We are often told that a ‘normal’ menstrual cycle is 28 days long and ovulation occurs on day 14. You may be like me where I used to think that my cycles were irregular because they rarely were ever 28 days long. As we go on into our menstruating years, most of us are left to our own devices, having to figure out this period stuff alone.

It is all too common for teenagers and women to have little knowledge of what is considered ‘normal’ when it comes to their menstrual cycles. So many teens and women struggle with their cycles month after month not knowing their extremely heavy periods or the severe period pain they experience every month is in fact not normal and is not just a part of being a woman!

So what is normal you ask? In this article I breakdown the healthy parameters of menstruation and the menstrual cycle so that you can be your best health advocate when things are not quite optimal and you are in need of some support. Having this knowledge is powerful. 

It’s important to note here that these parameters are based on ‘natural’ menstrual cycles and not cycles influenced by hormonal birth control. 

Let’s begin with your PERIOD…

Total Menstrual Blood Loss

The range for normal amount of total blood loss during your entire period is between 25ml-80ml. The average being between 30-50ml. 

Total blood loss under 25ml is considered too light and total blood loss over 80ml is considered too heavy (also known as menorrhagia). Both require further investigation to establish the cause of too little or too much blood loss during menstruation.

How to work out how much you are bleeding:

One fully soaked regular pad or tampon equates to about 5ml (1 teaspoon).

One fully soaked super pad or tampon equates to about 10ml (2 teaspoons).

So if you had 10 fully soaked regular pads/tampons or 5 fully soaked super pads/tampons across all bleeding days, you would have had 50ml of blood loss.

If you tend to change your pads/tampons before they are half-soaked, rather than fully soaked, just have the amount – i.e. a half-soaked regular pad/tampon equates to about 2.5ml. 

If you use a menstrual cup, they will often have volume measurement markers on the side of the cup.

You shouldn’t need to change your pad or tampon more frequently than every 2 hours during the day. You also shouldn’t be waking throughout the night needing to change your period products. Make sure to change your pads every 3-4 hours, tampons every 4-6 hours, menstrual cup every 12 hours, and period underwear 1-2 times per day.

Total Menstrual Bleeding Days

The normal range of bleeding days (your period) is 2-7 days per menstrual cycle. The average range is between 3-5 days. Your blood flow will typically be a heavy or moderate flow to begin with and then taper down to a light flow and/or 1-2 days of spotting before it finishes for that cycle. 

Bleeding for less than 2 days indicates that your uterine lining’s thickness isn’t sufficient and may be a sign of inadequate oestrogen production. Bleeding for more than 7 days indicates that you may be bleeding too much and for too long. If your period is usually say 5 days long each cycle and then it suddenly drops down to 1-2 days per cycle, this can be a sign of hormone imbalance.

Stop/start periods are also not normal. Stop/start periods are periods where bleeding stops for a day and then starts up again. This could be a sign of hormone imbalances or the position of the uterus.

Colour & Texture of Menstrual Blood 

Normal and healthy menstrual blood is bright red or crimson in colour. The texture should be like syrup and easily flowing. Your menstrual blood shouldn’t be very dark or brown (unless this is spotting) or clumpy or clotted, nor should it be pink or very thin and watery. These types of blood flow indicate hormone imbalances or other underlying causes. 

Small blood clots can be normal, but should be few and fairly small (1.9cm/5 cent piece or smaller). Repeatedly passing blood clots the size of a 50 cent piece (3.2cm) or larger is not normal and should be investigated.

Period Pain

My friends, period pain or any other pain experienced throughout the menstrual cycle is not normal! Period pain is common, yes, but it most certainly is not normal, despite what you may have been told. It is normal, however, to feel a mild discomfort. After all, your uterus is contracting to release it’s lining. But this sensation should not interfere with your life or daily activities. Pain that is quite uncomfortable or debilitating where you are relying on pain relief medication to get through the day, bed ridden, and/or cannot go to work or perform activities should be investigated.

Other health parameters for the REST OF YOUR CYCLE…

Menstrual Cycle Length

The textbook normal cycle length range is considered between 21-35 days. The average cycle length range is between 25-30 days. Cycles less than 21 days are called polymenorrhea (frequent menstrual bleeding) and cycles longer than 35 days are called oligomenorrhea (infrequent menstrual bleeding). Cycles either too short or too long warrant further investigation to determine the underlying cause. 

For optimal hormone health and fertility, my preference for a healthy cycle length range is between 24-35 days. This is to ensure there is enough time for follicle development, sufficient hormone production, and adequate luteal phase length (more on this soon).

It’s important to note that menstrual cycle lengths can fluctuate from cycle to cycle. Cycle fluctuations of 2-3 days per cycle is considered normal. If, however, your cycles fluctuate greatly in length, such as 30 days one cycle, 45 days the next, and then 59 days the next cycle, etc., then this is not considered normal and in fact irregular menstrual cycles. This could be a sign of Polycystic Ovarian Syndrome or may be due to another cause.

A note on teenagers – The normal cycle length range in adolescence is 21-45 days. As their bodies are getting used to the hormonal changes, their cycles may be slightly irregular to begin with.

Follicular Phase Length

The follicular phase is the first half of the cycle and starts on the first day of menstruation and lasts until ovulation. The follicular phase is the phase of the menstrual cycle that is highly variable. The length of this phase is determined by the moment ovulation occurs. The follicular phase can range between 10-22 days in length, but on average is around 10-16 days. If the follicular phase is significantly longer than the ideal range, it could be an indication of delayed ovulation, anovulation (no ovulation), irregular menstrual cycles, and/or Polycystic Ovarian Syndrome. 

Cervical Mucus

Have you ever noticed white and creamy or clear and stretchy fluid in your underwear or on toilet paper after wiping your vulva? This is cervical mucus (or cervical fluid) and it is totally normal! Cervical mucus is produced in the cervix and varies in consistency based on hormone fluctuations at certain times in the menstrual cycle. The presence of cervical mucus is a sign that you are approaching ovulation, are fertile and conception can be possible. 

There are other types of discharge, such as vaginal cell slough, which is the normal daily shedding of vaginal cells and is commonly seen as the crumbly white or yellow discharge in your underwear on most days throughout your menstrual cycle. If you experience thick white, grey, yellow, or greenish discharge that is accompanied by itchiness and/or offensive odour, this is a sign of an infection or bacterial overgrowth and should be investigated and treated.

Mid-Cycle Pain

Mid-cycle pain or ovulation pain is also called Mittelschmerz (German for ‘middle pain’) and is a twinge or slight ache or cramp on one side of your lower abdomen that occurs around ovulation. This is normal. The pain comes from the ovary that is releasing its egg at ovulation. The pain can occur just before ovulation, at the moment of ovulation, or just after ovulation has taken place. The pain usually lasts for a few minutes up to a few hours, but can also last a few days. The sensation should be very mild and bearable and if it isn’t then it should be investigated further. Mid-cycle pain may be accompanied by some mid-cycle spotting (see below). 

Luteal Phase Length 

Your luteal phase is the second half of the cycle and starts the day after ovulation and lasts until the day before your next period begins. The luteal phase should be between 11-17 days, but typically averages between 12-14 days. It is normal for the luteal phase to slightly fluctuate (2-3 days) in length from cycle to cycle. However, if the luteal phase varies 4 days or more (i.e. cycle #1 is has a 14 day luteal phase, cycle #2 is 10 days, cycle #3 is 16 days), then this is an indication that progesterone production is erratic or insufficient. 

If your luteal phase is 10 days or less, this is an indication that your luteal phase is too short and progesterone production is insufficient. This means that if you were trying to conceive and your luteal phase is too short, this doesn’t allow enough time for the fertilised egg to implant into the uterus for a pregnancy to occur. If your luteal phase is 18 days or longer, this is an early sign of pregnancy. 

To determine how many days are in your luteal phase, you can measure your basal body temperature. Basal body temperature is your waking temperature and is one of the fertile signs used in the Symptothermal Method of Fertility Awareness Based Methods. In the follicular phase of the cycle, your basal body temperatures are at a lower level (see image below). Your temperature will rise after ovulation has taken place and your temperatures will remain high until your next period. Progesterone has warming qualities and is the hormone responsible for the rise in basal body temperature during the luteal phase. The temperatures on the higher level are within the luteal phase. Count each day of every high temperature in the luteal phase and you will know how many days are in your luteal phase.

Premenstrual Symptoms

As with period pain, premenstrual symptoms (or premenstrual syndrome/PMS) are common, but aren’t necessarily normal, nor should they be symptoms we have to put up with every month! Symptoms are often experienced during the luteal phase of the cycle, 1-2 weeks before the next period.

There are many premenstrual symptoms that women may experience, including acne breakouts, tender and/or swollen breasts, digestive symptoms, mood changes, sugar cravings, headaches, cramps, fluid retention, the list goes on. These symptoms are often caused by various factors such as hormone imbalances, nutrient deficiencies, stress, fluctuations in neurotransmitters, side effects of hormonal birth control, etc. Premenstrual symptoms can vary in severity from very mild to quite severe.

Some teenagers, women and menstruators experience extremely severe symptoms and may have the condition Premenstrual Dysphoric Disorder (PMDD). PMDD is a cyclical, hormone-based mood disorder that presents with extreme symptoms in the luteal phase and eases within a few days of menstruation.

Intermenstrual Bleeding

Intermenstrual bleeding is bleeding or spotting that occurs outside of menstruation. Intermenstrual bleeding may also be called metrorrhagia or abnormal uterine bleeding. Any bleeding that is not menstruation isn’t normal and should always be investigated. Causes of intermenstrual bleeding include pregnancy, hormonal imbalances, infections, endometriosis, fibroids, polyps, hormonal birth control, endometrial hyperplasia, and uterine or cervical cancers. 

Spotting (or very light bleeding) can occur at ovulation (mid-cycle) for a day or two and is considered normal in most cases. It may be thin or watery and either bright red, light red or pink in colour. You may notice your fertile cervical mucus is blood-streaked. This type of spotting occurs due to the drop in oestrogen right before ovulation.

Spotting Before or After Your Period

Spotting is considered very very light bleeding and can be dark red or brown in colour. Spotting 1-2 days before your period is normal. Spotting for 3 or more days prior to your period is not normal and may be a sign of low progesterone or another condition. Please note that if you experience spotting prior to full flow bleeding, the spotting is not counted as your period. Day 1 of your period starts on the first day of full flow bleeding. The spotting days prior to your period are actually days of the luteal phase of the last menstrual cycle. 

It is also normal to have spotting at the end of your period for 1-2 days, as the flow tapers down. If you have spotting for 3 or more days after your period, then again, this also may be a sign of a hormone imbalance. 

A Final Note: 

If you have a once-off cycle here and there where you fall outside any of these normal parameters, there is no need to panic. Factors such as stress, illness, travel, jet lag, medications, etc. can disrupt the cycle in various ways such as delaying ovulation and making the cycle longer. If however, on a regular basis your cycles are outside these parameters then this may be a sign that you need to seek support for further investigation.

Healthy & Normal Parameters of the Menstrual Cycle Summary:

• Total menstrual blood loss = 25-80ml (30-50ml average).
• Total menstrual bleeding days = 2-7 days (3-5 days average).
• Colour & texture of menstrual blood = Bright red or crimson in colour. Texture is like syrup and easily flows. No or very few and small blood clots (1.9cm/5 cent piece or smaller).
• Period pain = No pain! Though a very mild discomfort is normal.
• Menstrual cycle length = 24-35 days (teenagers 21-45 days).
• Follicular phase = 10-22 days (10-16 days average).
• Cervical mucus = Creamy or clear and stretchy cervical mucus leading up to ovulation is normal!
• Mid-cycle pain = Mild ovulation ‘pain’ is normal, it can last for a few minutes up to a few hours. Some may even experience it for a few days.
• Luteal phase = 11-17 days (12-14 days average).
• Premenstrual symptoms = Ideally none to minimal and very mild.
• Intermenstrual bleeding = None. However, some ovulation spotting or very light bleeding mid-cycle can be normal in most cases.
• Spotting before or after your period = 1-2 days before and/or after period.

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References

Cole, L. A., Ladner, D. G., & Byrn, F. W. (2009). The normal variabilities of the menstrual cycle. Fertility and Sterility, 91(2), 522-527.

Crawford, N. M., Pritchard, D. A., Herring, A. H., & Steiner, A. Z. (2016). A prospective evaluation of the impact of intermenstrual bleeding on natural fertility. Fertility and Sterility, 105(5), 1294-1300.

Dasharathy, S. S., Mumford, S. L., Pollack, A. Z., Perkins, N. J., Mattison, D. R., Wactawski-Wende, J., & Schisterman, E. F. (2012). Menstrual bleeding patterns among regularly menstruating women. American Journal of Epidemiology, 175(6), 536-545.

Fehring, R. J., Schneider, M., & Raviele, K. (2006). Variability in the phases of the menstrual cycle. Journal of Obstetric Gynecologic & Neonatal Nursing, 35(3), 376-84.

Magnay, J. L., O’Brien, S., Gerlinger, C., & Seitz, C. (2020). Pictorial methods to assess heavy menstrual bleeding in research and clinical practice: a systematic literature review. BMC Women’s Health, 20(24), 1-15.

Reed, B. G., & Carr, B. R. (2018). The normal menstrual cycle and the control of ovulation. Endotext. https://www.ncbi.nlm.nih.gov/books/NBK279054/

The American College of Obstetricians and Gynecologists (2015). Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign. Committee Opinion, number 651, 1-4. 

The International Association For Premenstrual Disorders (IAPMD) (2019). What is PMDD? Retrieved from https://iapmd.org/about-pmdd

Yonkers, K. A., O’Brien, P. M. S., & Eriksson, E. (2008). Premenstrual syndrome. Lancet, 371(9619), 1200-1210. 

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