Abnormal menstrual bleeding is one of the most common problems that brings women to their physician. But what exactly is “normal”? When should you worry about your periods?

According to American Family Physician journal (Volume 99, Number 7)

“abnormal uterine bleeding falls outside population-based 5th to 95th percentile for menstrual regularity, frequency, duration, and volume.”

Or, you could say -“normal” is that periods vary widely for most women

How doctors talk about normal

Doctors sometimes use medical terms to describe abnormal bleeding-menorrhagia, metrorrhagia, even meno-metrorrhagia, which are imprecise and often misunderstood. In 2011 FIGO, the International Federation of Gynecology and Obstetrics developed standard definitions and descriptions of menstrual bleeding, also endorsed by the American College of Obstetricians and Gynecologists.

This post will outline the FIGO definitions. Anytime you are concerned about your bleeding you should talk to your doctor. This information may help you describe your concerns to your doctor and understand what is “normal” for you.

What is Your Menstrual Cycle?

The Menstrual cycle is the length of time from the first day of a period until the next one starts; in other words, from day 1 to day minus 1. You can also think of this as the frequency-how often you have a period. Every 24 to 38 days is considered normal.

• Infrequent->38 days
• Normal 24-38 days
• Frequent <24 days

The regularity of the menstrual cycle is how much the length varies over time, usually 12 months. Is it always 24 days, 28, 32? Or does it vary, sometimes 24, or sometimes 38? Either can be normal, but if your pattern suddenly changes, it may indicate something has happened.

• Regular cycles vary by 2-20 days over 12 months
• Irregular- cycles vary >20 days over 12 months

What is your menstrual period?

The duration or length of your menstrual period is how many days you bleed, no matter how much or how little. Again, what’s important is your usual pattern; for most women this stays consistent, so a change is usually noticed.

• Short <4.5 days
• Normal 4.5-8 days
• Prolonged >8 days

How heavy is your period?

The amount, or volume of a period is how much blood you lose. From 5-80 ml , or for Americans 1 teaspoon to 3 ounces, is considered normal although most of us find counting pads or tampons per day is easier to understand.

• Light <5 ml
• Normal 5-80 ml
• Heavy >80 ml

Amenorrhea means no bleeding for 90 or more days. Once a woman has not had bleeding for 12 months, this is menopause. (This does not apply if she stops bleeding because her uterus is removed, a hysterectomy. Menopause is defined differently in that case. )

What can change the cycle length or regularity, or the period length, duration, or amount of bleeding?

• Using some form of hormonal birth control
• Recent pregnancy
• Breast feeding
• Vigorous or intense physical activity
• Serious illness, injury, or surgery
• Starvation
• Peri-menopause (the months prior to menopause)

If you doctor determines that your bleeding is “abnormal” she may evaluate you for the common causes-

• complications of pregnancy-miscarriage, ectopic pregnancy
• uterine fibroid tumors-leimyomata
• cervical or uterine cancer
• bleeding disorders
• hormone dysfunction, including PCOS (polycystic ovarian syndrome)

Where to learn more about menstruation

Familydoctor.org offers this easy to understand outline of the causes and treatment of abnormal bleeding.

Abnormal uterine bleeding

Información en español – from the CDC

Sangrado menstrual abundante

Most cases of abnormal bleeding have a straight forward cause which can be determined by the history, examination, and appropriate testing. Most are treatable and not life threatening. However, since a few cases will be due to cancer, don’t ignore this important symptom.

Keeping track of your periods

You can use any blank paper or digital calendar to keep track of your periods but digital apps are a convenient way to keep track of your periods.

Flo Period & Ovulation Tracker

Flo Period Tracker, Ovulation & Fertility Calendar!

It’s a smart and simple female period tracker, helpful pregnancy week by week app, accurate ovulation and fertility calendar and PMS symptoms tracker for women all over the world. Flo Period Tracker not only tracks your period accurately, but it’s also a reliable pregnancy calculator, ovulation calendar, and true fertility friend for you. It’s the first period app, pregnancy calculator, fertility and ovulation calendar for women that uses machine learning (AI). All women, even those with irregular periods, can rely on this health tracker. Log your menstruation days in a handy period calendar, ovulation and fertility tracker, schedule menstrual cycle reminders, record moods and PMS symptoms, use a due date calculator, follow a pregnancy calendar and take full control of your health.

However you do it, take your menstrual record with you every time you visit your doctor.

Dr Aletha