Your period - What is "normal"?
Your period as a vital sign. What is “normal” and what is not.
The consensus is clear, the period is a vital sign for women’s health. Together with temperature, heart rate, respiratory rate, blood pressure and pain, menstruation is a critical indicator of overall health.
There is no perfect description of a “normal” menstrual cycle. There are many variations of cycle length, ovulation timing, heaviness of flow, and number of days of bleeding. With every female patient I encounter in my practice, we review what her periods and cycle are doing so that we can get a sense of her hormonal health. This post will focus on two questions:
1: What is commonly considered a normal period?
2: What are the red flags for me when it comes to women’s hormonal health?
What is a “normal” period?
Cycle length - A normal cycle can be anywhere from 21-40 days.
Regularity – A period may occur regularly, every 26 or 30 days exactly (for example) or it may be regularly irregular. Regularly irregular means that some women will have a range in which their period may occur, for example between 28-30 days. For the first few years a young woman is menstruating, her cycles can be irregular, and this is normal. As you age and your hormonal system matures, the cycles usually begin to form a more regular rhythm.
Flow - Blood flow is about 30-50ml per cycle. This can translate into changing your pad or tampon every 2-6 hours depending on the flow rate and day of your cycle.
Bleed time - Bleeding can last 2-7 days. Day 1 of your period is considered the first day of red blood. Brown spotting beforehand can be common, but it does not indicate shedding of the uterine lining and so we don’t count it as the start
What are some red flags potentially indicating imbalances in hormonal health?
- A change in a typically regular cycle. Remember, if you are always a little irregular that will flag less for me than if you are typically 28 days like clockwork and then suddenly your cycle length has changed.
- Heaviness of flow that is more than 80ml or you must change your pad or tampon more frequently than every 2 hours.
- Bleeding for longer than 7 days.
- Pain with your period that requires you to stay home from school or work or use pain medication. This is a common symptom but does not need to be a part of your normal.
- Cycle length is shorter than 21 days or longer than 35 days.
- Ovulation is less than 12 days before your period arrives. Not sure how to tell if you are ovulating? I review this on my Instagram account @dr.nicoleshortt
- Any symptoms that coincide with cycle changes like PMS, acne, mood changes, hot flashes, night sweats, insomnia etc.
- Bleeding between periods.
Remember that there is a difference between what is common and what is normal and your normal may be different than another woman. There is also the normal we are used to that is not actually healthy. I have many patients who tell me their normal is to bleed heavily for several days and change their pads every hour. This is considered abnormal uterine bleeding and should be addressed medically. Just because it has always been that way for you, does not mean there is nothing to be done about it.
Further to that, you are the best judge of your body. If something does not feel quite right, then it may not be, and it is worth a conversation with your healthcare provider.
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