Let’s Talk Periods: What’s Normal and Not, and when to Seek Help

Introduction

My big sister handles and coaches many young ladies, and as their “Auntie” who happens to be a midwife, I often get messages like, “Hi! Are you free? Can we talk about something?” Most of the time, it’s about menstrual irregularities. For their sake—and for many other women—I’m going to discuss this topic in detail. Understanding the menstrual cycle, including what is normal and what might be a sign of an underlying issue, empowers you to take charge of your health. In this guide, I will break down the phases of the menstrual cycle, outline typical patterns, highlight common abnormalities, and explain when it’s time to consult a healthcare provider.

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Understanding the Menstrual Cycle

Your menstrual cycle is the monthly series of hormonal changes your body undergoes to prepare for a potential pregnancy. The cycle begins on the first day of menstrual bleeding (the period) and ends the day before your next period starts. Although a 28-day cycle is often cited as the “average,” normal cycles can range anywhere from 21 to 35 days (Cleveland Clinic).

The cycle is divided into four key phases, each with its own purpose and physical signs:

1. Menstrual Phase

This phase marks the start of your cycle and lasts 3–7 days as the uterine lining (endometrium) sheds. You might experience mild cramping, which is similar to the way we prepare our home for a guest—laying out the best for someone special, only to pack it all away if the guest doesn’t show. The body, like us, resets if a fertilized egg doesn’t arrive.

2. Follicular Phase

Beginning on the first day of bleeding and continuing once menstruation stops, this phase is characterized by rising estrogen levels. Estrogen stimulates the regeneration of the uterine lining, and several ovarian follicles start maturing. This phase not only prepares the body physically but often lifts mood and energy levels as estrogen increases (Mayo Clinic).

3. Ovulation

Around the midpoint of your cycle—usually about day 14 in a 28-day cycle—ovulation occurs as a mature egg is released from the dominant follicle. Key signs include clear, stretchy cervical mucus (often compared to raw egg whites) and sometimes a slight pelvic pain on one side, known as mittelschmerz (Healthline).

4. Luteal Phase

After ovulation, the corpus luteum forms in the ovary and secretes progesterone. This hormone thickens the uterine lining, preparing it for a potential pregnancy. If the egg isn’t fertilized, the corpus luteum breaks down, progesterone levels drop, and the cycle begins anew.

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What’s Normal

Cycle Length and Regularity

• Cycle Length: A typical menstrual cycle lasts between 21 and 35 days. Even if your cycle isn’t exactly 28 days every month, slight variations are normal. A consistently predictable pattern, however, is a good indicator of hormonal balance. For example, if your period reliably arrives every 28 days, that consistency is a sign your body is functioning well.

• Regularity: While minor month-to-month differences are expected, significant fluctuations—say one month lasting 21 days and the next 35 days—might require further investigation (WebMD).

Bleeding Duration and Flow

• Duration: Normal bleeding usually lasts between 3 and 7 days. The heaviest flow often occurs during the first two or three days.

• Volume: Most women lose around 30–80 mL of blood per cycle (roughly 2–3 tablespoons). It’s normal to notice small clots. However, if you’re soaking through a pad or tampon every hour or passing clots larger than a quarter, that may indicate heavy menstrual bleeding (Cleveland Clinic).

Associated Symptoms

It is common to experience mild menstrual cramps, mood swings, slight bloating, and breast tenderness. Many women also notice fluctuations in energy, appetite, and even occasional nausea as hormone levels shift throughout the cycle.

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What’s Not Normal

While variations exist, certain signs indicate that your menstrual cycle may not be functioning typically.

Irregular Cycle Timing

• Inconsistent Length: If your cycles vary significantly—for example, one month lasts 21 days while another stretches to 40 days—this may indicate hormonal imbalances, stress, or conditions like polycystic ovary syndrome (PCOS).

• Too Frequent or Too Infrequent: If periods occur less frequently than every 35 days or more frequently than every 21 days, it’s important to have them evaluated (Mayo Clinic).

Abnormal Bleeding Patterns

• Heavy Bleeding: Bleeding so heavy that you must change your pad or tampon every hour, or bleeding lasting more than 7 days, can be a sign of heavy menstrual bleeding (menorrhagia). This could eventually lead to iron deficiency or anemia if left untreated (Cleveland Clinic).

• Intermenstrual Bleeding: Spotting or bleeding between periods isn’t typical and may signal underlying issues such as infections, polyps, or fibroids.

Pain and Discomfort

• Severe Cramps: While some cramping is expected, cramps that are so severe they interfere with your daily activities might indicate conditions like endometriosis or adenomyosis.

• Other Concerning Symptoms: Extreme fatigue, dizziness, or signs of anemia (e.g., shortness of breath or pallor) accompanying heavy bleeding are important warning signs.

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Possible Underlying Causes

Abnormal menstrual patterns can be linked to several conditions. Here are some common examples:

• Hormonal Imbalances: Conditions such as thyroid disorders or PCOS can disrupt the balance of estrogen and progesterone, leading to irregular or heavy periods.

• Structural Abnormalities: Uterine fibroids (noncancerous growths) or endometrial polyps can cause excessive bleeding or irregular flow.

• Coagulopathies: Blood clotting disorders, such as von Willebrand disease, may result in prolonged or heavy bleeding (New York Post on VWD).

• Infections or Inflammatory Conditions: Pelvic inflammatory disease (PID) or endometritis can lead to abnormal bleeding and pelvic pain.

• Other Factors: Extreme stress, significant weight fluctuations, and intense exercise can all affect your menstrual cycle.

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When to Seek Help

It’s vital to monitor your menstrual cycle and be aware of any significant changes. Seek advice from a healthcare provider if you experience any of the following:

1. Consistent Irregularity: Significant variations in cycle length or unexpected changes in your usual pattern.

2. Heavy or Prolonged Bleeding: Soaking through a pad or tampon every hour, bleeding lasting more than 7 days, or passing large clots.

3. Severe Pain: Cramps or pelvic pain that interfere with daily activities.

4. Intermenstrual Bleeding: Spotting or bleeding between periods, particularly if accompanied by pain.

5. Symptoms of Anemia: Persistent fatigue, dizziness, or shortness of breath that might result from heavy blood loss.

Early diagnosis of conditions like PCOS, fibroids, or bleeding disorders can lead to more effective treatment and a better quality of life.

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Tracking Your Cycle

Keeping a detailed record of your menstrual cycle can empower you with insights into your health. Here are some practical tips:

• Maintain a Diary or Use an App: Record the start and end dates of your period, note the heaviness of your flow, and document any accompanying symptoms (cramps, mood changes, unusual discharge).

Learn more about cycle tracking at Natural Cycles.

• Note Physical and Emotional Changes: Track your energy levels, sleep quality, and mood. This can help you identify patterns or triggers that affect your cycle.

• Share Your Records with Your Provider: Bringing this data to your healthcare appointments can help your provider gain a clearer picture of your reproductive health.

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Lifestyle Tips for a Healthy Cycle

Along with tracking, several lifestyle adjustments can support a healthy menstrual cycle:

• Adopt a Balanced Diet: A nutrient-dense diet rich in fruits, vegetables, lean proteins, and whole grains supports hormonal balance. If you experience heavy bleeding, include iron-rich foods like leafy greens and legumes. Staying hydrated is also essential for overall body function.

• Engage in Regular Exercise: Moderate physical activity can help regulate hormones and reduce stress, which in turn supports a regular cycle. Choose activities you enjoy—be it walking, yoga, or dancing.

• Manage Stress Effectively: High stress levels can disrupt your hormonal balance. Incorporate stress management techniques like mindfulness, meditation, or yoga into your routine.

• Prioritize Sleep: Adequate, high-quality sleep is crucial for hormonal regulation. Aim for 7–9 hours of sleep per night to help maintain cycle regularity.

• Listen to Your Body: Notice how your body responds during different phases of your cycle. Your energy, mood, and even cravings can provide clues about what your body needs at that time.

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Conclusion

Understanding your menstrual cycle is a powerful step toward taking

Embrace your cycle by tracking your patterns, adopting a healthy lifestyle, and staying in tune with your body. Remember, your body is your best indicator—trust your intuition and don’t hesitate to consult your healthcare provider if something feels off.

I invite you to leave a comment or ask a question—let’s continue the conversation and support one another on this journey to better health!

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Citations and Further Reading:

• Cleveland Clinic: Menstrual Cycle – https://my.clevelandclinic.org/health/articles/10132-menstrual-cycle

• Mayo Clinic on Menstrual Cycle – https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-cycle/art-20047186

• Healthline on Ovulation – https://www.healthline.com/health/womens-health/ovulation

• WebMD: Normal Period – https://www.webmd.com/women/normal-period

• Cleveland Clinic on Menorrhagia – https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding

• New York Post on VWD – https://nypost.com/2025/03/27/health/your-heavy-period-could-be-a-sign-of-this-blood-disorder/