Menstrual Cycle
Normal and Abnormal Bleeding
The menstrual cycle is more than just the period.
In fact, the period is just the first phase of the cycle.
The menstrual cycle is made up of two cycles that interact and overlap—one happening in the ovaries and one in the uterus.
A complex system of hormones controls your menstrual cycle.
- An area in your brain called the HYPOTHALAMUS produces a hormone called GnRH.
- GnRH stimulates the PITUITARY GLAND which produces FSH (follicle stimulating hormone)
- FSH stimulates the OVARY to develop a follicle which contains the egg, preparing it for release (ovulation). The ovarian follicle is producing estrogen.
- Estrogen stimulates the lining of the uterus called the endometrium.
OVULATION
Ovulation occurs when an egg is released from your ovary.
- Every month your ovaries form multiple small cysts called follicles. This process starts at the beginning of your menstrual cycle.
- Typically, only one follicle grows faster than the others, becoming the dominant follicle.
- This dominant follicle forms a cyst in the ovary that can grow up to 2.5 to 3.5 cm.
- Ovulation occurs when the cyst ruptures and releases the egg for the fallopian tube to capture.
Every month you form a cyst that is normally 2.5 to 3.5 cm.
Normal Menstrual Cycle
Your menstrual cycle is counted from the first day of your period up to the first day of your next period.
The average menstrual cycle is:
- 28 days.
Normal range:
- 21 to 35 days in an adult woman
- 21-45 days in your teens when first starting your cycles.
Normal length of menstrual flow:
- 3-7 Days
The average woman loses about two to three tablespoons of blood during her period.
A woman’s menstrual cycle length might be different from month-to-month. Your periods are still “regular”.
Each woman’s cycle length may be different, and the time between ovulation and when the next period starts can be anywhere from one week (7 days) to more than 2 weeks (19 days).
The brain, ovaries, and uterus work together and communicate through hormones (chemical signals sent through the blood from one part of the body to another) to keep the cycle going
When am I most fertile?
- Five days leading up to ovulation
- Day of ovulation
- Day after ovulation
Once the egg is released, it will survive up to 24 hours. If sperm reaches the egg during this time, you may get pregnant.
A man’s sperm can live for 3 to 5 days in a woman’s reproductive organs, but a woman’s egg lives for just 24 hours after ovulation.
Each woman’s cycle length may be different, and the time between ovulation and when the next period starts can be anywhere from one week (7 days) to more than 2 weeks (19 days).
How do I know when I am…
Ovulating?
Knowing when you’re ovulating is key to tracking your fertility window and determining the best time to get pregnant. There are a few different fertility awareness methods, also called rhythm methods. It’s best to use all three methods if you’re doing natural family planning.
Symptoms
- Increase in vaginal discharge or slick and slippery mucus (like egg white).
- Abdominal pain, often on one side of the tummy.
- Premenstrual symptoms (e.g. breast enlargement and tenderness, abdominal bloating and moodiness).
Basal body temperature method
Take your temperature each morning as soon as you wake up (before you get out of bed).
A woman’s basal body temperature rises slightly during ovulation (increases by 0.5 degrees Fahrenheit). If you track your temperatures leading up to ovulation, you should see a sustained rise in your basal body temperature after ovulation.
However, it’s important to note that the basal body temperature method is not good at predicting your ovulation when trying to conceive. Once you identify the rise in your temperature, you’ve already ovulated. However, this method is a good tool to monitor your pattern of ovulation.
Ovulation predictor kits
Ovulation predictor kits test your urine for levels of luteinizing hormone. When the ovulation predictor test becomes positive, ovulation will typically occur within 24 hours, indicating that you’re fertile and should have sex. These kits might not be reliable if you have irregular periods due to polycystic ovarian syndrome.
Your Menstrual cycles may change in different ways as you get older:
- For a few years after your first period, menstrual cycles longer than 38 days are common. Girls usually get more regular cycles within three years of starting their periods.
- In your 20s and 30s, your cycles are usually regular and can last anywhere from 24 to 38 days.
- In your 40s, as your body starts the transition to menopause, your cycles might become irregular. Your menstrual periods might stop for a month or a few months and then start again. They also might be shorter or last longer than usual, or be lighter or heavier than normal.
What are examples of irregular periods?
- Periods that occur fewer than 21 days or more than 35 days apart.
- Missing three or more periods in a row.
- Menstrual flow (bleeding) that’s much heavier or lighter than usual.
- Periods that last longer than seven days.
- Length of time between cycles varies by more than nine days. For example, one cycle is 28 days, the next is 37 days and the next is 29 days.
- Periods that are accompanied by severe pain, cramping, nausea or vomiting.
- Bleeding or spotting that happens between periods, after menopause or after sexual intercourse.
- Soaking through one or more tampons or sanitary pads in an hour.
Are you experiencing abnormal bleeding?
In the United States, 14% to 25% of women have irregular menstrual cycles.
Heavy Menstrual Flow?
- Bleeding that soaks through one or more tampons or pads every hour for several hours in a row.
- Needing to wear more than one pad at a time to control menstrual flow.
- Needing to change pads or tampons during the night.
- Menstrual flow with blood clots that are as big as a quarter or larger.
Heavy menstrual bleeding may be a sign of an underlying health problem that needs treatment. Blood loss from heavy periods can also lead to a condition called iron-deficiency anemia. Severe anemia can cause shortness of breath, fatigue, lethargy, and can increase the risk of heart problems.
Heavy bleeding may be related to problems with the lining of the uterus called the endometrium, or may be caused by an enlarged uterus.
Hormonal – Abnormal ovarian function can lead to abnormal hormonal production which can produce abnormalities in the lining of the uterus.
- Endometrial Hyperplasia (hyper = excessive, plasia = growth)
- Endometrial Cancer
Structural – There are conditions that can cause the uterus to enlarge, which can cause heavier flow.
Prolonged Menstrual Flow?
- Bleeding that exceeds 8 days in duration on a regular basis.
Most women experience unexpected bleeding between periods at least once in their lives.
Spotting between periods can occur at the beginning of a women’s reproductive years or near the end of a woman’s reproductive years.
- When a girl first starts her period, around ages 9-14, irregular cycles are more common.
- Women going through menopause — in their 40’s and 50’s — also frequently skip periods or experience heavier or lighter bleeding than usual.
There are many causes for bleeding between periods:
Hormonal – Some women spot during ovulation, most likely because of hormonal changes in estrogen and progesterone levels related to ovulation. Ovulation spotting typically lasts 1-3 days in the middle of your cycle and isn’t cause for concern.
Hormonal Contraception
- Breakthrough bleeding – Bleeding between periods often happens when you start to take hormonal contraceptives. This is because your hormone levels drop. It is also called breakthrough bleeding, and usually happens about 2 weeks after your last period. Breakthrough bleeding should stop after 1 or 2 months. Your periods will usually become more regular within 6 months. Bleeding between periods can also happen if you forget to take one of your oral contraceptive pills.
- Intrauterine contraceptive (IUD) affecting the lining of the uterus can sometimes cause irregular bleeding
Structural
- Polyps are abnormal growths on the cervix or inside the uterus.
Infections
- Vaginal bleeding between periods may be the result of an infection in the vagina, cervix or uterus (vaginitis, cervicitis or endometritis). Some sexually transmitted infections include:
- Chlamydia
- Gonorrhea
- Trichomonas
Frequent Menstrual Flow?
- Frequent menstrual periods occurring less than 21 days apart.
- Longer menstrual cycles that last more than 38 days.
- Bleeding between cycles.
- Amenorrhea or absent menstrual periods.
Most women experience unexpected bleeding between periods at least once in their lives.
Spotting between periods can occur at the beginning of a women’s reproductive years or near the end of a woman’s reproductive years.
- When a girl first starts her period, around ages 9-14, irregular cycles are more common.
- Women going through menopause — in their 40’s and 50’s — also frequently skip periods or experience heavier or lighter bleeding than usual.
Bleeding following sex?
- While vaginal bleeding after sex can be scary, it’s also common, affecting up to 9% of menstruating women.
- Bleeding during intercourse is not normal.
- The most common source for vaginal bleeding after sex is the cervix, which is the portion of your uterus that is at the upper part of your vagina.
There may be several reasons why the cervix can bleed following intercourse:
Cervical inflammation
- Inflammation from normal bacteria of the vagina.
- Inflammation from sexually transmitted infections -Chlamydia or Gonorrhea.
Cervical polyps
Precancerous or cancerous lesions of the cervix.
NOT HAVING A PERIOD?
Treatments for menstrual irregularities is tailored to each individual woman, depending on her age, overall health, severity of symptoms and whether she’s pregnant or would like to become pregnant in the future.
If you believe you are experiencing abnormal or heavy menstrual flow, I encourage you to see one of our specialists.
The providers at County Obstetrics & Gynecology have the knowledge, experience, and resources to identify the cause of your abnormal bleeding.