How do you know what’s normal and what’s abnormal when it comes to periods? Even after a decade or two of menstruating it can still feel like you don’t have a handle on when it’s coming, how many tampons you’ll need, and if you’ll be cringing with pain! Maybe you’re one of those people that wear a pad daily just in case, or have a heating pack with you at all times just to be sure you’re ready. If you’ve asked your friends about their periods, you probably get all kinds of answers because each of our cycles are pretty unique. Sometimes our cycles can change from month to month and then confuse us even more! Do you ever wish you could save your blood in a menstrual cup and show your friends, and hopefully a doctor, to get a better understanding of what on earth is going on? No one else wishes that? Okay, I guess I’m the only one! Consider this blog a discussion with a friend about the way you bleed and why that might be. The answers you’ve been waiting for could be on this page!
What’s normal when it comes to menstrual bleeding?
Cycle length should be around 21-35 days (from the first day of bleeding one month, to the first day of bleeding the next month). However, the ideal cycle length is 27-30 days. In my naturopathic opinion, a 21-day cycle is too short and anything longer that 35 days is too long. With a 21-day cycle your body is going through estrogen and progesterone too quickly, with a 35-day cycle your body is likely producing either too much estrogen or too much progesterone.
Days of Flow
The bleeding should last a maximum of 7 consecutive days, and it should not be heavy for the full 7 days. Bleeding for less than 7 days is okay though; if you’re on birth control you may bleed for only 3 days. Bleeding in between periods (aka metrorrhagia) is also not normal.
Colour of Blood
Typically the blood is bright red at the beginning of your period and as your period gets lighter in flow the blood becomes a darker brown. Essentially, your body is saving that stagnated, tough to expel blood until the end. You may refer to this as “spotting”. Some women start their period with a dark brown spotting blood; this may or may not be normal. Read on to find out.
Amount of Blood
How much blood is normal? Supposedly, the average woman menstruates about 35ml of blood over a whole period (that’s a little bit over 2 tablespoons) seems like nothing, right! Bleeding in excess of 80ml in one cycle (1/3 of a cup) is considered heavy bleeding or “menorrhagia”. It is typical for the first three days of menses to be heaviest, but not that heavy. The best way to know how much blood you are losing is to use a menstrual cup, like a Diva Cup, because the measurements are written right on the cup.
Amount of Pain
No amount of pain is normal! The ideal period has no pain before, during, or after your period. This includes back, uterus, and bowel pain. It’s normal to experience an occasional spasm as the blood passes but it should not interfere with your day or require pain medications.
What if your period doesn’t sound like it’s normal?
If your cycle length, days of flow, colour of blood, amount of blood, and amount of pain are usually pretty consistent but sometimes you have an “off” period there’s typically nothing to worry about. One abnormal period should not cause alarm, however, three consecutive abnormal periods warrants further investigation.
What could be the cause of abnormal cycles?
Abnormal periods can be caused by a vast number of things, but these are the most common reasons:
When you do not ovulate, your body produces a lot of estrogen and very little progesterone. When there is no progesterone to oppose estrogen, you build up your endometrial lining nice and thick but there’s no hormone withdrawal to bring on menses. If you do not ovulate, you will not have regular 21-35 day cycles. The bleeding you do get is extremely sporadic because there’s just too much lining and your body wants to get rid of a little bit of it at inconvenient times. What does this look like? Unpredictable bleeding and blood that’s sometimes bright red and sometimes dark brown because different areas of the endometrium are getting sloughed off at different times during the month.
Short luteal phase
After you ovulate, you are in the luteal phase of your cycle. The luteal phase is dominated by progesterone, which is needed to have a period. If you have a very short luteal phase then you likely have a very short cycle- closer to 21 days. Without progesterone you are in a so-called “estrogen dominant” pattern, as your body produces more estrogen than progesterone. This can translate into heavy and painful periods.
Oral contraceptive induced bleeding
Just because you are on birth control, does not mean you will have regular cycles. When starting a new form of birth control it can take your body up to 3 cycles to regulate, so it’s normal during this time to experience irregular bleeding. If you experience bleeding while you are taking the pill (not on the sugar days) or if you don’t experience bleeding while on the sugar pills, you should meet with your doctor to alter the dose of your medication. It’s also common for bleeding abnormalities to occur if you don’t take your pill regularly or miss pills!
This is a pathology where endometrial tissue ends up outside of the uterus, like on the ovaries, bowel, and surrounding ligaments. Endometriosis can cause irregularities in all of the criteria I mentioned. The key feature is extreme pain: pain around menses, back pain, abdominal pain, pain during sex, and pain going to the bathroom. You may also have extremely heavy and clotted periods and experience spotting often.
Fibroids are large masses of tissue in the uterus. They can grow in various places in the endometrial tissue, but cysts can appear in and around the ovaries too. Fibroids and cysts grow under the influence of estrogen ad cause heavy bleeding (menorrhagia). Think of it this way, when you have fibroids you have more endometrial tissue and more blood vessels to slough off when it comes to your menses. Your flow is likely greater than 80ml and is extremely clotted and stringy.
Also known as Polycystic Ovarian Syndrome. PCOS is diagnosed based on 3 criteria: infrequent menses, cysts in the ovaries, and elevated androgens. Testosterone is an androgen, and elevated androgens in a female cause acne, male pattern hair growth, or male pattern hair loss. With PCOS, there are also often issues with insulin so you may experience difficulty losing weight and/or gain weight easily.
Hyperthyroidism & Hypothyroidism
The first is elevated thyroid hormones and the second is decreased thyroid hormones. Both an increase and decrease in thyroid hormone can impair ovulation, which will prevent you from having a regular period.
This is a fancy term for not having a period because you don’t have enough stimulating hormone coming from the hypothalamus in the brain. The most common reasons for this are stress and low body weight. If you’ve skipped a couple of periods due to stress or you’re an Olympic athlete, you owe those missed periods to hypothalamic amenorrhea.
Endometrial and ovarian cancer can cause pain and abnormal bleeding. Make sure you schedule regular check-ups with you doctor. Benign tumors in the pituitary gland of the brain can also cause abnormal hormone production and abnormal menses. Keeping communication open with your doctor is essential when it comes to cancer screening.
Heavy bleeding may be due to a clotting disorder. Menses requires a fine balance between clotting the blood so that you don’t bleed too quickly, and decreasing clotting factors so that you can get the blood out of your system. If a clotting disorder runs in your family, speak with your doctor. Examples of clotting disorders are hemophilia and von Willebrand’s disease.If any of these causes of abnormal periods resonate with you, you may be on the path to figuring out what’s going on in your body. Always keep in mind that pregnancy and menopause will change your cycle and are worth mentioning too! Making sure you are not exposed to exogenous hormones; in meats, drinking water, and cosmetic products is also a great way to keep your period regular, light, and pain-free.
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