When I first got introduced to the world of women’s health online I was confronted with information about what a real healthy period actually is. It was exciting information for me at the time but I soon realised that it led me down a road to trying to attain perfection in my menstrual cycle. Perfectionism is not something that I struggle with in my life generally, but I think because my hormones and my health have been my particular area of trauma, it was easy for me to become a little obsessed without even noticing. Unfortunately the stress of striving for something unattainable was probably keeping me further away from the perfect period I was searching for. It is true that the menstrual cycle and monthly period can be seen as a monthly health “report card” and its wonderful to learn to monitor body signs that can signal you to underlying health problems, but its not ok for social media to make women feel like they aren’t good enough or healthy enough because their periods are not perfect all the time. My training as a fertility awareness educator has taught me that there is no such thing. It is common and normal for women to experience variations in their menstrual cycle especially under periods of stress, illness and change. The article below highlights some healthy parameters for a period there are certain key indicators of a healthy period, but please be aware that most women will have multiple deviations from the ideal throughout their menstruating years and thats ok.
Not all bleeds are true periods. A true period always follows ovulation. Bleeding without ovulation is called inter-menstrual bleeding. The bleed that occurs on the pill is a good example of a bleed that is not a real period because there is no ovulation while on the pill, therefore a pill bleed is actually a withdrawal bleed and not a real period. Inter-menstrual bleeding can occur for a number of different reasons. You can read more about it in my article here: https://talidavoinea.au/can-i-get-pregnant-on-my-period-the-difference-between-periods-and-intermenstrual-bleeding/
Length of Period
The length of a healthy menstrual cycle can vary from woman to woman, but typically falls within the range of 21 to 35 days. The menstrual period itself usually lasts around 3 to 7 days. Significant deviations from this range might indicate underlying health issues that need attention. Keep in mind that the first few years after menarche (the onset of menstruation), post-partum and the years leading up to menopause (perimenopause) can bring about changes in cycle length, which is generally considered normal.
Pain free periods are ideal and possible but mild discomfort, a tight or heavy feeling and mild cramping is common during menstruation and considered normal, especially within the first couple of days. Period pain is more common in younger women prior to pregnancy because uterine muscles are tight. Painful periods are thought to be more common alongside heavier periods but this is not necessarily true. Sometimes even very light periods can be very painful. It is more common to have more painful periods situationally under periods of stress or illness due to increased inflammation and muscle tension. Although pain free periods are possible, it may be unreasonable to expect pain free periods at all times. However, severe pain that interferes with daily activities might be indicative of a condition called dysmenorrhea. Dysmenorrhea can be primary, occurring without any underlying medical condition, or secondary, resulting from conditions like endometriosis, adenomysois or fibroids. While some discomfort is expected, it’s important to address debilitating pain with a healthcare provider.
The flow of menstrual blood can vary in terms of its consistency and colour. A healthy menstrual flow is characterised by the following:
Flow Volume: The volume of blood can range from light to heavy. Each period should consist of 1-2 heavy days, 1-2 moderate flow days and 1-2 light days or spotting. On average, women lose about 30 to 50 mls of blood during their entire period. A flow of 80mg or more that requires changing a pad or tampon every hour is considered heavy. Heavy flow can also be said to a total of 8 fully super sized pads or maxi tampons or 16 regular fully soaked pads or tampons across the entire period. Note this means fully saturated pads and not pads that are changed when they are half full because of comfort or choice etc. In general periods that last more tan 7 days are also considered heavy. If you use a menstrual cup, a heavy period is considered 3 full menstrual cups across the entire length of your period. Changing pads or tampon every 4 to 6 hours is usually considered normal although this may be more or less depending on the flow level of the day. If you find yourself changing these products more frequently, it might be worth investigating.
Colour: Menstrual blood can vary in colour from bright red to dark brown. Generally, brighter red blood is newer while darker blood indicates older blood. This is completely normal and reflects the time it takes for the blood to exit your body. Occasionally under periods of illness such as cold and flu, blood may change in colour. Light pink blood may indicate low estrogen, anaemia and low body weight. Orange and grey coloured blood may indicate potential infection such as bacterial vaginosis and some STI’s. To note, if there is an underlying infection there may be discharge at other times of the cycle as well and other symptoms. Some STI’s do not show symptoms until severe, so keeping up to date with regular screening is advised, especially if your sexual behaviours put you at higher risk.
Clots: Passing small blood clots during your period is also normal. Clots smaller than a 50c Australian coin or about 1 inch or 2.5cm/25mm in diameter are considered normal. Clots are a combination of blood and tissue shed from the uterine lining. However, if you notice unusually large clots, numerous large clots or experience heavy bleeding that makes it difficult to manage, consult your healthcare provider.
Light or Heavy Flow
The amount of blood lost during a period can vary significantly. A lighter flow may involve less blood loss and a shorter period, while a heavier flow can lead to more blood loss and a longer period. However, excessively heavy bleeding, known as menorrhagia, can indicate an underlying issue such as hormonal imbalances, fibroids, or polyps. Conversely, a very light flow might be due to factors like stress or changes in weight.
A regular menstrual cycle occurs at relatively consistent intervals and durations. While some irregularity is common, especially during the first few years of menstruation and as women approach menopause, drastic changes in cycle length or skipping periods altogether might warrant medical attention. Irregular periods could be a sign of hormonal imbalances, thyroid disorders, polycystic ovary syndrome (PCOS), or other underlying conditions.
Nagy, H., & Khan, M. A. B. (2022). Dysmenorrhea. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560834/