Menstrual Cycles – What’s Normal?

By: Dr. Janine Buisman Wilcox

It’s not often that we openly get to talk about the menstrual cycle in day-to-day life. Because of this, there are huge misconceptions as to what is a normal ‘cycle’.

One of the most important things to know is that your cycle on the birth control pill is not a menstrual cycle.  A pill cycle is a withdrawal bleed – bleeding as a result of the drop in hormones during the placebo (sugar pill) week of the birth control cycle.  Unfortunately, it really doesn’t tell us a lot about what may be going on underneath the hormone dose you’re getting.

In terms of your actual menstrual cycle.  This is what we are looking for:

  • Bleeding: 3-7 days long⁣.
  • Blood: Mostly liquid, a few clots are okay, but they shouldn’t be larger than 1-2cm⁣.
  • Volume: 25-80mL total (a regular tampon holds 5mL, a regular pad holds 5mL, a super pad – 10mL, a Divacup holds a total 30mL)⁣.
  • Discomfort: Mild abdominal discomfort is normal, but it shouldn’t interfere with your daily activities. The pain should be easily relieved by painkillers, and shouldn’t require painkillers throughout the bleeding cycle. 
  • 21-35 days long cycle from Day 1 of bleeding to Day 1 of bleeding the next cycle. It’s okay if it’s not the same length every month as long as it’s within 21-35 days and all of the other signs are pointing to healthy menstruation.⁣  
  • Ovulation near the middle of the cycle. The only way to really know if you’ve ovulated is to check blood progesterone later in the cycle, but there are other signs and symptoms that can indicate ovulation.  Some people do experience ovulatory pain, but it should be momentary and short! 
  • Menstruation (bleeding) should occur again 12-16 days after ovulation. In people with shorter cycles, we want to make sure there are at least 12 days after ovulation and before menstruation.
  • Premenstrual symptoms (PMS) are common, but avoidable!  There are things we can do to change the irritability, depression, cravings, bloating, breast tenderness, sadness, or anxiety.  You don’t need to suffer!

Understanding your cycle is so key to understanding your health.  It’s a great monthly check-in. If you think something is off – reach out!

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