Why Many Doctors Consider Your Period the Fifth Vital Sign

Monica Parker never used to keep track of her cycle, and she was always surprised by the timing of when it would show up.

“That made no sense, as I knew it was a monthly happening,” she tells Veracity. Looking back, she says this was driven by “denial, I guess.”

Part of the problem, she says, is that she never had easy periods. She characterizes her monthly flow as “gushing that ruined many pairs of underwear, and even some pants, sore breasts, awful cramps, and major mood swings.”

With cycles that rough, it’s understandable that she may have wanted to forget about her periods when they weren’t around. But there’s a reason she now says she wishes she had started tracking her monthly flow sooner.

Meet the Fifth Vital Sign

Anyone who has ever visited their doctor or made a trip to the emergency room knows the initial routine: body temperature, pulse, respiration rate, and blood pressure. These are the four vital signs every medical professional collects upon first being introduced to a patient. They are the information metrics that allow doctors to assess a patient’s overall health before moving on to a more thorough workup.

These four vital signs have been accepted methods of patient assessment since practically the beginning of modern medicine itself. They have been used for hundreds of years with little change to the routine.

But some doctors believe that at least one change may be called for.

Veracity’s OBGYN advisor Dr. Alyssa Dweck is one such physician. In fact, on one of her recent podcasts she explained that the American College of Obstetricians and Gynecologists (ACOG) “has actually deemed the menstrual cycle almost like another vital sign. It’s really an incredible window into women’s health because if something goes wrong with what’s typical about your menstrual cycle, it may be a sign of another health or wellness issue. So, it’s really important that we pay a lot of attention to this.”

When people who menstruate notice changes or problems with their cycles, there is often a reason, she tells Veracity. Periods tend to be pretty tightly aligned with overall health. So, when something goes awry with a person’s cycle, it can be a sign of issues elsewhere in the body. These underlying problems can range from hormonal issues like abnormal thyroid function or PCOS to other health issues like anemia or diabetes to lifestyle factors like stress or weight fluctuations.

When Your Flow Becomes a Warning Sign

Every person who menstruates experiences a “regular” period that is unique to their own body. Not everyone has a “perfect” 28-day cycle. Some people may run more toward 35-days, while others might find it common to be a week early or late from month to month.

But according to family medicine doctor Amber Robins, “Many women do a good job in tracking their periods and recognize when it is irregular. I often find women coming to see me when they notice they’ve missed a period or two.”

While missing a period may be an obvious sign of irregularity, bigger problems can arise when people who menstruate don’t notice more subtle signs or changes that their cycles may be communicating. These signs can include:

• Skipped or Nonexistent Periods: Having a period that takes long breaks or is noticeably absent is the biggest and most obvious sign that something might be off. The causes of period irregularity are wide-ranging–everything from extreme fluctuations in your weight or exercise intensity to increased stress or hormonal imbalance can mess with your monthly flow.

• Heavy Periods: “The area I have found less talked about is the heaviness of periods,” Dr. Robins says. “Many women do not recognize when periods are considered to be what we call abnormal uterine bleeding.” According to the Centers for Disease Control, changing your tampon or pad in under two hours, or passing clots the size of a quarter, is an indication that you are having abnormally heavy periods and warrants a trip to the doctor.

• Intense Pain and Cramps: Dr. Dweck says that patients often don’t realize when their periods are causing them more pain than they should. This may be because things like cramps can increase in intensity over time. If you’re cramping is unbearable and inhibits your ability to function in your day-to-day life and if that pain is not getting better with standard, over-the-counter meds or heating pads, it’s time to talk to your doctor about what’s going on.

• Fluctuations in Length: Just as your normal cycle may vary from the 28-day standard, the length of an average cycle can last anywhere from two to seven days. The problem comes when you notice changes in whatever your usual pattern is. If your period suddenly becomes much shorter or longer than expected, consult with your doctor.

• Spotting Between Periods: Finally, if you begin to have breakthrough bleeding between full cycles, you should bring it up at your next exam. While there are many reasons this could be happening, like a change in birth control, it could also be a sign of an underlying issue.

Because we don’t often talk to others about what is normal when it comes to periods, many patients may assume that what they are experiencing is in fact typical, even if it isn’t.

Healthy Cycle, Healthy Life

Now, more than ever, tracking your cycle changes is about as simple as it could get.

“Data collection is all the rage, and this applies to menstrual cycles,” Dweck said. “Women are using period apps that help them identify signs—not just whether their periods are getting shorter, but also whether they are developing migraines or other issues that may be related to their cycles.”

If you’re not tracking your cycle already, now is the time to start doing so, and there are plenty of apps to choose from to get you started. But that’s just the first step. What you do with that information also matters.

If you think something is even slightly off, it’s important to speak up and share the information you’ve collected with your doctor. It’s not uncommon for patients to sometimes feel uncomfortable talking about their periods. But unlike the other vital signs, your doctor can’t assess this one without the information you provide.

“I will just make a plug for the annual gyno exam, which a lot of people have put aside because of the pandemic and confusion over changes to pap smear rules,” Dr. Dweck says. “This may be a really good time to identify an issue you may not have necessarily noticed yourself.”

A Reformed Tracker

As for Parker, as she noticed her cycles becoming even more “wacky,” she became determined to figure out what was going on. She began tracking her period and brought that information to a doctor, who diagnosed the problem: perimenopause.

This diagnosis explained other symptoms she had been experiencing, ones she thought were unrelated to her period problems. “I had to educate myself about what was happening to my body,” she said. “I was experiencing a whole host of new symptoms—weight gain, joint pain, mood swings, insomnia, memory loss—all because of my hormones.”

Without knowledge of what was going on with her cycle, that diagnosis might have taken even longer. Today, the founder of Perimenopause Nation, an online space for people beginning this life stage, tracks her cycle religiously, and only wishes she had started doing so sooner.

When it comes to the fifth vital sign, Parker says she learned, “Head in the sand is not a good strategy.”