Your Period Is a Monthly Health Report Card
Think of your menstrual cycle as your body's monthly newsletter. It's providing valuable information about your hormones, thyroid function, stress levels, nutrition status, and overall health.
"The menstrual cycle is often called the fifth vital sign," explains Dr. Jen Gunter, MD, an obstetrician-gynecologist and author. "Just like checking your blood pressure or temperature, tracking your cycle can reveal important health insights."
Yet most of us were taught that periods are something to hide, not something to monitor. We learned about pads and tampons, but not about what a healthy cycle actually looks like—or what changes might signal a problem.
Let's change that.
What a "Normal" Period Actually Looks Like
First, let's establish the baseline. A normal menstrual cycle has quite a bit of variation, which is why it's important to know your normal.
Cycle Length
Normal range: 21-35 days (measured from the first day of one period to the first day of the next) Average: 28 days Key point: Consistency matters more than the exact number. If your cycle is always 32 days, that's normal for you.
Period Duration
Normal range: 2-7 days Average: 4-5 days Red flag: Bleeding for more than 7 days or less than 2 days consistently
Flow Volume
Normal: 30-40ml per cycle (about 6-8 regular tampons or pads per day) Heavy: Changing a pad or tampon every 1-2 hours, passing large clots Light: Barely needing protection, spotting only
Color
Normal: Bright red to dark brown/black Bright red: Fresh blood, typical on heavier flow days Dark brown/black: Older blood, common at the start or end of period Pink or watery: Can be normal if brief, but persistent pink blood might signal low estrogen
Cramps
Normal: Mild to moderate cramping for 1-2 days Not normal: Severe pain that interferes with daily activities, requires prescription pain medication, or doesn't respond to NSAIDs
What Your Period Is Telling You: A Symptom Guide
1. Very Heavy Bleeding (Menorrhagia)
What it looks like:
- Soaking through a pad or tampon every hour for several hours
- Needing to change protection during the night
- Passing clots larger than a quarter
- Bleeding for more than 7 days
Possible causes:
- Uterine fibroids (noncancerous growths in the uterus)
- Adenomyosis (uterine lining growing into the muscle wall)
- Endometriosis
- Thyroid disorders
- Blood clotting disorders
- IUD complications
- Iron deficiency anemia (which can be both a cause and effect)
Why it matters: Heavy bleeding can lead to anemia, causing fatigue, weakness, and shortness of breath. It also significantly impacts quality of life.
What to do: See your doctor. Don't accept "heavy periods are normal" as an answer. Treatment options exist, from hormonal birth control to surgical interventions.
2. Very Light or Absent Periods (Oligomenorrhea/Amenorrhea)
What it looks like:
- Periods occurring less than every 35 days
- Very light flow (barely needing protection)
- Missing three or more periods (when not pregnant or breastfeeding)
Possible causes:
- Polycystic ovary syndrome (PCOS)
- Thyroid disorders
- Excessive exercise (relative energy deficiency in sport, or RED-S)
- Low body weight or restrictive eating
- High stress
- Premature ovarian insufficiency
- Pituitary gland problems
- Recent discontinuation of hormonal birth control
Why it matters: Missing periods or very light periods can indicate hormonal imbalances that affect bone density, heart health, and fertility.
What to do: If you've missed three periods or your periods are consistently very light, see your doctor for evaluation.
3. Irregular Cycles (Variation of More Than 7-9 Days)
What it looks like:
- Cycle length varies significantly (e.g., 25 days one month, 38 the next)
- Unpredictable timing
- Can't reliably predict when period will arrive
Possible causes:
- PCOS (most common cause)
- Thyroid disorders
- Perimenopause (if over 40)
- High stress
- Significant weight changes
- Chronic health conditions
Why it matters: While some variation is normal, significant irregularity can indicate hormonal issues affecting ovulation.
What to do: Track cycles for 3 months. If variation persists, consult your doctor.
4. Severe Cramps (Dysmenorrhea)
What it looks like:
- Pain that interferes with work, school, or daily activities
- Pain radiating to lower back or thighs
- Nausea, vomiting, or diarrhea with cramps
- Pain not relieved by over-the-counter medication
Possible causes: Primary dysmenorrhea (no underlying condition):
- High levels of prostaglandins causing uterine contractions
Secondary dysmenorrhea (underlying condition):
- Endometriosis (most common)
- Adenomyosis
- Fibroids
- Pelvic inflammatory disease
Why it matters: "Period pain that disrupts your life is not normal and doesn't have to be tolerated," Dr. Gunter emphasizes. Severe cramps might indicate endometriosis, which affects fertility if untreated.
What to do: See your doctor, especially if pain is worsening, doesn't respond to NSAIDs, or interferes with daily life.
5. Spotting Between Periods
What it looks like:
- Light bleeding or spotting mid-cycle
- Pink or brown discharge between periods
- Spotting after sex
Possible causes:
- Ovulation bleeding (normal, brief spotting around day 14)
- Hormonal birth control adjustment
- Cervical polyps or ectropion
- Infection (STI or cervicitis)
- Cervical or uterine cancer (rare, but important to rule out)
- Pregnancy complications
Why it matters: While ovulation spotting is normal, persistent or heavy inter-menstrual bleeding requires investigation.
What to do: Track when spotting occurs. If it's mid-cycle and brief, likely ovulation. If persistent or heavy, see your doctor.
6. PMS That Interferes With Life
What it looks like:
- Severe mood swings, irritability, or depression
- Significant breast tenderness
- Intense fatigue
- Bloating or weight gain (>5 lbs)
- Food cravings or changes in appetite
- Difficulty concentrating
Normal PMS: Mild symptoms that are annoying but manageable PMDD (Premenstrual Dysphoric Disorder): Severe symptoms that significantly impact quality of life, relationships, or work
Possible causes:
- Hormonal sensitivity (fluctuations in estrogen and progesterone)
- Serotonin levels affected by hormonal changes
- Nutritional deficiencies (magnesium, B vitamins)
Why it matters: If symptoms interfere with your life, work, or relationships, it's beyond normal PMS and warrants treatment.
What to do: Track symptoms alongside your cycle. If severe, discuss treatment options with your doctor (lifestyle changes, supplements, SSRIs, or hormonal treatments).
The Red Flags You Should Never Ignore
See a doctor immediately if you experience:
Emergency symptoms:
- Sudden, severe pelvic pain (could indicate ruptured ovarian cyst or ectopic pregnancy)
- Soaking through a pad every hour for 2+ hours
- Passing clots larger than a golf ball
- Fever with period symptoms (could indicate infection)
- Fainting or dizziness with heavy bleeding
Schedule an appointment soon if:
- Periods suddenly become much heavier or lighter
- Cycle length changes significantly
- New severe cramping appears
- Bleeding lasts more than 7 days
- You miss three or more periods (and not pregnant)
- Bleeding after menopause
- Pain during sex
- Unusual discharge or odor
How to Track Your Cycle (Beyond Just Marking Days)
To truly understand what your period is telling you, track more than just when it starts:
What to track:
- First day of bleeding (this is cycle day 1)
- Last day of bleeding
- Flow volume (light, medium, heavy)
- Cramp severity (scale of 1-10)
- Other symptoms (mood, energy, bloating, breast tenderness, headaches)
- Spotting between periods
- Cervical mucus changes (optional, but helpful for understanding ovulation)
Tracking tools:
- Period tracking apps (Clue, Flo, Period Tracker)
- Old-school paper calendar
- Spreadsheet or journal
"Three months of tracking gives you valuable data to bring to your doctor," Dr. Gunter notes. "It's much more helpful than trying to remember details during an appointment."
Lifestyle Factors That Impact Your Period
Your cycle doesn't exist in a vacuum—it's affected by how you live:
Stress
Chronic stress elevates cortisol, which can suppress the hormones that trigger ovulation. This can delay periods or make them irregular.
Sleep
Poor sleep disrupts hormone production. Aim for 7-9 hours of consistent sleep.
Exercise
Moderate exercise: Beneficial for reducing cramps and PMS Excessive exercise: Can suppress periods (RED-S is a serious condition) Not enough movement: Can worsen cramping and PMS
Nutrition
Iron: Heavy periods can cause deficiency; deficiency can worsen heavy bleeding Magnesium: May help reduce cramps and PMS B vitamins: Support hormone production Omega-3s: May reduce inflammation and cramping Adequate calories: Restriction can stop periods
Weight
Significant weight changes (loss or gain) can affect cycle regularity. Body fat produces estrogen, so very low body fat can suppress periods.
When Birth Control Masks Underlying Issues
Hormonal birth control regulates your cycle—but it doesn't cure underlying problems. It can be an appropriate treatment, but shouldn't be prescribed without investigating the root cause.
"If you have irregular periods, heavy bleeding, or severe cramps, birth control might manage symptoms, but you still deserve a proper diagnosis," Dr. Gunter explains.
Before starting hormonal birth control for period problems:
- Get blood work (thyroid, hormones, iron levels)
- Consider pelvic ultrasound if bleeding is heavy or irregular
- Rule out conditions like PCOS, endometriosis, or thyroid disorders
Birth control is a valid treatment option—but it should be an informed choice, not a band-aid covering an undiagnosed problem.
Your Period-Tracking Action Plan
This cycle:
- Download a tracking app or create a tracking system
- Note first and last day of bleeding
- Track flow volume and cramp severity
- Pay attention to other symptoms
Next three cycles:
- Continue tracking consistently
- Notice patterns (same symptoms at same time each cycle?)
- Identify your "normal"
- Flag anything concerning
If problems arise:
- Bring your tracking data to your doctor
- Ask specific questions about your concerns
- Request appropriate tests
- Don't accept dismissive answers
Your period isn't just an inconvenience or something to "deal with." It's valuable health information. Pay attention to what it's telling you—and don't be afraid to speak up when something doesn't feel right.
Your cycle. Your body. Your health. Take charge of all three.
