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20 January 2022 | 9 mins read | Menstruation

What is menstruation?

Menstruation is simply a scientific term for “a person’s period”. Every month, in biological females of reproductive age, the uterus prepares for pregnancy. Guided by hormones released by the brain and the ovaries, it develops a nutrient-and-blood-rich lining to protect and support an embryo. If conception does not occur that month, the lining is not needed, and it is shed from the uterus and expelled through the vagina over a two to seven day ‘period’.

Menstruation typically begins around age 12 and ends around age 51, depending on factors such as race, geographic location, and health status.

Don’t some people menstruate more than once a month?

A period cycle lasts between 21 and 35 days (depending on the source). Someone who gets their period every 21 days will have more periods each year than someone who gets it every 35 days. Any of these cycles are normal.

Can you bleed too much?

Many women think that they are bleeding ‘too much’. If you ask your friends how much blood they think they lose during each period, you will probably get an interesting range of responses. The actual amount of blood loss varies, but on average, roughly 30-50 mL of blood – less than 2 ounces – is lost per period.

Menstrual blood loss of more than 80mL per cycle is considered heavy. Heavy bleeding can put a person at risk for anemia. Heavy bleeding can also indicate that there is an underlying medical condition that should be investigated. Your doctor might refer to heavy or prolonged bleeding as “menorrhagia”.

How do you know if your period is too heavy?

Your period might be considered too heavy if:

  • You are passing clots that are the size of a U.S. quarter, or larger. A quarter is 25 mm in diameter.
  • You have to change your tampon or pad more than every 3-4 hours.
  • You often have to change your tampon or pad in the middle of the night.
  • Your period lasts longer than seven days.
  • Your period is lasting longer than what is normal for you.
  • You have signs of anemia, such as:
    • Pallor
    • Cold hands and/or feet
    • Shortness of breath
    • Unusual fatigue

Alternatively, if you use a menstrual cup, you can simply measure the quantity in the cup each time you remove it. For the uninitiated, menstrual cups are planet-friendly silicone or rubber cups that you insert in the vagina to collect menstrual fluid. A reusable cup can be left in place for up to 12 hours; can be washed and reused for months or even years, protects against odor, and saves money in the long run.

What causes heavy periods?

Common causes of heavy periods include:

  • Fibroids or polyps, typically benign uterine growths.
  • Non-hormonal intrauterine devices. (in contrast, IUDs that release the synthetic hormone progestin are associated with lighter periods).
  • Perimenopause. Some people find that their period becomes shorter but heavier, or longer and heavier for a few years prior to menopause.
  • Inherited or acquired bleeding disorders.
  • Hormonal imbalances.
  • Endometriosis, a disorder in which tissue similar to the uterine lining grows in other parts of the body, usually within the pelvis or abdomen.

Should I see my health care provider about my heavy periods?

If you have signs that your period is too heavy, or if there is a significant change in your flow, see your health care provider. Although your period might not seem heavy to your provider, only you know what is normal for you. Excessive menstrual blood loss can be the result of an underlying medical condition that should be investigated – and that can usually be treated.

Can your period be too infrequent?

Like periods that are too heavy, periods that occur fewer than 6-9 times per year (“oligomenorrhea”) or don’t occur at all (“amenorrhea”) may reflect an underlying medical condition. In addition, having infrequent or no periods can make it more difficult to conceive. (For more information on infertility, see link to articles here)

  • Primary amenorrhea is diagnosed when a person has not begun to menstruate by their 15th birthday. Some causes of primary amenorrhea are present from birth but are only discovered when menstruation fails to start. Examples include:
    • Genetic abnormalities
    • Structural abnormalities of the reproductive organs.
  • Secondary amenorrhea is diagnosed when a person previously menstruated regularly but has not menstruated in at least three months; or they previously menstruated irregularly and have not menstruated in at least six months. Some causes of secondary amenorrhea are:
    • Pregnancy
    • Polycystic Ovary Syndrome (PCOS). For more information on PCOS see link to article here.
    • Prolactin-secreting pituitary tumors.
    • Hypo or hyper-thyroid disease. For more information on thyroid disease, see link to article here.
    • Intrauterine adhesions, usually resulting from a medical procedure.
    • Primary ovarian insufficiency, also known as premature ovarian failure or early menopause. Ovarian failure is considered to be premature if it occurs before age 40.
    • Hypothalamic amenorrhea, a condition in which the hypothalamus stops releasing GnRH, a hormone that regulates menstrual cycles. Hypothalamic amenorrhea is associated with:
      • A low percentage of body fat.
      • Weighing at least 10% less than ideal body weight.
      • Anorexia nervosa. For more information on anorexia nervosa and other eating disorders. see link to article here.
      • Bulimia nervosa. see link to article here.
      • Participating in excessive or unusually strenuous exercise.
      • Emotional stress.

Most conditions that cause secondary amenorrhea can also cause oligomenorrhea or primary amenorrhea.

The single most common cause of oligomenorrhea is PCOS. Additional causes include systemic lupus erythematosus (“lupus”) and certain medications.

Should I see my health care provider about my infrequent or absent periods?

Although infrequent or absent periods might sound blissful to people who dread the discomfort (or pain) and inconvenience associated with menstruation, infrequent or absent periods usually reflect an underlying medical condition with broader consequences. The goal is to correct the underlying condition, which may also result in having regular periods.

What if my periods are regular but want to have infrequent periods?  

If you have normal, regularly spaced periods, but wish they didn’t come quite so often, there are ways to safely and intentionally reduce their frequency. Extended cycle birth control pills are designed to stretch the time between periods to one period every three months or even a year. If you don’t want to take a pill every day, hormone-releasing IUDs can make periods lighter or absent. Injectable birth control can do the same.

Be sure to talk about the pros and cons with your health care provider before making a decision.

Are there any other ways to avoid having my period?

Menstruation stops during pregnancy and for a few weeks after delivery. Breast-feeding usually delays the return of your period for a few extra weeks, or sometimes for the entire time of breast-feeding. Remember, though, that you can get pregnant after delivery but before you get your period back, and don’t rely on breast-feeding for birth control!

Period tracking apps: not just pretty calendars.

The Halza app can do more than alert you to expect the bloating and the bleeding; by using an app such as Halza, you will be able to learn patterns and keep track of potentially life-saving information. Menstrual symptoms can indicate possible disorders, which go beyond periods, such as endometriosis and depressive illnesses. No more wondering how many of your periods lasted for 11 days, and no more misremembering how long a period headache lasted. Period tracking apps can be invaluable, because no matter what you think now, you are unlikely to remember the details when it counts. Look for an app that is not only loaded with impressive-looking features but is one that you will actually use.

How Halza can help?

Manage your family’s health easily with the Halza app. Store, track & share all of your child’s medical records to have them with you, wherever you go. Monitor your child’s growth and vaccination schedule as well as upload reports and doctor’s notes all with the Halza app. QuickShare a complete overview of you or your child’s health with any attending doctor in seconds, during emergencies or whenever you need.

Simplify your health journey with Halza.

Jill Garner
Jill GarnerRegistered Nurse and Diabetes Educator