Normal vs Not-So-Normal Menstrual Cycles
By Angel Thomas, RN, BSN, Fertility Coach
The views and opinions expressed are those of the authors and should not be considered medical advice. Always consult your doctor, or a mental health professional, for the most appropriate treatment.
Women and people who menstruate may be asked by their doctors, “Are your menstrual cycles normal?” Or they may be asked, “Do you have an irregular period or irregular cycles?” But what do “normal” and “regular” really mean? Our bodies are unique and our cycles are too. We have the ability to pay attention to our bodies, find our own “normal” and “regular,” and bring up any concerns to our doctors for guidance.
This article will help you gain some insight to know what your concerns are. Anything that concerns you about your cycles should be discussed with your OB/GYN or fertility specialist (reproductive endocrinologist or RE). Use this cycle information to help guide your questions.
How do hormones normally change during the menstrual cycle?
Estrogen, follicle stimulating hormone (FSH), luteinizing hormone (LH), and progesterone are key hormones throughout the menstrual cycle. Each hormone has different or overlapping functions. Each hormone should also (normally) be high or low at a certain time throughout the phases of the menstrual cycle.
The beginning of the menstrual cycle starts with menstruation (menstrual period), which occurs during the early follicular phase, then ovulation happens and the cycle ends with the luteal phase. During the follicular phase, estrogen and FSH increase as the body develops follicles (fluid-filled sacs with a microscopic egg inside) in the ovaries. This is why it is called the follicular phase!
Then, one of these follicles will become dominant and mature an egg. Once the egg is mature, the body has a “surge” or “peak” of luteinizing hormone (LH) to prepare to release the egg for ovulation.
Tip: a follicle is also called a cyst. Many tend to think of a cyst as a “bad” thing, but there are many different types of cysts. Follicular cysts are normal and needed for ovulation.
Once ovulation has occurred, the cycle moves from the follicular phase to the luteal phase, which is the time after ovulation before the next cycle begins. Estrogen falls after ovulation, then begins to increase again, with another drop before a period starts. The follicle that released the egg turns into a corpus luteum (this is why it’s called the luteal phase!) and produces progesterone. Progesterone increases during the luteal phase and is necessary to sustain pregnancy if it has occurred (meaning the egg was successfully fertilized by sperm). If pregnancy does not occur during the cycle, progesterone drops, and menstruation begins.
Why is this important? Because depending on where you are in your cycle, low or high hormones may be normal. If testing hormones at home, be sure to read the test instructions and don’t hesitate to ask your doctor for help interpreting results. If testing hormones with your doctor, it’s always okay to ask why a certain hormone may be low or high.
What is considered normal menstruation (period) bleeding?
There are a lot of questions about what normal menstrual bleeding is during a cycle. A few examples include:
- Am I bleeding too much or for too many days?
- What is considered the first day of my period?
- Is it normal to get two periods in a month?
- Is it normal to have missed periods?
Day one of the menstrual cycle is the first day of your period (meaning full flow, spotting does not count). This is when the lining of the uterus sheds if pregnancy did not occur during the last cycle. Normal menstruation may last for 4-6 days, involve losing an average of 30 milliliters (or 2-3 tablespoons) of blood, and may include passing small clots.
Not-so-normal menstruation bleeding may show up as heavy or prolonged periods (also called Menorrhagia), or passing of large clots (around the size of a quarter or larger). “Heavy periods” are defined as losing 80 or more milliliters of blood during your period. “Prolonged periods” are defined as bleeding for more than 7 days. These patterns should be discussed with your OB/GYN or other healthcare provider.
Tip: on average, a regular tampon or pad can hold 5 ml of blood. If you are changing your regular flow pad or tampon every 1-2 hours, you may have heavy bleeding. Keep in mind that if you are using a super flow product, they may hold twice the amount of a regular flow product, or 10 ml of blood.
What is the normal length of a menstrual cycle?
Menstrual cycle length is the number of days from the start of a period to the start of the next period. A normal menstrual cycle may range between 21-35 days, on average.
It may not be normal to get a period less than 21 days since your last period, or longer than 35 days since your last period started. When periods consistently occur every 21 days or shorter, this is known as Polymenorrhea. When periods consistently occur every 35 days or longer, this is known as Oligomenorrhea. These lengths should be discussed with your OB/GYN or other healthcare provider
What are normal cramps during a menstrual cycle?
Normal cramps during menstruation may be uncomfortable and mild to moderately painful, but should be able to be managed. It also may be normal to experience slight cramping around ovulation.
Painful cramping with menstruation is known as Dysmenorrhea. Not-so-normal cramps during menstruation may involve severe pain that interferes with daily activities and responsibilities, and may lead to calling out of work, skipping social events, or having depressed feelings. These types of cramps should be discussed with your OB/GYN or other healthcare provider.
What are normal signs of ovulation during a menstrual cycle?
Normal ovulation signs may include:
- Cervical mucus or discharge that is slippery, clear, and stretchy
- Increased libido (sex drive)
- Spotting
- Mild abdominal cramping
- Headache
- Nausea
- Increased energy
- Breast tenderness
- Bloating
It’s important to note that even with a history of normal cycles and ovulation, it is not uncommon to have a cycle here or there that is longer or shorter than your normal cycle length. If a cycle is shorter than expected, ovulation may have occurred earlier than usual. If it is longer, ovulation may have occurred later than usual.
Not-so-normal signs around ovulation may include heavy bleeding, significant pain, or cramping. These should be discussed with your OB/GYN or other healthcare provider.
Is spotting normal during a menstrual cycle?
Spotting may be normal at certain times throughout your menstrual cycle. Your uterus and cervix have a lot of blood vessels that help prepare your body for pregnancy. Some causes of spotting may include:
- Irritation of the cervix or uterus in early pregnancy (from something like intercourse or vaginal suppositories)
- Ovulation
- Implantation (when an embryo implants or “burrows” into the uterine lining if pregnancy has occurred)
Tip: implantation bleeding may or may not be seen with pregnancy, so should not be used as an indicator of pregnancy.
Spotting throughout the entire menstrual cycle, or spotting for more than 7 days, may not be normal and should be discussed with your OB/GYN or other healthcare provider.
What is normal cervical mucus or discharge during a menstrual cycle?
Cervical mucus or discharge normally changes throughout the phases of a menstrual cycle. After a period, cervical mucus may be thick, chunky, sticky and white, like paste. As ovulation approaches, cervical mucus may be slippery, clear, stretchy, or watery, like egg-whites. After ovulation, cervical mucus thickens again to prevent bacteria from entering the cervix. It also may be normal to have a pink tinge in cervical mucus, which may indicate spotting. It may be normal to notice a lot or a little of these types of mucus.
Discharge that has a strong odor, causes irritation, or is an abnormal color like green or gray is not-so-normal and should be discussed with your OB/GYN or other healthcare provider.
Are mood changes during my cycle normal?
It can be normal to have mood changes or premenstrual syndrome (PMS) with your period and changing cycle phases. Your hormones are shifting! If you notice this, consider prioritizing your emotional wellbeing by practicing self-care and setting boundaries, if needed. These boundaries may include pausing social media, cutting down on social events, or having honest conversations about what you need.
If you are trying to conceive (TTC), your period may be an especially difficult time. If you find yourself needing some extra support, consider connecting with a fertility coach, or reaching out to your OB/GYN or RE, as they may be able to recommend a mental health professional that specializes in fertility struggles.
It is not-so-normal to have severe mood changes that make you feel hopeless. If you feel you are in crisis and may harm yourself or others, call 911 or your local crisis service line right away. You can also dial or text 988 for the National Lifeline, which provides free support at all hours.
The Final Takeaway
Differences in cycle length, bleeding patterns, period pain, cervical mucus, hormone levels, and mood can vary greatly. Some of these differences may be related to things like the onset of your first period (menarche), stopping contraception (like birth control pills or an IUD), excessive weight gain, approaching menopause (perimenopause), excessive exercise, certain medications, polycystic ovary syndrome (PCOS), endometriosis, stress, illness, and underlying medical conditions like thyroid disorders. It’s essential to find your “normal” so that you can know when something might be not-so-normal.
Tip: Guidelines for normal menstrual cycle lengths vary among countries, regions, governing bodies and organizations. According to the International Federation of Gynecology and Obstetrics, the normal average is between 24-38 days and this average is used in various countries/territories internationally. Coupling this with mostly standard USA guidelines of 21-35 days, consider that 21-38 days may be normal.
