorrhoea and also viral infections including HIV and HPV (the virus that causes cervical cancer)," says Dr Anita.
Around the time of your period, your vagina’s pH level actually increases slightly. You’ve no doubt heard that you’re more likely to contract a yeast infection while on your period because of this, but the jury’s still well and truly out. "For some people it's in the middle of the cycle because of higher levels of oestrogen, which yeasts love," says Dr Anita. "But I see plenty of women who tend to get yeast infections around the time of their period, too. This may be because of the change in the bacterial population enables it to thrive, take over and cause that awful itchy discharge that most of us know – and none of us love."
3. The cervix softens slightly
This is your body’s way of making sure that the blood flows out of your body during your period. "It happens as a response to release of prostaglandins, which are small chemical messengers involved in the inflammatory response. Fun fact: these were first discovered in semen and called prostaglandins because they were thought to originate from the prostate gland."
4. You have contractions (even though you’re not about to give birth)
No, seriously. In response to hormones known as prostaglandins, your womb makes small, rhythmic contractions. "This is to ensure the lining is shed and makes its way down and out through the cervix and into the vagina," Dr Anita adds. "It’s also the reason for period pain, which you may experience in your lower abdomen, but also in your back, buttocks and thighs due to the connection of the nerves that supply the pelvic area."
5. … Which make you poo more
Those prostaglandins we mentioned earlier also cause your bowels to contract, and that in turn causes you to need the toilet more. "It's not uncommon to go for a lot more number twos, or even have slightly looser stools than normal," Dr Anita says. "The drop in progesterone also contributes, as higher levels of progesterone are suggested to slow down gut motility." So if you’re pooing more than normal, don’t sweat it.
6. It produces anticoagulants to allow the blood to flow down and out
"The blood lost during your period comes away from the wall of the womb and will clot inside, so your body has to make anticoagulants – chemicals which break down clots – in order to re-liquify the blood so it can flow out."
Clotting may look pretty sinister, but it’s usually nothing to worry about. "If the amount of blood present exceeds the speed at which your body can make these anticoagulants you may experience clots, which can escape through your softened cervix. They tend to be small, usually no more than the size of a 50 pence coin. However larger clots, and lots of them, is a sign that there’s quite heavy bleeding going on, so it’s worth visiting your GP to check it's not causing anaemia and whether there’s an underlying reason."
Four things Dr Anita says aren’t normal and require a GP visit:
1. Persistent itching
While some vaginal itching on your period is normal, if it’s constant and doesn’t go away it could be a sign of something else. "There are some other causes that potentially need to be ruled out including skin disorders such as Lichen Sclerosis, which requires a different type of treatment."
2. Excruciating pain
"It's normal for your period to be a bit uncomfortable, but pain that doesn't go away with regular paracetamol, ibuprofen, rest and a hot water bottle may be a sign of an underlying problem, such as endometriosis, and may need further investigation."
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3. Very heavy bleeding
"Heavy is defined in the text books as more than 80ml – not helpful! – while others say changing pads/tampons every two hours, but it's difficult to give a threshold that's right for everyone. If your period is so heavy that it interferes with your daily life, causes you to feel unwell, starts to become heavier or just generally concerns you, it's worth going to have a chat with your GP. It's usually a non-sinister cause, and could actually be related to something like a thyroid problem which is simple to treat. It's also worth checking you're not anaemic as a result."
4. Bleeding outside of your period
OK, not strictly 'during', but your period is the only time of the month that you're supposed to bleed. Don't be afraid to go and speak to your GP if you're bleeding between periods, including after sex. It's usually something completely benign but always warrants seeking medical advice, as in a tiny minority of cases it can be a sign of something serious.