The menstrual cycle is a normal process in which the body prepares for egg fertilization and pregnancy. If pregnancy does not occur, the cycle starts over with a menstrual period.

Each woman has a unique menstrual cycle and should keep track of the first day of each menstrual period. This helps to determine what is normal, including how long the woman’s cycle is, and whether her cycle varies in length each month. Change in the menstrual cycle may be a sign that something is wrong, so it is important to know what normal is.

Menstruation

Textbooks describe a menstrual cycle of 28 days with a seven-day period. While this is normal, longer or shorter cycles are also normal. In fact, the menstrual cycle can last anywhere from 21 to 40 days. Women should mark the first day of each menstrual cycle on a calendar so that they can determine what is normal for themselves. The first day of the menstrual cycle is the day that one’s period begins. The period is also called menstruation.

Menstruation may seem like a messy event with quite a bit of blood loss. The fact is that blood loss is minimal with only .5 to 2.5 ounces lost throughout the period. There may be some small blood clots during menstruation, but this is normal. Blood may turn brownish or blackish at the end of menstruation as the rate at which blood is expelled slows toward the end of the period.

Women may continue daily activities during menstruation, such as swimming and sexual activity. In fact, some women find that orgasms help to relieve menstrual cramps.

Ovulation

Ovulation occurs about two weeks into the cycle when an ovary releases an egg. There may be some discomfort on one side of the pelvis. This is called Mittelschmerz, and it is pain felt as a follicular cyst bursts to release the egg – a normal process. Some women may periodically experience very little spotting during ovulation, but this is of no concern.

Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)

Premenstrual syndrome (PMS) occurs within the week prior to menstruation. It is a normal reaction to the higher levels of the hormone progesterone. Progesterone prepares the uterus for pregnancy, and this hormone keeps the body pregnant if the egg is fertilized.

The higher progesterone levels may cause irritability, tender breasts, food cravings, and bloating. PMS is often not as noticeable during the teenage years, but may become much more noticeable in the late 20s and 30s. In her Mayo Clinic article, “Premenstrual syndrome (PMS),” Sandhya Pruthi, M.D. says, “About 75 percent of menstruating women experience mild to moderate premenstrual symptoms. But up to 10 percent of menstruating women have premenstrual dysphoric disorder (PMDD) – a severe, sometimes disabling form of premenstrual syndrome (PMS).” PMS and PMDD “usually improve within a few days after menstruation begins.”

PMDD symptoms may include depression and symptoms that often accompany depression, such as mood swings and crying, fatigue, anxiety and feeling overwhelmed, body aches, disinterest in usual activities, and changes in eating and sleeping patterns.

Abnormal Menstrual Cycle

Call a doctor if any of the following is true:

• Periods last more than 10 days.
• Menstrual cycle is shorter than 21 days or longer than 40 days. Some teenagers may have menstrual cycles as long as 45 days.
• Periods have an excessive number of blood clots or clots are the size of a quarter or larger.
• Significant spotting or bleeding occurs between periods.
• Premenstrual dysphoric disorder (PMDD) symptoms are present.
• Menstrual cramps are quite painful.

Menstrual Cycle Variations and the Last Menstrual Period (LMP)

The menstrual cycle follows a pattern and is an indicator of health for women. Keeping track of the first day of each menstrual period provides insight into a woman’s unique cycle and whether it varies. Some women have a 28-day cycle, each month; while others have cycles that vary from 21 to 35 days. A woman may notice that she has a heavier period one month, followed by a lighter period the next, and this is her usual pattern.

Once a woman knows her pattern – what is normal for her – then she can more easily tell if something is wrong. She can show her physician her calendar and clearly explain what changes she has been experiencing. This is a crucial step towards regaining health when problems arise.

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