Is my menstrual cycle normal? |05 March 2020

Dr (Mrs) Roshan Zeirideen Zaid

Menstruation is an important part of a women’s life. Most women experience a monthly menstruation cycle during her reproductive age. Cycles continue from the day that she starts her menstruation (menarche/puberty) till the day that it stops (menopause). Menstruation simply means cyclical shedding of the uterine (womb) lining with blood. Lining of the womb prepares for a pregnancy every month but getting thicker to receive the fertilised egg (embryo), in the absence of pregnancy the lining sheds and the cycle restarts again.

Every woman has a unique menstrual pattern. The pattern consists of cycle length, amount of bleeding, number of days of bleeding, pain or discomfort associated with bleeding and other associated factors such as back pains, etc. Whatever the pattern of cycle one follows it has to fall in the category of accepted normality of a menstrual cycle. Women often believe that their menstruation is ‘normal’ no matter how their bleeding is. This is mainly due to the taboo of talking about menstruation or menstrual related issues among women. Ironically women themselves know very less about an issue that is so close to them.

What are the characteristics of normal menstruation?

Menstrual cycle should have the following characteristics:

1)        Cycle/pattern

2)        Length of cycle

3)        Number of days

4)        Amount of bleeding

5)        Pain/discomfort/cramps

6)        Other symptoms

The menstruation cycle should have a pattern or a cycle. Usually it’s a monthly cycle in most women i.e every 4 weeks. But some can have once 5 or 8 weeks or once in few months. The normal cycle length varies from around 24-35 day cycles. On an average the bleeding lasts for about 3-7 days, rarely in some up to 8-10 days. The bleeding and the cramps are more in the first few days of starting the menses and eases after that. The pain or bleeding should not be affecting the day to day lifestyle of the woman at all, or it should readily respond to simple pain medicine. Some associated symptoms like back pains, head aches etc are common in many.

In short normal menstruation is a few days of mild to moderate amount of bleeding with some cramps or discomfort which occurs cyclically which doesn’t affect the quality of life of a woman.

Said this many women with prolong heavy bleeding for years always assumed that their periods are ‘normal’.

When does a menstrual cycle becomes abnormal?

Menstruation in women is considered abnormal when normal characteristics of a menstrual cycle are not present or altered. It is considered abnormal when there’s no consistent cyclical pattern or loss cycle. An abnormal cyclical pattern could also be one where a woman bleeds heavily, experiences more pain than normal in turn having a drastic effect on their day to day lives. If a woman’s sanitary napkins are soaked through and through, or if she uses extra additional napkins to protect herself from bleeding, then it could be a sign on an abnormal menstrual flow. If a woman is using extra pain medicine for excessive pain or if her pain is associated with vomiting, nausea or feeling faintish and/or other similar symptoms, these could be signs of an abnormal pain related to menstruation. Experiencing bleeding in between two cycles or even post menstrual prolong spotting all needs to be evaluated. Furthermore, if a woman has pain with urination or defecation (passing stools) during periods as well as experiences pain during sexual intercourse, she can have an underlying secondary cause for the excessive pain. Severe unbearable pains and excessive flow could have other secondary causes.

What should you do when experiencing an abnormal menstrual cycle?

First and foremost women are in denial of the fact that their cycle could be abnormal. Every woman wants to feel that her cycle is normal in spite of heavy or painful bleeding. If a woman has any of the symptoms of an abnormal menstrual cycle, it is important to identify and accept that there is a problem. Sometimes it might be a simple life style thing that is affecting the cycle.

The most common factors that can affect a woman’s menstrual cycle are

• Stress
• Changes in body weight
• Change in Physical activity/ exercise
• Diet
• Use of contraception
• Age

Stress is the factor that can change your periods drastically. Stress varies from day to day life, work, studies etc. Most of the time it gets neglected since it’s the commonest culprit. 

Diet, activity levels, and body weight all tend to go hand-in-hand. A sudden increase in body weight or a drastic drop in body weight could both result in a change in a woman’s menstrual cycle. Age is always a factor that affects the menstrual cycle. After puberty a woman’s menstruation cyclical pattern eventually builds up after a few years. With years passing by, having children, weight changes with age and child bearing, her designed cycle pattern will change with time. More obvious changes are seen after the age of 40 – 45 and more irregularities are noted before a woman’s menstrual cycles come to an end at about the age of 50 years.

Another cause for changes in a woman’s period is her choice of contraception. The use of contraceptive methods such as emergency contraceptive pills, intra-uterine devices (Cu loop), intra-uterine systems (Mirena) and implants can also cause irregularities in a woman’s menstrual cycle.

What are the other factors that can cause abnormalities in the menstrual cycle?

The commonest will be hormonal imbalances which either can be found in women who have Polycystic Syndrome (PCOS) and other hormone irregularities, for example thyroid, prolactin or other hormonal issues. While all these can affect a woman’s menstruation, chronic long-term health issues also contribute to menstrual irregularities. Certain medications could have an impact too.

Structural abnormality like fibroids, polyps, thickening of tissues and cancers of the uterus (womb) and the neck of the womb (cervix) can also cause abnormal bleeding and pain. Infections can also cause changes in the menstrual cycle.

Abnormalities of the menstrual cycles can be due to a simple reversible cause or a primary cycle issue or could have a secondary underlying cause. Treatment or correction of this problem will depend on the cause. Women need to understand the normality of menstrual cycles and be able to identify when the cycles are moving away from normality. Recognition and treatment is in order if a cycle behaves abnormal.

By Dr (Mrs) Roshan Zeirideen Zaid

Consultant Obstetrician, Gynaecologist, Fertility Specialist & Laporoscopic Surgeon

MBBS (SL) MRCOG (UK), DFSRH (UK), CCT (UK)

Diploma in Gynae Laparoscopy (DMAS) (India), Fellowship in Gyane Laparoscopy (FMAS) (India)

Fellowship in Assisted Reproductive Technology (FART) (India)

Dip RCOG Obstetrics & Gynaecology Ultrasound Scanning (UK)

Board Certified (UK)

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