Do you have normal periods?
"Do you have normal periods?" It’s a standard question asked of women during their regular check-up. But what is ‘normal’? How does a woman tell? And what if your periods are not normal? What might it mean?
Let’s face it, menstruation is not exactly dinner table conversation. And, perhaps because periods are not often discussed, many women find it hard to judge accurately how normal their own are. According to medical journal Pharmacy Today, 14% of women who lose a normal amount of blood every month consider their periods to be heavy. Conversely, 30% of women with heavy bleeding consider menstruation to be light.
The range of ‘normal’ for periods is wide, but they have some common features.
- Menstrual periods generally start between 10 and 16 years of age; around two years after the breasts first start to develop.
- Girls often start their periods at a similar age to other women in their family - if you can, find out when your mother, sister or grandmother started
- Periods are often not regular when they first start, but generally settle into a pattern after about three years. Some women never have a regular cycle, however.
- Periods occur anything from every 21 to every 40 days. The much-quoted cycle of 28 days occurs in just one woman in 10.
- Bleeding lasts around three to five days.
- About 30-40ml of blood is lost per period, but it can look like more. To help gauge how much blood you lose, estimate that a tampon holds around 5ml of blood, while sanitary pads hold anything from 5-15ml each.
- Bleeding is generally heaviest for the first day or two, lighter over the next day or two, maybe finishing with a day or so of spotting.
- The blood does not usually clot, but small amounts of tissue from the lining of the uterus are normal and can look a little like clots. The difference is that clots are dark in colour and are generally accompanied by heavy bleeding, while uterine tissue is lighter coloured.
- Some discomfort is normal, but periods are not generally painful.
- As women approach the menopause, periods may become more irregular again and tend to finish around the age of 52.
Periods with features differing from this may suggest an underlying problem.
What if my periods are not normal?
No periods
It is normal to have no periods:
- before you reach puberty
- when you are pregnant
- if you are breastfeeding
- if you have reached menopause.
View a Human Atlas video on menopause.
If you have no periods, but you should, it is known as amenorrhoea. There are two categories of amenorrhoea.
Primary amenorrhoea
Your periods have not yet started and you are 16 years or older.
Secondary amenorrhoea
You usually have regular periods, but they have stopped for six months or longer.
Amenorrhoea may be caused by:
- strenuous exercise
- stress
- some medications, including the oral contraceptive pill (it can take three to six months to start periods again after stopping the pill)
- chronic illness
- problems with the ovaries
- hormonal imbalances such as polycystic ovarian disease, malfunction of the thyroid gland, hypothalamus (part of the brain that helps regulate the menstrual cycle) or pituitary gland
- anatomical problems with the uterus, cervix or vagina
- the absence of puberty
- depression and some other forms of mental illness
- low bodyweight.
Painful periods
Dysmenorrhoea is the medical term for painful periods. The pain and discomfort is usually most severe for the first day or two of your period. Dysmenorrhoea tends to peak quite soon after puberty, so if your periods are getting increasingly painful as you get older, see your doctor.
What are the symptoms of dysmenorrhoea?
The common symptoms of dysmenorrhoea are pain and cramps in the lower abdomen.
Other symptoms that may be related to dysmenorrhoea include:
- headaches
- nausea
- constipation or diarrhoea
- vomiting.
As with amenorrhoea, doctors usually divide dysmenorrhoea into two categories.
Primary dysmenorrhoea
Primary dysmenorrhoea may affect more than half of all women, and has no known underlying cause. The symptoms, which luckily do not last very long (usually around one to two days), are caused by prostaglandins, hormone-like substances found in many body tissues. Prostaglandins stimulate contractions of the muscles of your uterus during your period. These contractions compress the blood vessels to the uterus, temporarily cutting off the blood supply and depriving the tissues of blood, which triggers pain.
Secondary dysmenorrhoea
Secondary dysmenorrhoea is caused by an underlying gynaecological problem or condition such as:
The use of intrauterine devices (IUDs) - not the hormone-delivering Mirena intrauterine system - for contraception has also been associated with dysmenorrhoea and heavy bleeding.
Heavy periods
Menorrhagia is the term given to periods that are long and heavy. Menorrhagia affects 10-15% of women, and is one of the main reasons for having a hysterectomy. It may involve periods that are prolonged, lasting for longer than seven days, and/or excessive bleeding with flooding or clots.
Women with menorrhagia lose 80ml or more of blood per period, compared with the 30-40ml lost typically. If you are changing your tampon or sanitary pad more often than every hour, flooding or becoming anaemic, this is a good indication you have menorrhagia.
What causes menorrhagia?
Menorrhagia may be caused by:
- hormonal imbalances
- a bleeding disorder
- fibroids
- polyps (small growths on the cervical or uterine wall)
- endometriosis
- polycystic ovarian syndrome
- thyroid disease
- liver or kidney disease
- infection
- IUDs (not including the intrauterine system Mirena, which is in fact a treatment option for menorrhagia)
- malignancy.
If you have no periods (and think you should), painful periods or heavy periods, see your doctor who should be able to investigate further and advise you of treatment.
Original material provided by everybody, April 2009. Reviewed by Dr Martin Sowter, FRCOG FRNZACOG.
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