Menstruation is so much more than a symbol that signifies you have reached the phase in your life where you are able to birth a child. As I mentioned in my blog, "The Fifth Vital Sign: The Menstrual Cycle", it can also reveal serious health conditions. It is important to understand what is normal for your cycle so that you can address an issue immediately when things go awry. Check out, "The Importance of Tracking Your Period" for tips on how to track your cycle and why it is important.
So what is a normal menstrual cycle? Is there even a such thing as normal? In medicine, there is always a guide for what is considered "normal". However, everyone of us are uniquely made and some may have a "normal" outside of those given perimeters. Nevertheless, using what medicine has defined as normal is still very beneficial. There are abnormal symptoms that you want to be aware of and address to prevent obstacles such as infertility or iron deficiency anemia from occurring.
What should your period look like?
The flow, color, and consistency of your period, can change slightly from month to month due to lifestyle choices, hormonal changes, age, and the environment. Any drastic changes in menstruation should be evaluated by a healthcare provider.
Period length: The average period is 2-7 days in length.
Color of Menses:
Bright Red: Fresh blood that sheds from the uterine lining. Present for some all throughout menses, and for others in the beginning of their period or around days 2-3.
Dark Red/Brown: Can occur at the beginning or end of the period. As blood sits in the uterus it is exposed to oxygen. The longer blood interacts with oxygen the darker it gets (oxidized). Brown blood can also be a sign of implantation bleeding revealing early pregnancy.
Black: Can occur at the beginning or end of the period. This represents blood that has taken longer to leave the uterus and has further oxidized from dark red/brown to black in color. Black blood can also be due to a vaginal blockage. Other symptoms that may be present with a vaginal blockage include foul smelling discharge, difficulty urinating, vaginal itching, and fever.
Pink: Can signify an infection or anemia. Pink blood can also occur when period blood mixes with cervical fluid.
Orange: Can be due to an infection, such as bacterial vaginosis (BV), or trichomonaisis.
Blood loss: The average woman loses about two to three tablespoons (30-50ml) of blood during menstruation. Your flow may change from month to month, and when menarche (a women's first period) occurs it may take a few cycles for your period to normalize. Typically, you will have a heavier flow in the beginning of your period and it will lighten up as the days go by. You may also notice a few small clots (less than 1 inch) pass during menstruation, which is normal.
How to determine blood loss: Your period only contains about 36% of blood, the rest is fluid that consists of mucous, endometrial tissue, and vaginal secretions. Measuring the amount of blood loss will depend on what sanitary products you utilize and how often you change them.
Pads/Tampons: A fully soaked regular sized pad or tampon holds 5ml of liquid. Extra-absorbent pads and tampons hold about 10ml of liquid. Variations exist between brands, so make sure to look at the packaging for their specific absorbency.
Menstrual cups: Menstrual cups are the easiest way to determine blood loss. Many cups have measurement marks, and tell you how many milliliters a full cup holds (typically 12ml)
Measuring blood loss can be difficult. Many women change their sanitary products before they are fully saturated for hygienic reasons. Also, you have to take into consideration that only 36% of fluid loss is actually menstrual blood. A good rule of thumb is that if you are changing a fully soaked pad/tampon every hour, you are experiencing abnormal heavy bleeding.
Menstruation is such a valuable tool in evaluating the health of your body. There are variations in what a "normal" period should look like for each woman. The most important thing to take away is 1. know what is normal for your body, 2. understand what the changes in your cycle mean, and 3. to seek help when problems arise.
If you have any questions about your menstrual cycle feel free to contact me.