Periods: What's Normal?
The Menstrual Cycle
The menstrual cycle is counted from the first day of bleeding from one cycle to the first day of bleeding for the next cycle − this typically lasts about 28 days.
Your period is considered day 1.
By day 5, your estrogen levels start to increase, which causes the endometrium (lining of the uterus) to thicken.
By day 14, an egg is released from the ovary and moves into one of the fallopian tubes (called ovulation). After ovulation, progesterone levels increase as estrogen decreases.
By day 28, if the egg is not fertilized, progesterone and estrogen levels decrease. The endometrium is shed during your period.
How Pregnancy Occurs
Around day 14, an egg is released from the ovary and moves into one of the fallopian tubes during ovulation. If you have unprotected sex around this time, the egg and sperm may join in the fallopian tube. Once joined, the fertilized egg will move through the fallopian tube into the uterus, where it attaches and grows during pregnancy.
Dysmenorrhea − Painful Periods
Painful periods are called dysmenorrhea. Most women who menstruate have mild pain for 1-2 days each month. However, for some women, the pain is so bad that it prevents them from participating in their normal activities for several days a month. Severe pain can also be accompanied by diarrhea, nausea, vomiting, headache, or dizziness.
Types of Dysmenorrhea
- Primary Dysmenorrhea: the cramping pain that presents before or during your period and lessens after the first few days of your period. Primary dysmenorrhea usually starts soon after a girl begins having periods and becomes less painful as you age or after giving birth.
- Secondary Dysmenorrhea: pain caused by a disorder in the reproductive organs. This pain tends to get worse over time and lasts longer than normal menstrual cramping. Certain conditions cause secondary dysmennorhea, including:
- Endometriosis: tissue similar to the lining of the uterus (endometrium) grows in other areas of the body, including the ovaries, fallopian tubes, and bladder. This tissue breaks down and bleeds in response to hormone changes, especially around your period, which causes pain. Adhesions (scar tissue) may form in the pelvis where the bleeding occurs, also causing pain.
- Fibroids: growths that form on or inside the uterus. Fibroids growing in the wall of the uterus can cause pain.
- Adenomyosis: occurs when the endometrium (inner lining of the uterus) grows into the muscle wall of the uterus, resulting in painful and heavy menstrual bleeding.
What should I do about my painful periods?
Tell your provider if you are experiencing painful periods. They may want to perform a pelvic exam to help identify the cause of your pain. Medications are usually the first step in treating painful periods. Your provider may recommend over-the-counter NSAIDS (such as ibuprofen) or different forms of birth control to help. Birth control pills, patches or rings that contain estrogen and progestin can treat painful periods. Hormonal intrauterine devices (IUDs) can also be used. Other recommendations include regular exercise, adequate sleep, relaxation, and applying heat to your abdomen. If these remedies do not alleviate your painful periods, speak with your provider about additional options.
Heavy Menstrual Bleeding
Heavy menstrual bleeding is common but not normal. If you are concerned about your heavy periods, please contact your provider. Heavy periods may be a sign of an underlying health issue including fibroids, polyps, irregular ovulation, bleeding disorders, or cancer.
What is considered “heavy” bleeding?
- Bleeding that lasts longer than one week
- Bleeding that soaks through a pad or tampon every hour for multiple hours
- Needing to wear more than one pad at a time
- Periods with blood clots the size of a quarter or bigger
What can be done to treat heavy bleeding?
Your provider will want to know about your history and any medications you are taking. You may have a pelvic exam, blood work, or an ultrasound to determine the cause of the heavy bleeding. Often, medications are used to help with heavy bleeding, including hormonal birth control, hormone therapy, or NSAIDs (such as ibuprofen). If medication does not help, your provider may recommend further treatment or procedures.
Uterine bleeding is considered abnormal in the following cases:
- Bleeding between periods
- Bleeding after sex
- Heavy menstrual bleeding
- Menstrual cycles shorter than 21 days or longer than 35 days
- Irregular periods when the cycle length varies by more than 7 days
- Bleeding after menopause
Abnormal uterine bleeding is more common when a girl first starts having periods or during perimenopause (around the age of 50).
It is important to talk to your provider about any abnormal uterine bleeding.