There are certain things I hear from women over and over again:
“I thought this was just part of getting older.”
“My periods have always been like this.”
“I figured this was normal after having kids.”
“I was told my labs were normal.”
Sometimes a symptom really is part of a normal life transition. But there’s an important distinction I wish we made more often:
Something can be common without being something you simply have to live with.
Here are a few symptoms that deserve another look when they’re persistent, severe, changing, or affecting your quality of life.
1. Periods that disrupt your life
Periods vary from person to person. But regularly bleeding through pads or tampons, passing clots the size of a quarter or larger, becoming anemic, missing work because of pain, or planning your life around your period deserves evaluation.
Heavy or painful periods can have many causes, including fibroids, adenomyosis, endometriosis, hormonal changes, and other medical conditions.
And sometimes we don’t find one simple explanation.
Either way, “I’ve always had bad periods” isn’t the end of the conversation.
If your menstrual cycle is interfering with your life, we can talk about why—and what your options are.
2. Feeling exhausted all the time
Life is tiring. Parenting is tiring. Working is tiring.
But persistent fatigue shouldn’t automatically be attributed to being busy.
Depending on the situation, fatigue may lead us to think about sleep, anemia or iron deficiency, thyroid disease, medications, mood, nutrition, pregnancy, chronic medical conditions, and more.
Sometimes the answer really is that you’re stretched too thin.
But before deciding that exhaustion is simply your new normal, it’s reasonable to ask whether something else is contributing.
3. Pain with sex
Painful sex is more common than many women realize—and many don’t bring it up unless I ask.
Pain can have multiple causes, including vaginal dryness, pelvic floor dysfunction, infection, endometriosis, vulvar conditions, hormonal changes, scar tissue, and other pelvic conditions.
During perimenopause and menopause in particular, changing and declining estrogen levels can contribute to vaginal dryness and changes in vaginal and urinary tissues that make sex uncomfortable or painful.
There are treatments.
You don’t have to accept painful sex as the price of having a baby or getting older.
4. Leaking urine or feeling pelvic pressure
Yes, urinary leakage is common after pregnancy and childbirth.
No, that doesn’t mean you have to spend the rest of your life crossing your legs every time you sneeze.
Urinary leakage, pelvic heaviness or pressure, difficulty emptying your bladder or bowels, or feeling or seeing a bulge from the vagina can be signs of pelvic floor dysfunction or pelvic organ prolapse.
Evaluation can help determine what’s happening, and treatment may include pelvic floor physical therapy, lifestyle changes, medications, devices, procedures, or other options depending on the problem.
5. Changes in your hair that feel significant
Hair changes can be complicated.
Temporary increased hair shedding is common in the months after giving birth. Genetics also play an enormous role in hair growth and loss.
But new or significant hair thinning—or increased coarse hair growth on the face or body—may sometimes be associated with hormonal, nutritional, thyroid, medication-related, or other medical factors.
Not every hair change requires an extensive workup.
But if something has noticeably changed, especially alongside changes in your periods, skin, weight, or other symptoms, mention it.
6. Perimenopause symptoms that are affecting your quality of life
Perimenopause doesn’t begin on your 50th birthday.
Perimenopause can begin years before the final menstrual period, often starting in the 40s.
…And symptoms may include changes in menstrual cycles, hot flashes, night sweats, sleep disruption, vaginal or urinary symptoms, and mood changes.
Not every symptom in your 40s is caused by hormones, which is exactly why thoughtful evaluation matters.
But when symptoms are related to the menopause transition, there are evidence-based treatment options—including hormonal and nonhormonal approaches.
You don’t earn extra points for suffering through it.
“Normal” isn’t the only question we should ask
In medicine, determining whether something is dangerous is important.
But that’s not the only thing that matters.
I also want to know:
Is this new for you?
Is it getting worse?
Is it affecting your relationships, work, sleep, exercise, sex life, or ability to do the things you enjoy?
And most importantly—does it bother you?
Because sometimes the better question isn’t:
“Is this normal?”
It’s:
“Is there something we can do about it?”
— Dr. Z
Sources & Further Reading
American College of Obstetricians and Gynecologists (ACOG). Heavy Menstrual Bleeding.
American College of Obstetricians and Gynecologists (ACOG). When Sex Is Painful.
American College of Obstetricians and Gynecologists (ACOG). Pelvic Support Problems.
American College of Obstetricians and Gynecologists (ACOG). The Menopause Years.
American Academy of Dermatology (AAD). Hair Loss: Who Gets and Causes.
