Is My Period Normal or Not?

Diagnosing Abnormal Uterine Bleeding

Female doctor consulting female patient
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If you bleed for more than 7 days at intervals of less than 21days or more than 35 days, and you estimate your menstrual flow to total more than a ¼ cup, you are likely having abnormal uterine bleeding.

What's Normal?

Your period is the result of a complex process of hormone changes that cause the lining of your uterus or endometrium to build up and then shed. The length of this cycle varies from woman to woman but a normal cycle length is between 21 and 35 days.

Once your cycle length is established it normally doesn’t vary much from month to month. On average, a woman bleeds for 5 days every cycle with a range of 3 to 7 days. This works out to be about once a month.

The normal amount of bleeding is also really different between women. On average, the menstrual flow each cycle is about 35 ml and the clinical definition of heavy menstrual bleeding is 80 ml. Not sure how much that is? Well, considering that a ¼ cup is 60 ml and a ½ cup is 125 ml most women lose less than a ¼ cup of blood and tissue debris each month. The problem is this doesn't translate well into the real world. There is no good way to measure how much you are bleeding when the blood has been absorbed by pads or tampons.

What Can Go Wrong?

The answer is simple, a lot.

Remember ovulation has to occur in order for your period to come at a regular interval. So, the first challenge in figuring out the cause of abnormal uterine bleeding is to determine whether or not you are still ovulating.

Usually, this can be determined by changes in the length of your cycle. If you are still bleeding at the same time in your cycle, you are likely still ovulating. If you are bleeding at other times during your cycle or if your cycle interval has changed dramatically you are likely no longer ovulating.

This is a condition known as anovulation.

Describing Your Bleeding

Abnormal uterine bleeding can be further classified by describing the amount and timing of the bleeding. Your bleeding can be heavy and/or your bleeding can occur at times in between your period, which is clinically called intermenstrual bleeding.

It is important for you to think about the timing and amount of your bleeding so you can tell your healthcare provider as these are important clues in determining the underlying cause of the abnormal uterine bleeding.

What Will Your Healthcare Provider Ask You?

Your healthcare provider will likely ask you other questions that will help narrow down the possible causes of the abnormal bleeding. You should be prepared to answer these questions which may include:

  • How old were you when had your first period?
  • When was your last menstrual period?
  • How long have you been having the abnormal bleeding?
  • How many pads or tampons are you soaking through every month?
  • Are you having any pain with the bleeding?
  • Do you have any other medical conditions?
  • Are you taking any medications or supplements including herbal remedies? If yes what are they?

What Else Will Your Healthcare Provider Do?

Your healthcare provider will (I hope) want to examine you. They should start with a general physical exam to look for signs of other medical conditions that could cause abnormal uterine bleeding and to evaluate for signs of anemia resulting from prolonged heavy vaginal bleeding. They also will need to do a pelvic exam. You should not be embarrassed if you are currently bleeding. If you are due for cervical cancer screening they may collect a Pap test during the exam.

Based on your history and physical exam, your healthcare provider will likely have a list of possible causes of the abnormal uterine bleeding and will order tests based on this list. These tests may include blood tests and imaging studies, usually an ultrasound. Depending on the clinical picture your healthcare provider may also recommend a sampling of the lining of your uterus.

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