Menstrual cycle: What's normal, what's not

Do you know when your last menstrual period began or how long it lasted? If not, it might be time to start paying attention. Tracking your menstrual cycles can help you understand what's normal for you, time ovulation and identify important changes — such as a missed period or unpredictable menstrual bleeding. While menstrual cycle irregularities usually aren't serious, sometimes they can signal health problems.

What's the menstrual cycle?

The menstrual cycle is the monthly series of changes a woman's body goes through in preparation for the possibility of pregnancy. Each month, one of the ovaries releases an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a menstrual period.

What's normal?

The menstrual cycle, which is counted from the first day of one period to the first day of the next, isn't the same for every woman. Menstrual flow may occur every 21 to 35 days and last two to seven days. For the first few years after menstruation begins, long cycles are common. However, menstrual cycles tend to shorten and become more regular as you age. Your menstrual cycle may be regular — about the same length every month — or somewhat irregular, and your period may be light or heavy, painful or pain-free, long or short, and still be considered normal. Within a broad range, normal is what's normal for you.

How can I track my menstrual cycle?

To find out what's normal for you, start keeping a record of your menstrual cycle. Begin by tracking your start date every month for several months in a row to identify the regularity of your periods. If you're having problems or you're concerned about the timing, flow or discomfort of your periods, then also make note of the following every month:

• End date. How long does your period typically last? Is it longer or shorter than usual?
• Flow. Record the heaviness of your flow. Does it seem lighter or heavier than usual? How often do you need new sanitary protection?
• Pain. Describe any pain associated with your period. Does the pain feel worse than usual?

What causes menstrual cycle irregularities?

Menstrual cycle irregularities can have many different causes, including:

• Pregnancy or breast-feeding. A delayed or missed period can be an early sign of pregnancy. If you haven't had your period in six weeks and you've been sexually active, take a pregnancy test. Breast-feeding typically delays the return of menstruation following pregnancy.
• Eating disorders, extreme weight loss or excessive exercising. Eating disorders — such as anorexia nervosa — extreme weight loss and increased physical activity can disrupt menstruation.
• Polycystic ovary syndrome (PCOS). This common hormonal disorder may cause small cysts — fluid-filled sacs or pockets — to develop in the ovaries along with irregular periods.
• Premature ovarian failure. Premature ovarian failure refers to the loss of normal ovarian function before age 40. Women who have premature ovarian failure may not have periods or may get them irregularly.
• Endometriosis. This disorder causes tissue that normally lines the inside of your uterus to grow outside your uterus. Endometriosis can cause pain — sometimes severe — especially during your period.
• Pelvic inflammatory disease (PID). This infection of the reproductive organs may cause irregular menstrual bleeding.
• Uterine fibroids. Uterine fibroids are noncancerous growths of the uterus. They may cause heavy menstrual periods and bleeding between periods.

What can I do to prevent menstrual irregularities?

For some women, use of birth control pills can help regulate menstrual cycles. However, some menstrual irregularities can't be prevented. Regular pelvic exams can help ensure that problems affecting your reproductive organs are diagnosed as soon as possible.

In addition, consult your health care provider if:

• Your periods suddenly stop for more than 90 days
• Your periods become erratic after having been regular
• You bleed for more than seven days
• You bleed more heavily than usual — soaking through more than one pad or tampon every hour or two
• Your periods are less than 21 days or more than 35 days apart
• You bleed between periods
• You develop severe pain during your period
• You suddenly get a fever and feel sick after using tampons

Remember, tracking your menstrual cycle can help you find out what's normal for you and what isn't. If you have questions or concerns about your menstrual cycle, talk to your health care provider.

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