The length of the menstrual cycle and the amount of discharge: what is normal and what is not
It has taken root in the minds of many women, and not only that the menstrual cycle is necessarily 28 days long, and ovulation occurs on the 14th day.
The length of the menstrual cycle and the amount of discharge: what is normal and what is not
While this is an ideal situation, this is not the case in most women where cycle lengths range from 25 to 32 days on average. Then we will see that in some particular situations the length is much wider (or shorter)
We remind you that the length of a menstrual cycle does not mean when menstruation lasts but how much time passes between the beginning of a menstrual period and the day before the next one.
Therefore there is a very high variability between women and even the same woman can register differences between one month and another.
Remember that the menstrual cycle consists of 4 phases:
- the follicular phase : from the 1st day of menstruation to ovulation. It is a phase whose length is variable and which therefore determines the overall length of a menstrual cycle.
- ovulation : in which follicular dehiscence occurs and the release of the oocyte ready to be fertilized.
- the luteal phase which runs from ovulation to the next menstrual period and is between 11 and 16 days long
- the menstrual phase which is the transition between the luteal phase of one cycle and the follicular phase of the following cycle.
The menstrual flow lasts on average 4 days (from 2 to 6)
Normally the menstrual flow losses are between 30 and 80 ml and 8=% of the flow is concentrated in the first two days. Between 2 and 30 mg of iron are lost during a period of this type.
Menstrual cycle disorders
When is a menstrual cycle abnormal?
- When its length is not between 25 and 36 days and that is when the cycle is irregular or very irregular
- When the amount of menstrual flow is altered (too much and leakage or too little leakage)
Irregular menstrual cycle
Depending on the type of irregularity we speak of:
- Primary amenorrhea : if the first menstrual period has not yet occurred at the age of 18
- Secondary amenorrhea : absence of menstruation for more than 4 months in women who have already had menarche (first menstruation)
- Oligomenorrhea : the duration of the menstrual cycle is more than 36 days
- Polymenorrhea : the duration of the menstrual cycle is less than 25 days
Polymenorrhea
Women with cili less than 25 days suffer from polymenorrhea: the cause may be having non-ovulatory cycles or short follicular or luteal phases.
It is a condition that can be accentuated in the perimenopause phase.
There are women who have very short cycles, 18-23 days, even in the absence of hormonal imbalances. However, such close menstrual losses can cause the woman to suffer from anemia.
Oliogomenorrhea
We speak of oligomenorrhea when the duration of the cycles is greater than 36 days. The reason is related to the increase in the length of the follicular phase.
Oligomenorrhea should never be underestimated because it can be caused by hormonal imbalances such as polycystic ovary syndrome which affects about 10% of women of childbearing age.
In addition to PCOS, other causes may be hyperprolactinaemia, the presence of a luteal ovarian cyst (persistence of the corpus luteum for more than 16 days).
In some conditions, oligomenorrhea can lead to secondary amenorrhea.
Secondary amenorrhea
Pr secondary amenorrhea means the absence of menstruation for at least 4 months in women who have already had menarche.
Primary amenorrhea
We speak of primary amenorrhea when the first menstruation ( menarche ) has not yet appeared in an 18-year-old woman.
This condition is usually due to the presence of birth defects or disorders.
Other causes can be found in situations of metabolic and physical stress (e.g. in girls who practice sports at a competitive level such as dance, gymnastics and athletics) in which the percentage of body fat is insufficient for the maturation of the reproductive axis, or in neoplasms childish.
Primary amenorrhea should not be confused with delayed puberty in which there is a slow rise in gonadotropins and therefore sexual maturation occurs slowly but does occur.
Abnormal amount of menstruation
When the menstrual flow is too much, too little or too much, we talk about changes in the amount of menstrual flow.
If a leak between 30 and 80 ml is considered normal, the following conditions are distinguished
- Hypomenorrhea : loss less than 20-30 ml
- Hypermenorrhea : loss greater than 80 ml
- Dysfunctional uterine bleeding which are distinguished in
- menorrhagia : menstrual bleeding more than 80 ml
- metrorrhagia : if the discharge occurs between periods, or before puberty or after menopause
- meno-metrorrhagia : prolonged blood loss, i.e. starting during the menstrual phase and continuing into the intermenstrual phase
When the losses are abundant, the woman may experience an important condition of anemia (decrease in hematocrit, iron and hemoglobin values below 10 g/dl)
While this condition may be normal in a girl whose menarche has been occurring for 2-4 years, as the system is still immature, it should instead be well controlled in a woman over the age of 35. If haemorrhages appear at this stage it is important to carry out investigations.
Dysfunctional haemorrhages can have endocrine causes (two samples are taken, one in the mid-follicular phase and another in the mid-luteal phase), or they can be due to lesions or organic pathologies affecting the external genitalia, cervix or uterus (myomas, polyps or more rarely neoplasms, abnormal course of pregnancy in case of incomplete births or ectopic pregnancy). Obesity is a condition that can favor bleeding, but also the presence of blood diseases .
Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.
Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.