Menstrual Periods: What’s normal and what’s not

Menstrual Periods

What’s normal and what’s not

Menstruation

Menstruation, also known as a period, is the 3-8 days of vaginal bleeding women experience as part of their reproductive (menstrual) cycle each month. Periods are a key feature of female puberty. They typically begin by age 12 for most girls, but they can start as early as 8 years old and as late as 16 years old.

A woman’s body prepares for They are not created during the menstrual cycle; they simply reach maturity. Eventually, the ovaries run out of eggs and the female’s hormone levels drop. At this point, a woman’s body enters a stage known as

The Menstrual Cycle

Periods should occur every 21 to 35 days. The first day of a woman’s period is the first day of her menstrual cycle. The cycle ends on the first day of her next period.

The menstrual cycle is made up of the following 3 phases:

1. Follicular Phase (Days 1-14)

The follicular phase is kicked off with menstrual bleeding which lasts 3-8 days and tends to be heaviest on days 1 and 2. The bleeding signals that there is no pregnancy. The egg and the lining of the uterus are expelled from the body long with the blood contained within the lining by travelling through the cervix and down the vagina. Meanwhile, the ovaries are getting ready to let go of a new egg. Glands in the brain release hormones that stimulate the production of follicles. Follicles are fluid-filled bumps that form on the surface of the ovaries. Each follicle contains an egg. As the follicles develop, one follicle will become bigger than the rest and will be the one to provide the mature egg for this cycle. The other follicles recede back into the ovary. Estrogen levels rise during this time. Estrogen is responsible for causing the uterine lining to thicken. Thickening occurs after the menstrual bleeding has stopped. In addition, blood and nutrients are brought into the uterus through surrounding arteries.

Sometimes two or more follicles, instead of one, mature. As a result, several eggs are released that can be fertilized and lead to the possibility of conceiving multiples (twins or triplets).

2. Ovulatory Phase (~Day 14)

During the ovulatory phase, the mature egg is freed from the follicle. The egg moves into the fallopian tube where fertilization may occur (i.e., meets with sperm). The egg breaks down approximately 24 hours after its release if fertilization does not occur.

3. Luteal Phase (Days 15-28)

The follicle that released the egg begins to secrete a hormone called progesterone. This hormone prevents the uterine lining from shedding. If pregnancy occurs, the follicle continues to produce progesterone, but if pregnancy does not occur, the follicle breaks down and progesterone production stops. The uterine lining sheds and menstrual bleeding occurs again, indicating the commencement of the follicular phase, the next cycle.

Vaginal Discharge

Vaginal discharge is fluid that is excreted from the vagina and cervix. Discharge is normal. In fact, vaginal discharge is an important everyday part of keeping the vagina clean and free of infection. The vagina is a mucus membrane. The cells that make up the mucus membrane expel fluid to keep the tissue lubricated and healthy. The fluid picks up dead cells, bacteria, and other debris and removes it from the vagina. In general, discharge should have a clear or white/off-white color, it may leave a yellowish stain in your underwear, and it may have a slight, subtle odor. If your vaginal discharge has an unusual color like yellow-green or grey, a strong smell, or any other abnormal changes, it may indicate an infection. Speak with a healthcare provider.

Vaginal discharge changes throughout a woman’s cycle. The texture and quantity of discharge can help indicate where you are in your cycle, such as when you are ovulating (peak fertility).

During Period

During a woman’s period, blood and uterine lining are mixed with the fluids present in vaginal discharge. Only roughly 2-3 tablespoons of blood are lost during a period. As a result, discharge in this stage is red. Discharge can sometimes appear brown or even black in color. This is typically not a concern and is the result of the blood being old. The blood has taken a while to leave the uterus and has had a chance to oxidize.

After Period

Little to no vaginal discharge tends to occur right after your period. Hormones such as estrogen which stimulates cervical fluid production are low.

Approaching Ovulation

As the egg begins to mature, vaginal discharge begins to become white, cloudy, and sticky.

Around Time of Ovulating

There will be a larger quantity of vaginal discharge around this time, and it will be thin, stretchy, and have a wet consistency.

After Ovulation

Vaginal discharge is white, cloudy, and sticky and the amount will decrease as period approaches.

Period Symptoms: what’s normal and what’s not

The menstrual cycle is a complex biological process that is largely controlled by hormones. This process can take a big physiological and mental toll on women. Menstrual cycles are unique and vary among women. Things like stress, medication, diet, reproductive disorder (for example polycystic ovarian syndrome, endometriosis, uterine fibroids, etc.), and other non-reproductive related disorders can affect a woman’s period. The menstrual cycle can sometimes be a window into a woman’s overall health. Some symptoms are common for a period, while other symptoms (like abnormal symptoms listed below) are not and warrant a visit to a healthcare professional.

Normal Period Symptoms

• Bleeding lasts between 3-8 days
• Bleeding is regular (i.e., comes once every month)
• Mood fluctuations
• Trouble sleeping
• Food cravings
• Cramps in lower abdomen and/or back
• Bloating
• Breast tenderness
• Acne

Abnormal Period Symptoms

• Periods stop
• Periods last longer than 8 days
• Periods are heavy
• Severe pain
• Bleeding in between periods

References

1. Society of Obstetricians and Gynaecologists of Canada (SOGC). Normal Periods [Internet]. Ottawa (CA): SOGC; [date unknown] [cited 2022 Jul 27]. Available from: https://www.yourperiod.ca/normal-periods/menstrual-cycle-basics/

2. Karapanou O, Papadimitriou A. Determinants of menarche. Reprod Biol Endocrinol [Internet]. 2010 Sep 30 [cited 2022 Jul 27];8:115. DOI: 10.1186/1477-7827-8-115.

3. Porras-Gómez TJ, Moreno-Mendoza N. Neo-oogenesis in mammals. Zygote [Internet]. 2017 Aug [cited 2022 Jul 27];25(4):404-422. Available from: https://pubmed.ncbi.nlm.nih.gov/28780921/ DOI: 10.1017/S0967199417000363.

4. Takahashi TA, Johnson KM. Menopause. Med. Clin. N [Internet]. 2015 May [cited 2022 Jul 27];99(3):521-534. DOI: https://doi.org/10.1016/j.mcna.2015.01.006.

5. Thiyagarajan DK, Basit H, Jeanmonod R. Physiology, Menstrual Cycle [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Oct 30 [cited 2022 Jul 27]. 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500020/

6. Spence D, Melville C. Vaginal discharge. BMJ [Internet]. 2007 Dec 1 [cited 2022 Jul 27];335(7630):1147-51. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099568/ DOI: 10.1136/bmj.39378.633287.80.

7. American Academy of Pediatrics Committee on Adolescence; American College of Obstetricians and Gynecologists Committee on Adolescent Health Care, Diaz A, Laufer MR, Breech LL. Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Pediatrics [Internet]. 2006 Nov [cited 2022 Jul 27];118(5):2245-50. Doi: 10.1542/peds.2006-2481.

8. Cleveland Clinic. Abnormal Menstruation (Periods) [Internet]. Cleveland (OH): Cleveland Clinic; 2019 Aug 25 [cited 2022 Jul 27]. Available from: https://my.clevelandclinic.org/health/diseases/14633-abnormal-menstruation-periods