Your period might be something you prefer not to think about. Maybe you even feel uncomfortable talking about it. (I know I did for a long time!) I thought it was gross, or embarrassing, or impolite, and I’d always feel my face flush when the subject would come up—even in the doctor’s office!
When I was dealing with hypothalamic amenorrhea, the subject was very much “out of sight, out of mind,” and that was just fine for me, at that time; I was happily oblivious to all the things that were—or weren’t—going on down there. But when my cycle finally returned, it was different than I’d experienced it in high school. I found myself wondering what was normal, and what wasn’t. Some months I felt great, but other months I felt awful…once, my cramps got so bad that I threw up! Sometimes I’d go for almost a year without any symptoms of PMS at all, and other times I’d know exactly when Aunt Flo was about to arrive because I’d have back pain, sore breasts, and all kinds of acne. I finally started getting answers when I started studying medicine, and I found it extremely helpful, empowering, and eye-opening to gain so much knowledge about my own body.
Why Are Periods So Important?
The answer most people would give for this question would be fertility—conceiving and carrying a pregnancy. But our periods offer so much more insight into our own lives and livelihoods than the seasons in which we’re thinking about creating new life. Our periods, and the delicate web of hormones that makes up the menstrual cycle, have to do with so much more than pregnancy.
The average lady experiences 450 cycles in her lifetime, which amounts to 10.6 years [Reference]. If we’re spending that much of our lives on our periods, we deserve to do so in comfort. Yet, so many women suffer from extreme bloating, GI trouble, excruciatingly painful cramps, mood swings, and other symptoms. It doesn’t have to be that way.
Many abnormal periods don’t cause problems on their own. Clots, discoloration, and changes in flow usually are manageable without much thought or attention. But the hormonal imbalances that cause those abnormalities carry an enormous risk for long-term health problems, such as:
- Breast, uterine, or ovarian cancer
- Heart disease, including heart attacks and strokes
- High blood pressure
- Kidney disease
- Adrenal or thyroid disorders
- Insulin resistance and diabetes
It still blows my mind that periods are such a taboo subject. They’re a normal part of women’s health, and give us valuable insight into our well-being. Censorship of period conversations limits a woman’s access to essential information about her sense of well-being. Periods aren’t gross. They aren’t weird, and they shouldn’t be hush-hush. In fact, every single person on earth is only here because of the function of a woman’s reproductive system.
The female body is amazing, and each of us should have the privilege of understanding what our period reveals about our health. So, if you have questions about your cycle, are wondering if your period is normal, or what it could mean if it’s not, this post is for you.
What is considered a “normal” period?
Menstrual cycles are considered normal if they last between 21 and 35 days. The first day of your period is counted as the first day of the cycle, and you count upwards until the first day of your next period. Bleeding should be bright red in color, last for 2-7 days, and fill a regular pad or tampon every 4-6 hours (1-2 tablespoons of blood per day). A few small clots are normal, but there shouldn’t be any large clots or intense pain. Mild cramping is normal on the first day or two, (or even the day before) but should be light enough that it doesn’t interfere with your life. In general, if you need to take painkillers, that’s usually a sign that something is running amok. Some women also experience a day or two of light spotting leading up to their period, which is normal, but mid-cycle pain or spotting is not.
Usually, when we think of the menstrual cycle, we divide it into two parts: period week, and everything else. But there’s so much more going on behind the scenes. Ovulation (the release of an egg) takes place around halfway through the cycle (which would be day 14 or 15 of an average, 28-day cycle) and there are rhythmic fluctuations of hormones released through the hypothalamic-pituitary-gonadal axis, triggering predictable patterns of estrogen, progesterone, and other chemicals. Typically estrogen is highest during the first two weeks of the cycle (called the follicular phase) and progesterone takes over during the last two weeks of the cycle (called the luteal phase). To learn more about the details of hormonal changes throughout the cycle, the four sub-phases of the cycle and what they mean, how to track your own cycle, and ways to find out when you’re ovulating, check out this post: Female Fertility 101
When cycles deviate from the norm, the best course of action is to make an appointment with your healthcare provider to get to the bottom of your symptoms and put together a treatment plan that’s right for you. But for the sake of educational purposes (not as a diagnosis or treatment) let’s talk about what could be going on if a woman’s cycle deviates from the status quo.
What an Abnormal Cycle Could Mean:
This graphic (thank you, google) is pretty good, but I’d like to add a few more things. First of all, if menstrual blood is dark brown or black during your period (meaning not the very beginning or end, and you’re not pregnant) that could also signify an infection, and should be discussed with your healthcare provider. Mid-cycle brown blood may result from ovarian cysts, PCOS, or uterine fibroids. Some women also experience mid-cycle spotting around the time of ovulation, and this can range from pink to red, to brown in color. Dark blood is also common during menopause.
Probably the most common “abnormal color” on this list would be light pink blood, which really just signifies a very light flow to the point where the menstrual blood is so diluted that it looks pink rather than red. This is indicative of a hormonal imbalance, which needs to be addressed.
Light flow: Pinkish blood, scant spotting (in lieu of a period), or a flow that more closely resembles a few teaspoons per day (rather than a few tablespoons) can be normal if you’re taking hormonal birth control or are approaching menopause. Most other cases point to a hormone imbalance, especially in terms of estrogen/progesterone, often resulting from lifestyle factors like overexercising, under-eating or an otherwise unbalanced diet, elevated stress levels, weight changes, lack of sleep, or new medications. Light flow can also be a consequence of imbalances in other hormones, such as adrenal or thyroid, which would be assessed via laboratory testing. A lighter-than-normal period that comes on a few days early may also be a sign of pregnancy.
Heavy flow: As with a lighter flow, heavy menstrual bleeding can be normal with certain forms of birth control, or around menopause. It also can point to an imbalance in estrogen/progesterone resulting from lifestyle factors such as those described above, thyroid dysfunction, or from a menstrual disorder such as PCOS, endometriosis, or fibroids.
A heavy menstrual flow often points to: estrogen dominance or relative progesterone deficiency which may have a number of different root causes.
Long Cycles (>35 days) can be triggered by medication use, or during periods of hormonal fluctuation such as perimenopause, adolescence, or breastfeeding. Abnormal reasons include hormonal imbalances resulting from lifestyle factors, thyroid abnormalities, diabetes or other problems with blood sugar control, PCOS, or elevated prolactin (from breastfeeding or other causes). When a cycle is longer than 35 days, it is usually because ovulation is delayed (a long follicular phase). This can result from a number of different conditions, which we’ll address in another post.
Short Cycles (<21 days) usually points to either early ovulation (or absence of ovulation), or a short luteal phase. Both of these issues can create problems when trying to conceive, whether in terms of timing of sex for conception, or because the luteal phase is not long enough for the endometrial lining to reach an appropriate thickness for implantation and pregnancy. This is usually a consequence of low progesterone levels. Short cycles may also be a symptom of thyroid or adrenal dysfunction.
Bleeding that lasts longer than 7 days could point to a number of different problems, including anovulation, a clotting disorder, fibroids, or another type of pathology such as an infection, and should be evaluated by a healthcare provider.
A few small clots (less than the size of your finger tip) are normal, but large clots point to a hormone imbalances such as elevated estrogen or progesterone deficiency. This can result from lifestyle factors, endometriosis, adenomyosis, fibroids, or thyroid abnormalities.
Occasionally, women experience light spotting during adolescence or peri-menopause, but it can also occur around the time of ovulation for some women. Typically, spotting between periods points to a hormonal imbalance, especially low progesterone during the luteal phase, or from PCOS, endometriosis, or damage to the vaginal tissue. It may also indicate another type of pathology, such as an infection, fibroids, or abnormal tissue growth, and should always be evaluated by a healthcare provider.
A day or two of mild cramps around the start of your period is normal, but if the cramps last longer than that or are severe, there may be something deeper going on. Usually, severe or prolonged cramps point to inflammation in the body, which can result from an imbalance in sex hormones (estrogen/progesterone/testosterone), thyroid hormones, adrenal hormones, or even an underlying inflammatory or autoimmune disease. If you’re experiencing intense period pain, it doesn’t have to be that way. (P.S. There’s more you can do than just take birth control.)
Some women experience one-sided cramping around the time of ovulation, which is called mittelschmerz. This is normal, but it is not experienced by everyone. If the pain is extreme, talk with your healthcare provider.
To sum things up…
Outside of the case of pathology (such as infection, PCOS, endometriosis, or life transitions like menopause), hormonal imbalances are common and can cause all kinds of changes to the menstrual cycle. Typically, abnormal sex hormone levels fall into predictable patterns of symptoms, summed up in the chart below:
|Estrogen Dominance||Estrogen Deficiency||Progesterone Deficiency||Testosterone Excess|
|Flow||Heavy||Light||Heavy or normal||Heavy or normal|
|Cycle Length||Short||Irregular or long||Irregular or long||Irregular, and usually long|
|Period Length||Longer||Shorter, or with spotting||Longer, or with spotting||Normal length, long, or short, often with spotting|
|Cramps||Heavier||Lighter||Heavier or normal||Usually severe|
|Other symptoms||Low libido, insomnia, weight gain||Vaginal dryness, recurrent UTIs, fatigue||Hair loss, low libido, recurrent miscarriage, weight gain, dry skin||Abnormal hair growth, infertility, weight gain|
We’ll be diving into these patterns (and others) in more detail in future posts, but for now…know that if your cycle feels “off” or doesn’t seem to reflect your normal, you can get help. Usually, healthcare providers prescribe birth control pills to mask over some of the symptoms related to dysfunctional sex hormone levels, but it doesn’t have to be that way. There are explanations and answers, and you can manage your reproductive health holistically if that’s something that aligns with your individual values. To get started, check out this post about balancing hormones naturally, consider making an appointment for a personalized natural health consultation, and stay tuned for more info about hormone imbalances, coming soon!