I am 28 and have no children. I have been experiencing unusual periods for the last year. There is no pain, and the cycles are still pretty regular, about 26 days apart. The problem is, I have very dark, almost black spotting the first day or so, and then nothing for a day or so. This goes on and off for a few days, and then what seems like my "actual" period begins, with cramps and heavier blood flow. My period used to last about five days, but now with this spotting it is approaching about eight. I am getting very worried. Should I be concerned? I live in a non-English-speaking country, so your advice would be most appreciated.

-- Jenna

The type of bleeding pattern you describe could be due to any of several things. Your cervix may be slightly stenotic, or closed, preventing menstrual blood from escaping easily. When this happens, some blood may back up, leaking out only a bit at a time; old blood looks blackish. Once your period is well-established, the sheer amount of flow and cramps as your uterus tries to expel the menstrual lining would cause heavier, redder and crampier bleeding.

Instability of the uterine lining due to polyps or fibroids may also cause such a pattern. The area of the lining over an abnormal growth may shed a few days before the rest of the uterine lining, causing spotting; again, if the blood sits around for a little while before being released, it will be dark. Infection is another possibility, as is not ovulating.

The best bet is to see a gynecologist. If you are going to be back in your own country soon, then you can wait until you are home. If you are going to be overseas for a while, you should try to find a gynecologist there; many speak English and have excellent training and skills. If you cannot find an English speaker, bring along someone who can translate for you.