Dr Olga Sambolska*

The normal menstrual cycle is the monthly hormonal process in the female reproductive system that involves the uterus, ovaries and brain to prepare for possible pregnancy.

The cycle begins on the first day of menstrual bleeding and ends the day before the next period starts. If pregnancy does not occur, the uterine lining sheds as menstrual bleeding.

Understanding what a normal menstrual cycle looks like helps women recognise healthy patterns and identify changes that may need medical attention.

Normal cycle length 

For adult women, a normal menstrual cycle lasts 21 to 35 days.

A 28-day cycle is common, but it is not necessary for health. The most important thing is the same regularity and a consistent bleeding pattern.

If the cycle comes a few days earlier or later, it is still considered a normal menstrual cycle as long as the pattern remains stable. 

Normal period duration

A normal period typically lasts 2-8 days. If menstrual bleeding lasts more than eight days, it is not physiologically normal and is classified as prolonged menstrual bleeding, which should be evaluated.

How much bleeding is normal? 

Normal menstrual blood loss is difficult to measure precisely, but in practical terms, normal bleeding usually means:

• Changing a pad or tampon every 3-4 hours  
• Bleeding that gradually decreases after the first few days
• Small blood clots occasionally (about the size of a grape or coin)

This pattern is typical of a normal menstrual cycle.

Heavy periods may include:

• Soaking through a pad or tampon every 1-2 hours
• Needing double protection
• Bleeding longer than eight days
• Passing large clots frequently
• Feeling very tired, weak, or short of breath (possible anaemia)

Heavy bleeding is common but not something that can be ignored! 

Period pain: is it normal or not?

Mild menstrual cramps are common during a normal menstrual cycle and usually improve with rest. Photo: canva.com

Mild to moderate menstrual cramps are common in reproductive-age women.

Pain is considered normal if it:

• Occurs on the first 1-2 days of bleeding
• Improves with rest or pain medication
• Does not interfere with daily life

Pain is considered abnormal if it:

• Is severe or disabling 
• Gets worse with age
• Does not respond to painkillers
• Is associated with pain during sex, bowel movements or urination

Severe or worsening pain may indicate conditions such as endometriosis or adenomyosis and should be evaluated. 

Hormonal symptoms during the cycle

Hormonal changes during a normal menstrual cycle can cause symptoms, especially before menstruation. Common symptoms include:

• Bloating 
• Breast tenderness
• Mild mood changes
• Headache
• Fatigue
• Food cravings

These symptoms are common and usually normal. However, severe mood or emotional fluctuation,  anxiety or depression before periods may suggest PMS or PMDD and needs attention.

What is considered abnormal and needs gynaecologist evaluation?

• Periods that stop for more than three months 
• Cycles shorter than 21 days or longer than 35 days
• Very heavy or prolonged bleeding
• Bleeding between periods or after sex
• Severe pain affecting work or daily activities
• Sudden changes in your usual cycle
• Symptoms of anaemia (fatigue, dizziness, palpitations)

Period, hormones and fertility 

In reproductive-age women, periods are closely linked to ovulation and fertility.

• Regular cycles usually indicate ovulation
• Irregular cycles may still include ovulation but can make timing harder
• Heavy or painful periods don't mean infertility

If you are trying to conceive or concerned about fertility, changes in your normal menstrual cycle are worth discussing with a health care provider.

Lifestyle factors and period 

Many everyday factors can influence your cycle, including:

• Stress (may delay periods or change bleeding patterns)
• Weight changes (both loss and gain can affect cycles)
• Excessive exercise (may delay periods or cause amenorrhoea)
• Poor sleep (can worsen PMS and cause irregularity)
• Travel or shift work (can temporarily disrupt cycles)

These changes are common and often reversible.

If you have concerns about your menstrual cycle, please contact your OB-GYN specialist to discuss them in detail. — Family Medical Practice

Dr Olga Sambolska. — Photo courtesy of Family Medical Practice

*Dr Olga Sambolska graduated from Lviv National Medical University in 1996 and began her medical career at the Volyn Regional Maternity Hospital in Ukraine. Since 1998, she has been a registered obstetrics and gynaecology doctor, providing health care to women in relation to pregnancy, birth control, menopausal issues, contraception, menstrual cycle disorders and sexually transmitted diseases. She is fluent in English, Ukrainian, Polish and Russian.

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