Physician Assistant Elizabeth Hedlund provides some helpful information on menstrual cycles.

What is a normal menstrual cycle? Most girls will have their first menstrual period at the age of 11-13, but some will start earlier, and some will start later, which is okay! A complete menstrual cycle starts on the first day of menstrual bleeding (day 1) and ends on the day before the next menstrual period starts. Most cycles will be 25-30 days long but sometimes they can be as short as 21 days or as long as 35 days. The first 4-7 days will be when the bleeding occurs, often there will be 1-3 “heavy” days and then the bleeding gets lighter until it stops.  

Pain and Cramping

Some women have minimal to no cramping pain, some will have severe cramps. This pain can start the day before the bleeding starts. It is most often low in the pelvis, but pain can also occur in the abdomen, low back, and even the buttocks and legs.  

Starting Out

When girls first start having menstrual cycles, they can be irregular, meaning that there may be menstrual bleeding more randomly and not every month. Some women have PMS (premenstrual syndrome) or the more severe form called PMDD (premenstrual dysphoric disorder). This often starts the week before menstrual bleeding and includes mood changes such as depression, anxiety, and irritability. There can be bloating and breast tenderness also. This can be severe for some women.

Perimenopause

At about age 35, women’s hormones begin changing toward menopause, slowly at first. This phase is typically called perimenopause. These changes can affect the menstrual cycle, more so as she is closer to menopause. Many women report that their bleeding becomes heavier as they get older, then cycles can also become unpredictable.  Sometimes they will seem typical, other times shorter, heavier, longer, lighter, etc. 

Menopause

The average age of menopause is 51. Menopause is simply when menstrual periods stop. However, we don’t say that a woman is postmenopausal until she hasn’t had menstrual bleeding for more than 12 months. Sometimes women will not have any menstrual bleeding for 6-11 months and then her body decides to have one last cycle. Just for fun, one last time, hooray!  It is important to remember though, that women in perimenopause (ages 35-51) can still ovulate and therefore can still become pregnant.  Some women will notice that they start having other menopause symptoms in the perimenopause phase.  These include hot flashes, night sweats, vaginal dryness, skin changes, brain fog and mood changes.  These symptoms can wax and wane through perimenopause, peak during menopause, and carry on into postmenopause for several years. The average time frame for a woman to have the first hot flash until the last hot flash is 9 years! 

Red Flags

While menstrual cycles can vary quite a bit from one woman to another and still be within normal expectations, there are some red flags that indicate further evaluation and possible treatment are needed. One red flag is pain. Conditions such as endometriosis, adenomyosis, and ovarian cysts can cause much pain for women. If menstrual cycles regularly keep you from going to school, work, or getting things done that need to get done, or if your cramping pain seems to be getting worse over time, seek further evaluation. Heavy bleeding is also a red flag. If you are changing protection (pads, tampons, etc) every 60-90 minutes for more than 1 day, this is excessive bleeding and should be evaluated.  Excessive bleeding is also when bleeding lasts more than 7 days, or if bleeding stops and starts several times throughout the month. If you are having any other symptoms such as abnormal vaginal discharge/odor, vaginal pain or itching, genital rashes or skin lesions, or recurrent pelvic pain, please seek further evaluation. 

Infections can cause abnormal menstrual bleeding. Some women can have vaginal bleeding while pregnant and not know they are pregnant. If your cycle pattern changes and there is even a small possibility that you could be pregnant, take a pregnancy test. If it’s been 3-6 months with no menstrual bleeding, this should also be evaluated. Many women can struggle with symptoms of hormone imbalance, which is usually estrogen dominance. See past articles on this topic for more detailed information.  

Help is Available

As always, if you are concerned or not sure if something is wrong, ask your health care provider for help in evaluating what’s going on. If you can, talk to your mother, sisters, aunts, or grandmothers.  Sometimes these types of things have a genetic component. There is help for severe symptoms. We can discuss any of this further with you!