We’ve all been there: You’re in the middle of your period, and it feels like it’ll never end. Maybe you’re experiencing cramps, or clots, or heavy bleeding, or anxiety. But—is it normal? How do you know if your cramps are run of the mill or over-the-top? How can you tell if your clots are regular or extreme? What about that overflowing menstrual cup: Normal or not?
To get to the bottom of this, we tapped Kylie Fowler, MD, MS, FACOG, a pediatric gynecologist and adjunct professor at the University of Minnesota Department of Women’s Health, who set the record straight.
WTF is a normal period?
Of course there’s no one-size-fits-all, but we kicked things off by finding out how a pro would define a “normal” period.
“There are actually guidelines for what is normal and abnormal,” says Fowler. “Once you have had a period for more than two years, each menstrual cycle should occur every 21 to 35 days.”
In terms of length, a normal period should last between two and seven days, Fowler says. “Bleeding for longer than seven days is not normal and could indicate a bleeding problem,” she says. “Bleeding for less than two days may indicate anovulatory bleeding, or bleeding without releasing an egg.”
Periods that fall within these ranges, with no or mild pain, “indicate a lot of things are going right with your body, such as thyroid function, adrenal function, and adequate nutrition,” Fowler says. But don’t worry: “It’s also normal to not be like clockwork,” she adds. “If your cycle is 28 days one month, 32 the next, and 26 the third, that’s normal—not everyone has strict cycles of the same length every time.”
Red flag: Skipping a period
Skipping periods is definitely a sign of an issue, Fowler says. “You should never go more than two months without a period,” she says. “This includes athletes. It’s never normal for athletes of any age to be skipping periods.”
There might be some exceptions. “For example, if you’re breastfeeding or using hormonal contraception,” Fowler adds. “But you should always discuss irregular or absent menses with your doctor.”
Bleeding too frequently could also be a cause for concern. One rule of thumb: If you have periods that are “too frequent, too infrequent, too heavy, too painful,” it’s time to pay a visit to your doc.
Green flag: Cramps that are relieved by OTC meds
“Normal cramps should be alleviated by common over-the-counter medications,” Fowler says. She lists the best options as ibuprofen or naproxen, or acetaminophen for those who can’t take ibuprofen or naproxen.
Red flag: Extreme cramps
If you’ve popped over-the-counter meds and you’re still doubled over in pain, schedule a visit to your gynecologist. Fowler advises that if ibuprofen, naproxen, or acetaminophen don’t provide enough relief, you should speak to your doctor. “Periods should not routinely require you to miss school, work, or activities that you enjoy due to pain,” she says.
Green flag: Low-key PMS
Though no one likes PMS, the truth is that mild PMS symptoms are, sadly, par for the course. “PMS symptoms that are typically more mild and do not generally require more than supportive care” are normal, Fowler says.
These care measures include “rest or exercise—depending on the person—as well as stress relief measures, good hydration and a balanced diet, and over-the-counter pain relievers,” according to Fowler. If these provide relief, your PMS symptoms are likely normal (though, yes, they still suck).
Red flag: Premenstrual dysphoric disorder (PMDD)
“PMDD is a mood disorder,” Fowler says. “It’s classified with other mood disorders, such as anxiety and depression.” Though it may occur monthly, around the same time PMS symptoms would normally pop up, it’s an entirely different beast.
With PMDD, “the drop in hormones associated with the week before and early days of menses causes a drop in mood-regulating hormones like serotonin,” Fowler says. “PMDD can cause severe mood changes, including panic attacks, problems with focus or concentration, and even suicidal thoughts.”
If you’re experiencing any of these, don’t leave it untreated—make an appointment with your doctor. “PMDD can be difficult to talk about, but should never be ignored,” Fowler notes. The good news? There’s a solution. “What many people don’t know is that use of antidepressants—specifically a class of medications called SSRIs—are first-line treatment for PMDD,” she says. “Hormonal medications, such as the traditional birth control pill, are used if antidepressants are not providing adequate improvement in symptoms.”
Fowler also notes that there are many good resources for people with PMDD out there. “IAPMO is my favorite,” she says.
Green flag: Small clots
If you’re looking for a rule of thumb when it comes to blood clots, think of loose change. “In general, clots that are smaller than a quarter in diameter are normal,” Fowler says.
Red flag: Quarter-sized clots
On the other hand, big clots necessitate a convo with your GYN, though they can also be A-OK. “If clots are larger than a quarter, this can be normal—but should be reported to your doctor,” Fowler says.
Red flag: Super heavy bleeding
“You should never soak a tampon or pad in less than two hours,” Fowler says. “This is equivalent to about 10 milliliters of blood accumulation in a menstrual disc within two hours, or overflowing it within six hours,” she says, assuming you’re using an average disc or cup, which usually hold about 25 to 30 milliliters. Call your doctor immediately if you’re experiencing this type of bleeding. “If your bleeding is this heavy, you may need urgent attention,” she says.
You can also measure your bleeding over the course of your entire period. “Bleeding over 80 milliliters over the course of an entire period is considered heavy menstrual bleeding and is abnormal,” Fowler says. “This can be hard to track and quantify, although with a menstrual disc or cup—I recommend Flex—you can record menstrual blood loss daily based on the volume your disc holds and how full it is.”
If you use pads or tampons, “there’s a tool called the pictorial blood loss assessment chart, available through Google search, that can help quantify how much bleeding you are having,” she says.
If you use period underwear, you may have a harder time figuring out just how much you’re bleeding. “Measures of bleeding with period underwear depend on the expected absorbency of the individual product and can be more difficult to quantify,” Fowler adds.
Heavy bleeding can lead to other issues. “There’s a worldwide epidemic of low iron and anemia in menstruating people around the world,” Fowler says. “Sometimes periods are normal, but iron intake is too low. Sometimes it is a mix of menses that are too heavy and iron input that is too low. Sometimes iron intake is fine, but there are problems with clotting or stopping bleeding.”
Whatever the case may be, there’s no need to suffer silently. “There are hormonal medications that can help, but there are other medications, like tranexamic acid, that are non-hormonal and can reduce menstrual blood loss,” Fowler says. The bottom line? “If you feel your bleeding is too heavy, don’t ignore it,” she says.
The same goes for any red flag. If you’re experiencing any signs of an “abnormal” period, you should absolutely talk to your doctor about it.
