From teenage years through menopause, tracking changes in your menstrual cycle can be both confusing and concerning. Is a missed period cause for worry? What about differences in flow or timing? Understanding typical menstrual patterns can help provide clues as to what deserves extra attention from a health care provider.
Recognizing what’s normal
A typical menstrual period lasts around five days, plus or minus two days. So, three to seven days is a normal amount of bleeding, according to Andrea L. Baker, MD, an OB-GYN specialist with UT Physicians Women’s Center – Texas Medical Center.
The most predictable menstrual cycles generally occur during the prime reproductive years. Periods should be most regular and uniform in our 20s to early 40s, said Baker, assistant professor of obstetrics and gynecology at McGovern Medical School at UTHealth Houston.
“During this time, your body sticks to a routine that becomes your normal,” Baker said. “It may not be someone else’s normal, but your body should be regulated, so it’s pretty consistent throughout those years.”
Understanding age-related changes
Variations are common during certain life stages, however. Periods can be irregular right after they first begin and in the years leading up to menopause.
“Typical changes before menopause might include a lengthening cycle, so the time between periods can be a little longer,” Baker said. “The amount of bleeding also can decrease.”
For those using hormonal birth control, particularly IUDs, the absence of periods can be expected. Baker said they work twofold.
“It increases your cervical mucus to act as a physical barrier to sperm, but it also keeps the endometrium quite thin,” Baker said. “You’re still ovulating and going through your menstrual cycle, but there isn’t enough endometrium to bleed.” Baker describes this as a beneficial side effect of using an IUD for those who want to avoid their monthly period.
Contributing lifestyle factors
Body weight and activity levels can also significantly impact menstrual patterns, according to Baker.
Women who are heavier with a higher BMI can have longer, heavier periods due to the increased estrogen from the adipose tissue, or body fat. Women who are underweight, have an eating disorder, or are athletic with frequent exercising may experience lighter periods — or they could stop.
“When people are fit, it affects the hypothalamic-pituitary-adrenal axis, which is how our brain talks to our ovaries,” Baker said. “The lack of body fat with the decreased amount of circulating estrogen is what causes an interruption.”
When should you be concerned?
Baker said cramps can be normal during your menstrual cycle if they are controllable with over-the-counter medications. But severe cramping can indicate a problem if it affects daily activities, keeping you from going to school or work.
Be on the lookout for these additional circumstances that might require medical attention:
- Irregular bleeding patterns between periods
- Bleeding that continues beyond seven days
- A missed period beyond 90 days while not pregnant
- Bleeding after a year of no menstrual cycles (postmenopausal)
- A heavy flow that requires changing a pad or tampon more frequently than every hour
- Significant blood clots or tissue in menstrual blood
Whether you’re experiencing your first period, well into your reproductive years, or approaching menopause, recognizing what’s normal for your body and understanding warning signs can empower you to seek appropriate care.
