Vaginal Bleeding and cycling monthly is a normal part of reproduction and being a woman. Not every woman cycles monthly or exactly the same time each month. Some women may not get their menses monthly. Some women may bleed many days and have a heavy flow while others may have a short and light flow.
What Are The Parameters Of Normal Cycles And Flow And When Should I Seek Evaluation?
Cycles shorter than 21 days apart or longer than 90 days apart, need evaluation. While estrogen builds up the lining of the uterus, progesterone the second hormone, is only made after ovulation and the amount and duration depend on the balance of hormones and the quality of the ovulation. Progesterone lasts only 14 days and once withdrawn, causes the uterine lining to shed as menses. All developing follicles in the ovary jockeying to be the one that makes and releases the egg, add to the total amount of estrogen made monthly. By a positive feedback mechanism, one follicle pulls ahead, matures more, and releases the egg. Meanwhile, all along, the estrogen made until this time is building up the uterine lining in preparation for pregnancy. Once the egg is released, the follicle changes and makes progesterone which lasts 14 days. This changes the character of the uterine lining and makes it secretory/ juicy and a great environment for a fertilized egg. If there's no fertilized egg to tell the follicle to continue making progesterone and hold the lining in, it sheds resulting in a menses.
Heavy or late menses can often disguise an unsuccessful or undiagnosed pregnancy. Two-thirds of all pregnancies result in miscarriages and many are unknown or not detected as such. If your period is ever late along with experiencing pregnancy symptoms and then get your period or vaginal bleeding, you may need evaluation from a clinician for a blood RH and/or serial blood pregnancy tests to make sure the pregnancy completely resolves.
In general, the average menstrual cycle (meaning day one of bleeding of one cycle to day one of bleeding of the next cycle) is 28-35 days apart though 25-42 is also considered normal. Some women's cycles are even further (42-90 days) apart. As long as you get a decent menstrual bleed using at least 4-5 feminine hygiene products per day for at least 3-5 days every 90 days, this is generally considered to be within normal limits. If your cycles are more irregular (like greater than 90 days apart) OR you only get a light menses regardless of your cycle length (using less than 3 feminine hygiene products /day for less than 4-5 days, evaluation by your clinician is advised. You may need to be given progesterone to fully slough the lining of the uterus. Long-term unopposed estrogen without adequate progesterone causing a decent menses, can increase the risk of uterine precancer or cancer.
Lack of a menses or a cycle greater than 90 days apart can also be related to other issues including stress, prescription medications (hormonal, mental health/psychiatric, cancer/chemo) polycystic ovarian syndrome, an elevation of prolactin, a brain hormone that makes breast milk, excessive exercise, anorexia or malnutrition, and severe weight loss. Please call us if you experience any of these issues. It is important to have adequate estrogen in your body ( whether naturally made in your body or contained in medication such as birth control pills) to allow calcium and other minerals to maintain normal bone health, remodeling, and bone integrity. This is especially important in the teen years through age 30 when we develop and create most of our bone density for the rest of our lives. Lack of estrogen can increase the thinning of bone which can increase the risk of bone fracture even if you are not postmenopausal.
What Is Considered To Be Too Much Bleeding During Your Cycle?
In general, most women during menses, bleed an average of 3-7 days of varying heaviness. If you bleed longer than 7 days, please discuss this with us as there are many suggestions we can make to shorten the number of days you bleed and or the heaviness of your flow. Please call to make an appointment to discuss these issues as we have many options to improve this quality of life issue. If you bleed and soak more than one super tampon or maxi pad per hour for more than 4-6 hours, with decreased activity or rest, you need to call your clinician. Also, if you pass clots larger than a quarter (like golf ball or larger sized clots) for 4-6 hours, you need evaluation as this is considered to be hemorrhaging and you may need to be referred to an ER.
Other Vaginal Bleeding:
Bleeding after sex can be related to a variety of issues and evaluation or a call to your clinician is always advised. Post coital/sex bleeding can be a sign of a sexually transmitted infection or cervical cancer. It can also be related to a lack of estrogen in post-menopausal women.
Women who are menopausal and have gone a full year without a period and experience any bleeding, spotting, staining or what they suspect might be blood, need a clinical evaluation as these symptoms in a post menopausal woman can be related to uterine /endometrial cancer.
Please call us if you ever experience any of these symptoms, We are here to evaluate you and address any issues you may have. Lastly, bleeding from hemorrhoids or urinary tract infections can be mistaken for vaginal bleeding as well. If you are not sure or are concerned, call us and we are happy to help you. We have same-day appointments available.