What is a normal period?

When I ask women about their periods, they will often say they have the “normal” amount of pain, or a “normal” length period, or a “regular” colored period.

What they really are trying to say is that they have a culturally normative, or commonly experienced, type of period.

Today we are going to talk about what a physiologically “normal” period is, and what your body is trying to tell you when you don’t follow this pattern.

First off, there should be no pain or disability with your period.

This is the most important thing because culturally we have come to believe that a painful, grouchy, fatigue-ridden period (or start of the period) is normal, expected, and experienced by everyone.

No.

This is not normal.

Pain and disability is experienced by many girls and women with their periods.

But it is not normal, and should not be tolerated.

We must change out cultural expectation around this because a dysfunctional period leads to a dysfunctional menopause.

And believe me, if you think a dysfunctional period is bad . . . . it’s got nothing on a dysfunctional menopause.

Ok. That’s my intro tirade.

Now let’s look at other components of a normal period

1) Length of Cycle

The normal/optimal length of a cycle is 28 days.

The first day of the cycle is the first day that you bleed.

The last day of the cycle is the last day you do not bleed – that is the day before you bleed again.

The first half of the cycle (first 14 days or until ovulation) is called the follicular (proliferative) phase.

This phase will come to an end when sufficient follicle stimulating hormone (FSH) is produced in the brain to mature the oocyte (egg) that will mature enough to be ovulated mid-cycle.

This first phase of the cycle is largely brain dependent and reflective of the vitality and responsivity of the ovary.

The second half of the cycle (second 14 days or until the bleed starts) is called the luteal (secretory) phase.

The length of your cycle is largely based on hormone fluctuations that are influenced by the mileau of your body.

Hormones

Estrogen causes tissue proliferation.

For the uterus, that means the higher estrogen is the more the uterine lining is built.

Progesterone causes the proliferation to be maintained.

So you need enough estrogen and progesterone to be able to make the uterine lining (called the endometrium).

And you need the estrogen and progesterone to decrease enough so the uterus releases the endometrium and you start bleeding.

Now in standard biomedicine (AKA Western medicine, conventional medicine, standard medicine, allopathic medicine) a cycle is only considered to be abnormal if it is less than 21 days (polymenorrhea), or longer than 37 days (oligomenorrhea), or less frequent than every 90 days (amenorrhea).

The bleeding that we are talking about here is for women who are still cycling and this is the bleeding part of their cycle. We will talk about other types of bleeding outside of the menses on a different video. We are also assuming no pathology, like cancer, is present. We will talk about that type of bleeding in a different video.

2) How many days of bleeding

3-5 is considered normal

For me factors that influence whether someone has a 3 or 5 day cycle have to do with their reproductive vitality.

So women in their 20s and 30s will tend to have bleeds of 4-5 days, and women in their 40s will tend to have bleeds of 3-4 days. Women who are experiencing a physiologic normal perimenopause in their late 40s and early 50s will have periods between 2-3 days.

Over 7 days of bleeding is metrorrhagia.

Long bleeds recapitulate long bleeds.

That is because the underlying hormonal issue persists, and the more blood you lose, the more iron you lose, so it is hard to stop bleeding because iron is one of the things that helps to stop the bleed.

3) Amount of blood

The normal amount of blood lost in a period is 30-50 ml (2-3 tablespoons)

This is hard to measure.

If women have to change a regular tampon, pad, or cup more often than every 2 hours, this is considered to be a heavy bleed.

A light bleed means they only need to change a regular tampon, pad or cup a couple times a day.

Now with menstrual underware it is harder to measure how much you bleed, so you need to check using a pad, tampon, or cup.

4) Color of blood

Normal menstrual blood is bright red.

If your bleed is pink, or light red with kind of a separation of a clear (serous) fluid this means low estrogen

If your bleed is brick red or darker this means you have high estrogen or oxidized (old blood)

If your bleed is brown and sticky this means old blood, probably from that last cycle

5) Clotting

There should be no clotting with a normal period

If you clot, that means you have high estrogen

If you use a cup, you could see clots that are not related to estrogen.

Blood has clotting agents in it, and any blood that sits around will start clotting.

Thank god.

6) Spotting

There should be no spotting running up to your period, or after the bulk of your flow

Often times people who experience spotting will note the spotting is a different color than the period blood.

If the blood is dark and sticky spots before or after the period, this suggests the uterus is not in ideal position.

If the spotting is pink and thin or watery, this suggests there is low estrogen.

The three major things that influence the nature of a menstrual bleed are

1) Hormone levels

2) Iron levels

3) Uterine position or other factor related to the uterus (such as fibroid)

References

James AH. Heavy menstrual bleeding: work-up and management. Hematology Am Soc Hematol Educ Program. 2016 Dec 2;2016(1):236-242. doi: 10.1182/asheducation-2016.1.236. PMID: 27913486; PMCID: PMC6142441.