What’s Normal, and What's Not, When It Comes to Your Period?

Sep 3

5 min read

Menstrual cycles are often referred to as the 5th vital sign because they provide meaningful insight into overall health, but many people don't get good information on what is considered (not) normal, or how and where to seek help for period-related pain or issues.

Periods can look different from person to person. Your cycle doesn’t have to be exactly 28 days long, and having some cramping or changes in energy doesn’t necessarily mean something is wrong.

But there are some general guidelines for what is considered a normal menstrual cycle—and certain symptoms that are worth discussing with a healthcare provider or seeking help for. If you're not sure where to start, of the best ways to understand your cycle is to start tracking it! Many apps offer free tracking, or even use good old pen and paper to get started.

If you’ve ever wondered “Is my period normal?”, here’s what to look for.

How Long Is a Normal Menstrual Cycle?

A menstrual cycle is counted from the first day of one period to the first day of the next. Cycles should occur every 21-35 days, although some variation in exact length from month to month can occur.

Stress, illness, travel, changes in exercise, nutrition, hormonal contraception, pregnancy and postpartum changes, and perimenopause can all affect your cycle. However, they should occur at least every 3 months. If your periods are consistently very irregular, suddenly become irregular after previously being predictable, or stop unexpectedly, talk with your healthcare provider.

How Long Should a Period Last?

A typical period generally lasts 2–7 days. Your flow may be heavier during the first few days and gradually become lighter. What matters isn't just the number of days you bleed, but also how much you're bleeding and whether your period is interfering with your everyday life. Chat with your healthcare provider if you notice bleeding that regularly lasts longer than a week or represents a significant change from your usual periods.

How Much Period Bleeding Is Normal?

It can be difficult to know exactly how much blood you're losing during your period. Instead, it can be more useful to pay attention to how frequently you need to change your period products and whether your bleeding is difficult to manage.

Talk with your healthcare provider if you are:

Soaking through a pad or tampon every hour or two
Frequently needing to use multiple period products at once
Regularly bleeding through your clothing or bedding
Waking during the night specifically to change period products
Passing frequent or large blood clots
Bleeding for longer than 7 days
Feeling unusually fatigued, weak, dizzy, or short of breath during or after your period

Heavy menstrual bleeding can have several causes and may also contribute to iron deficiency or anemia, which can also make you feel fatigued.

How Much Period Pain Is Normal?

Mild to moderate cramping can occur during menstruation, particularly during the first day or two. I should not interfere with you normal daily function. Consider talking with a healthcare provider if your period pain:

Causes you to regularly miss work, school, exercise, or social activities
Requires significant pain medication to get through your day
Causes nausea, vomiting, fainting, or severe fatigue
Wakes you from sleep
Has become progressively worse
Causes significant pelvic, abdominal, back, rectal, or leg pain
Occurs with bowel movements, urination, or sex
Happens throughout the month rather than only during your period

Significant menstrual pain can be associated with conditions including endometriosis, adenomyosis, uterine fibroids, ovarian cysts, pelvic floor muscle dysfunction, or issues with fascial mobility and scar tissue. Identifying the underlying cause is an important part of finding the right treatment. If your provider isn't willing or able to explore underlying causes or you do not feel like your pain is taken seriously, consider getting a second opinion.

Are Blood Clots During Your Period Normal?

Small blood clots can occur during menstruation, particularly on heavier-flow days. However, regularly passing large blood clots, especially those around the size of a quarter or larger, is something to mention to your healthcare provider. This is particularly important when large clots occur along with very heavy bleeding, prolonged periods, or significant pain.

Is Spotting Between Periods Normal?

There are several reasons you might experience spotting outside of your period, including hormonal contraception, ovulation, pregnancy, or hormonal fluctuations. However, repeated bleeding between periods, bleeding after sex, or a new change in your bleeding pattern should be evaluated. Keeping track of when spotting occurs in relation to your cycle can provide helpful information for your healthcare provider.

Are Bowel Changes During Your Period Normal?

Absolutely - changes in bowel movements around your period can happen because the hormones involved in menstruation can also affect your digestive system. Many people find themselves getting more backed up or constipated leading up to menstruation, and you may notice looser stools, increased bowel frequency, or bloating on your period.

More significant symptoms deserve attention, particularly:

Severe pain with bowel movements
Rectal or pelvic pressure
Significant constipation or diarrhea
Pain that consistently worsens around your period
Difficulty completely emptying your bowels

Bowel symptoms that consistently follow your menstrual cycle can sometimes be associated with endometriosis. Pelvic floor muscle dysfunction may also contribute to painful or difficult bowel movements.

When Should You See a Physician About Your Period?

In short, you should seek care for any menstrual symptoms that are significantly affecting your quality of life. It may be time to talk with your healthcare provider if your periods are:

Extremely painful
Very heavy or difficult to manage
Lasting longer than about 7 days
Frequently occurring less than 21 or more than 35 days apart
Accompanied by large blood clots
Associated with significant bowel, bladder, or sexual symptoms
Suddenly different from your usual menstrual cycle

Can Pelvic Floor Physical Therapy Help With Period Pain and Symptoms?

Pelvic floor physical therapy can significantly help with many symptoms that occur or worsen around your period. While pelvic floor PT may not treat every cause of painful or abnormal periods, it can be a valuable part of your care team to make your cycles easier.

Hormonal changes and inflammation throughout the menstrual cycle can influence the muscles, nerves, connective tissues, and organs of the pelvis. For some people, this means symptoms become noticeably worse before or during their period. Pelvic floor physical therapy is particularly helpful to work on muscles, joints, fascia, and teaching on how to optimize your periods so that you feel your best in all phases of your cycle.

Pelvic floor physical therapy may be particularly helpful if your period is associated with:

Pelvic, abdominal, low back, hip, or tailbone pain
Increased pelvic pressure or heaviness
Pain or difficulty with bowel movements
Constipation or difficulty fully emptying
Urinary urgency, frequency, or discomfort
Pain with sex
Pelvic floor muscle tension or spasms
Abdominal or pelvic tightness and restricted mobility
Symptoms associated with conditions such as endometriosis or adenomyosis

Treatment should look at more than just the pelvic floor muscles. Depending on your symptoms, pelvic floor PT may address the pelvic floor, abdominal wall, hips and spine, breathing and pressure management, nervous system sensitivity, and mobility of the tissues and organs within the abdomen and pelvis.

At Core Connections Pelvic Health, we regularly help women go from not wanting to leave the house during menstruation, to getting back to the things they love through all phases of the menstrual cycle. Our goal is to understand why your symptoms are happening and create an individualized plan of hands-on therapies, movement therapies, and educational support to find lasting resolution for period pain and symptoms!