What is normal and what is not?
A woman’s menstrual cycle (period cycle) tells us a lot about her health, fertility, and overall well-being.
Proper monitoring and understanding of both the cycle and its irregularities are important guides for women in maintaining their reproductive health.
When did your last menstrual period start, or how long did it last?
Tracking your menstrual cycles helps you understand what is normal for you, accurately measure your ovulation, and identify important changes — such as a missed period or unexpected uterine bleeding. While menstrual cycle irregularities are usually not serious, they can sometimes signal potential future health concerns.
What is the menstrual cycle?
Each month, one of the ovaries alternately releases an egg through the process of ovulation. At the same time, monthly hormonal changes prepare the uterus for a possible pregnancy. When ovulation occurs around the 14th day of the cycle, and the egg is not fertilized, the endometrium sheds from the uterus through the vagina, causing a bleeding that typically lasts 4–5 days. This is the menstrual period.
What is normal?
The menstrual cycle, which is counted from the first day of one period to the first day of the next, is not the same for every woman. A menstrual period may occur every 21 to 35 days and last from two to seven days. In the early years after a woman first begins menstruating, long cycles are very common. However, menstrual cycles tend to become more organized and more regular as a woman gets older. Your menstrual cycle may be regular — with roughly the same length every month — or somewhat irregular. Your period may be light or heavy, painful or painless, long in duration or relatively short, and still be considered completely normal. In a broad sense, “normal” is whatever is normal for you personally and individually.
It is very important to consider that certain types of contraception, such as birth control pills and intrauterine devices (IUDs), may change your menstrual cycle.
As you approach menopause, your cycle may become irregular again. However, because the risk of uterine cancer increases with age, discuss any irregular bleeding (metrorrhagia) that occurs during menopause with your gynecologist.
How can I track my menstrual cycle?
To understand what is normal for you, start keeping a record of your menstrual cycle in a calendar.
Begin by tracking the start date each month for several consecutive months to determine how regular your periods are. If you are concerned about your period, also note the following each month:
- Start and end dates.
- How long does your period usually last?
- Is it longer or shorter than usual?
- Flow. Record the heaviness of your flow. Does it seem lighter or heavier than usual? How often do you need to change your sanitary protection?
- Are any clots present?
- Abnormal bleeding. Do you experience bleeding between periods?
- Pain. Describe any pain related to your period. Is it worse than usual?
- Other changes. Have you noticed changes in mood or behavior?
- Did anything new occur during this menstrual cycle?
What causes menstrual cycle irregularities?
Irregularities and disruptions in the menstrual cycle can have many different causes, including:
Pregnancy or breastfeeding. A missed period may be an early sign of pregnancy. Breastfeeding almost always delays the return of menstruation after childbirth.
Eating disorders, excessive weight loss, or excessive exercise. Eating disorders — such as anorexia nervosa — significant weight loss, and high levels of physical activity can disrupt menstruation.
Polycystic ovary syndrome (PCOS). Women with this endocrine disorder may have irregular periods as well as enlarged ovaries containing small fluid-filled follicles that appear as tiny cysts on each ovary during a gynecological ultrasound.
Premature ovarian insufficiency. Premature ovarian insufficiency refers to the loss of normal ovarian function before age 40. Women with this condition — also known as primary ovarian insufficiency — may have irregular or occasional periods for years.
Pelvic inflammatory disease (PID). This infection of the reproductive organs can certainly cause irregular menstruation.
Uterine fibroids. Uterine fibroids can cause heavy menstrual bleeding as well as prolonged menstrual periods.
What can I do to prevent menstrual disorders?
For some women, the use of birth control pills can help regulate their cycles. Treating any underlying issues, such as an eating disorder, can also be beneficial. However, certain menstrual disorders cannot be prevented.
Additionally, consult your gynecologist if:
Your periods suddenly stop for more than 90 days, and you are confirmed not to be pregnant.
Your periods become irregular after having been consistently regular.
You bleed continuously for more than seven days.
You bleed more heavily than usual, or you need to change your pad or tampon more than once every two hours.
Your periods occur less than 21 days apart or more than 35 days apart.
You experience bleeding between periods.
You have very severe pain during your period.
You suddenly develop a fever and feel unwell after using a tampon.
If you have questions or concerns about your menstrual cycle, speak with your gynecologist promptly.
