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Are my periods normal?

WASHINGTON (THE WASHINGTON POST) – How often should I be getting my period? I’ve heard it’s every 28 days, but my cycle is sometimes longer or shorter. How do I know if my periods are “normal?”

What it means for a period to be “normal” varies so much that it’s no surprise many people remain unsure.

Let’s take the average Dutch woman: She may experience about 450 periods in her life (that can add up to more than eight whole years spent menstruating).

But in populations with more pregnancies, such as the Dogon people in Mali, women may experience a small fraction of that – an estimated 100 periods over the course of their lives.

Scientists speculate that this spike in total lifetime periods happens in developed economies because less time is being spent in pregnancy or breastfeeding (both of which suppress menstruation). On top of that, menarche, or the onset of menses, is starting at a younger age than in prior generations.

This is a big deal because excessive bleeding and severe pain during periods can consume so much more of women’s lives now.


What’s a normal period?

So what does this all mean? Well, there’s a textbook definition of normal, and there’s what’s normal for you. Sometimes these things overlap and sometimes they don’t. But these parameters from the International Federation of Gynaecology and Obstetrics are often used by clinicians:

-Normal periods occur between every 24 to 38 days.

-Bleeding doesn’t last longer than eight days.

-They occur with some predictability, with variation of no more than nine days (for people ages 26-41, it should be no more than seven days).

-The amount of blood loss doesn’t seem too heavy (or too light) to you.

That last one can seem a bit tricky. After all, we’ve only lived in our own bodies, how do we know what amount is “too heavy?”

Physicians defer to the patient to inform us if their bleeding is so heavy as to be bothersome to them. Some other clues blood loss is higher than usual include:

-You’re changing your pad or tampon every 1-2 hours.

-You frequently need to change your pad overnight.

-You pass large clots (larger than 1 inch).

-Your doctor diagnoses you with anaemia.

Yet after reviewing all these parameters, what’s “normal” still depends on you.

“It’s more about how can we optimise periods for people,” said Alison Edelman, professor of obstetrics and gynaecology at Oregon Health & Science University. “If something’s not working for you, even if your period is ‘normal,’ you need to be talking to your provider about it.”

How to treat period cramps

One adjustment to consider for bad cramps is the timing of your medications. NSAIDs, such as ibuprofen, target prostaglandins – compounds produced by the body at the beginning of menstruation that can cause painful uterine contractions.

Does ibuprofen not work well for you? According to Edelman, that could be because many of us are used to taking these medicines in the moment we’re experiencing pain, but at that point, prostaglandin levels are already quite high.

Instead, start taking ibuprofen a day or two in your cycle before cramping would begin. “If we can hit that before prostaglandins are even generated, you might have better control of your pain,” she explained.

Still, NSAIDs won’t work for everyone. Options to help control painful cramps – and figure out why they may be happening – should be discussed further with your physician.

Why your period might fluctuate

Some months your period may just be “off.” This alone might not be a major cause for concern, but it’s important to keep track because irregular periods can be a sign of certain health conditions. Use a period-tracking app on your phone, a spreadsheet, a digital calendar or an old-fashioned paper calendar.

Pregnancy: Pregnancy is always at the top of the list of reasons for a missed period. So if you’re sexually active, take a pregnancy test. Remember, you can still have spotting in the first trimester.

Endometriosis: This is an extremely painful condition where uterine tissue grows outside the uterus. It can cause abnormal bleeding and is underdiagnosed, even though it affects about 10 per cent of women of reproductive age.

Other events: Some other events that cause fluctuations in your period include stress (such as from traveling or preparing for a big test), extreme exercise, large changes in weight, disordered eating, an acute illness and, of course, pregnancy, breastfeeding, puberty and menopause.

Vaccination: As we’re in vaccine season, it’s worth recalling that coronavirus vaccination is associated with a small temporary increase in cycle length and slightly higher risk of heavier period, as shown in studies from Edelman and her team.

She notes that these changes typically resolve by the first post-vaccination menstrual cycle, but thinks the public should be as aware of them as any other potential side effects.

“If you didn’t expect to get a high fever with the vaccine, and then all of a sudden you got a high fever with the vaccine, you’d think something was really wrong.”

But having that knowledge can provide some reassurance, Edelman said.


What I want my patients to know

People with heavy blood losses during menses often think it’s par for the course because their mother and sister have the same symptoms. It’s really important that we don’t normalise suffering. Take a step back and assess your symptoms from afar. If they’re keeping you from doing – much less enjoying – your daily activities, don’t put off talking to your physician. – TRISHA PASRICHA