What is a healthy period and why is it so important?

It’s important to be aware of the signs and symptoms of a healthy and unhealthy period so you can readily identify any causes for concern. For example, an absent period or extended cycle length, as well as constant spotting or fluctuations in your monthly cycle can all be signs you need to take a closer look at what’s going on in your body. Let’s dive into what a “normal” or healthy period looks like, how you can assess your own cycle, and why it’s so important to maintain a healthy cycle in order to support optimal health.

What does a healthy period look like?

A regular menstrual cycle will look different for everyone, but should ideally last between 26-35 days including your bleed, with 28 days being the average. Within this timeframe, you should normally bleed for between 3-8 days, with the flow again being unique to every woman.

During this 26-35 day cycle, your body progresses through four different phases, with each phase involving different hormonal changes and fluctuations.

Stage 1: Menstruation (Days 1-7)

Each new cycle begins on the first day of your period, which lasts for up to 8 days (but on average usually 5-6 days). At this time, your body realises that the egg it prepared in your previous cycle hasn’t been fertilised. As a result your endometrial or uterine lining begins to shed, taking the unfertilised egg along with it to be discarded. This is what a period is: the removal of the unfertilised egg from your body via bleeding. During the first stage of your cycle, you’re producing the lowest levels of both oestrogen and progesterone.

Stage 2: Follicular Phase (Days 7-14)

During phase two, your body increases production of follicle stimulating hormone (FSH), which tells your ovaries to prepare for ovulation by producing tiny follicles, each of which houses an immature egg. In every menstrual cycle, one of these follicles will mature into an egg, producing oestrogen as it develops, while the extra follicles will die off.

At the same time, your body produces high amounts of oestrogen and your uterine lining begins to build up, preparing to facilitate the implantation of an egg, should it be fertilised.

Phase 3: Ovulation (around Day 14)

While ovulation will occur on a different day of the cycle for different people, it takes place at around the midway point. So, in a regular 28-day cycle, this means you can expect to be ovulating around the day 14 mark. When you ovulate, your high levels of oestrogen trigger the release of gonadotropin-releasing hormone (GnRH), which signals to your body to increase production of both luteinising hormone (LH) and FSH. As soon as your LH levels rise, ovulation will occur within two days. When it does, the mature follicle releases its egg from your ovary, allowing the egg to travel to your fallopian tube where fertilisation can take place.

Ovulation only lasts for a very short period of time during your cycle, and it’s the critical window for fertilisation and pregnancy to occur for anyone trying to conceive. In fact, you’re at your most fertile in the three days leading up to ovulation, and while ovulation is occurring. 

While your egg can only survive for 24 hours after it’s released, sperm can survive a little longer and potentially linger in the fallopian tube, so it’s possible to fall pregnant even if you’re not sexually active during the time ovulation is occurring.

Phase 4: Luteal Phase (Days 15-28)

The second half of your cycle sees your oestrogen and progesterone levels continue to increase, allowing your endometrial lining to get even thicker to support fertilisation if it occurs.

If fertilisation does take place, the egg will be fertilised in the fallopian tube, before implanting into the thickened uterine lining. Then, your body will produce human chorionic gonadotropin hormone (HCG) and more progesterone to maintain the thickened uterine lining, so the fertilised egg can successfully implant and grow.

If fertilisation doesn’t occur, the egg instead will die (at around the 22 day mark of your cycle), at which point your body realises it doesn’t need to maintain the thickened uterine lining anymore. As a result, your production of progesterone plummets, and the uterine lining begins to shed, which is the beginning of your period.

Now you understand the hormonal and physical fluctuations and changes happening in your body throughout a typical menstrual cycle, let’s get into how you can identify whether your period is healthy and normal.

What if your cycle doesn’t fit within these timeframes?

If you’re in the first few years of menstruating, don’t panic! It can often take several years for your cycle to normalise once you start having periods. Often people have longer cycles initially, which shorten and become more regular as they progress.

We also know around an eighth of women ovulate on day 14 of their cycle, which clearly tells us very few people are experiencing a cycle length of exactly 28 days. So while this may technically be the average cycle length, don’t stress if you fall a little outside of this timeframe.

However, if you’re consistently noticing your cycles are far shorter than the 28-day average, this may indicate your body is experiencing high stress, or hormonal fluctuations including excessively high oestrogen production, or inadequate progesterone production (or a combination). In fact, it’s quite common for girls who are just beginning their periods, or women entering menopause to notice their periods are shorter or lighter than “normal”, which is often down to the reduced production of oestrogen and progesterone during these life stages.

Or, if your cycle seems unusually long, you may be experiencing inadequate food or energy intake, excessive weight loss or exercise, an eating disorder, or you may not have enough body fat to sustain a healthy period. Lengthy cycles can also be owing to health conditions including endometriosis, PCOS or hypothyroidism. In some cases, hormonal birth control can lead to longer cycles too, as some contraceptives can interfere with your natural hormone production. Whatever you think might be contributing to your long cycles, it’s a good idea to book in to see your health professional for a check up, to ensure your body is healthy and feels safe enough to support optimal function and hormone production.

If you experience irregular cycles which change in length significantly month to month, this may be another sign your hormones are imbalanced, or your body isn’t functioning optimally and further investigation is needed. Sometimes, it’s down to something as simple as the fact you’ve been unwell and your body is recovering. Other times, it’s due to inadequate nutrition or excessive weight loss, or an underlying health condition. Regardless, if your cycles are really inconsistent, this falls outside of what we want to see from a “healthy” period, so it’s time to speak to your health professional to dive a little deeper.

How much bleeding is healthy?

Some women will experience light bleeding only, and others will have a heavier flow, which naturally makes it difficult to determine a “normal” or healthy bleed. Generally, we say  anything between 10-80 mL of blood and tissue loss during a period is healthy, with 35 mL being the average - or the equivalent of roughly 2-3 tablespoons across the length of your bleed.

This amount of bleeding is a good indicator that your body is producing a healthy amount of progesterone at the right point in your cycle each month to facilitate the building up of your uterine lining, allowing your body to support implantation should it happen. It’s a really good sign of healthy, well-functioning hormones.

However, if you’re bleeding excessively, soaking through several tampons or pads hourly or you’re seeing big clots in your bleeding, you should check in with a health professional to rule out any health concerns, and ensure you’re not at risk of anaemia due to blood loss.

On the other hand, if you’re barely bleeding at all, this may be a signal that your body’s hormone production is low or imbalanced, due to factors like weight loss, inadequate body fat or energy consumption, excessive exercise or stress. It’s important to address these potential causes, and to speak to a health professional if you’re concerned, as healthy and adequate hormone production is crucial for good health and optimal body function. While a very light period may seem like a good (or convenient!) thing, it’s not an indicator of ideal health, so you want to address whatever is going on for you and your body.

Is pain normal?

Over the years we’ve developed a common misconception that period pain is normal, and just “part of being a woman”, or a person with ovaries. However this is not the case at all. Excessive pain is not normal, and you don’t have to suffer in silence or accept the pain you experience each month at a certain point in your cycle.

While some discomfort, bloating and distention in your lower stomach is relatively normal, particularly right before or during your period, if you’re noticing painful cramping in your stomach, back or elsewhere, this is a signal from your body that something is off. It’s a red flag, indicating further investigation is needed to rule out conditions such as endometriosis or PCOS, which can cause painful periods. A doctor or medical professional should be able to help you identify the cause of pain, and provide advice on how best to manage and reduce your pain and symptoms moving forward. It’s important to recognise you can improve the pain you’re experiencing, so don’t accept it and continue to suffer!

Are PMS symptoms normal?

PMS, or premenstrual symptoms including headaches, bloating, cramping, digestive discomfort and nausea, normally occur around days 15-28 of a regular and healthy cycle. Some of the various symptoms which may be considered “normal” as part of a healthy cycle include:

• Bloating. Many women find themselves feeling very bloated right before their period, as your body begins to retain more water and salt than normal owing to the changing levels of oestrogen and progesterone happening internally. Bloating is one of the most common PMS symptoms and isn’t a cause for concern. It should ease within the first 2-3 days of your period.

• Acne. Breaking out in the week before your period is another normal PMS symptom, especially in “problem” areas including your jawline and chin. These spots are closely linked to hormone production, so fluctuations can trigger the onset of acne or pimples in these areas, or anywhere else on the body and face for some women too.

• Fatigue. If you notice yourself feeling exhausted or tired at the start of your period, you’re not alone, and it’s typically nothing to be concerned about. At this point in your cycle, your reproductive hormones drop dramatically (which is what triggers your bleed), meaning your body often feels extremely drained and lethargic - especially compared to the days prior when it was experiencing surging hormones and energy levels. This fluctuation can also lead to difficulty sleeping, which can contribute to fatigue even more.

• Cramping. Provided it’s not too painful or debilitating, some abdominal cramping is fairly normal. Particularly a few days before your period begins, you may experience some minor aching lasting up to several days. Some women will suffer more severe pain, however as we’ve discussed, extreme pain is not normal, and should be addressed immediately to help you get the relief you deserve.

• Headaches. The hormonal fluctuations right before your period can cause headaches in many women in the days prior to your period, or in the first few days of your bleed.

• Mood swings. Your hormones are running amok, so be kind to yourself and recognise that many women experience moodiness or heightened emotions and sensitivity in the days before their period starts. It’s perfectly normal, unless these emotions are causing debilitating anxiety, depression or other concerning symptoms.

• Breast sensitivity. Many women experience swollen, sore or aching breasts in the days prior to their period, owing to the fluctuations in progesterone production. This is again very normal as part of a healthy cycle.

• Abnormal digestion and bowel movements. While some women experience constipation and gas before (or during) their period, others will experience diarrhoea or nausea. The bowel changes can be experienced in a variety of different ways, but they’re largely a normal response to your body’s fluctuation hormones during this stage of your cycle.

If you’re experiencing symptoms outside of this list, or a severe expression of any of the above, don’t be afraid to speak up and advocate for yourself. You deserve relief and support always. Any severe symptoms can be a telltale signal from your body that something isn’t quite right or needs addressing. Pain and symptom management are available to you.

What if your period is absent?

If you haven’t had a period in a while, you may be tempted to celebrate the freedom and relief that comes with a lack of monthly bleeding, however it’s not something to be desired. After all, a healthy period is an indicator that your body is functioning as it should be, it’s getting the food and energy, rest and nourishment that it needs to feel safe to support healthy reproductive function and hormonal production. It’s a sign that you’re not stuck in a state of fight-or-flight or extreme stress, and your body’s crucial processes are working as they should be.

So, on the other hand, if your period has been absent for a few months, we refer to this as amenorrhea. Amenorrhea indicates there’s been some unwanted change to the function of your reproductive system.

There are various causes of amenorrhea, including:

• Inadequate food and energy consumption

• Excessive exercise or lack of rest and recovery

• Excessive weight loss

• High stress levels or chronic stressors

• Illness or some medications

• Disordered eating or eating disorders

• Underlying genetic or health conditions

A missing period may indicate your body doesn’t feel “safe” enough to support reproductive function. Whether low energy availability, insufficient food consumption or excessive exercise or stress is contributing to this, your body is basically stuck in “fight or flight”. This means your body feels unable to rely on the fact it will be adequately nourished, fed and cared for in the near future. As a result, it tries to conserve precious energy by “switching off” some of the less pressing functions - one of the first of which is your reproductive system and hormone production. After all, if you can’t even provide your own body with a healthy environment to support yourself, you definitely can’t support another human in the form of a growing baby. So your body responds by “pausing” your period, until you address whatever is putting your body in this high-stress state.

There are some times in a woman’s life where it may not be a concern if her period is missing, including pre-puberty, during pregnancy, or after menopause. However if you don’t fall into these categories, and your missing period persists for three months or more, it’s important to investigate further. 

Treatment for amenorrhea will depend on what’s causing the condition for you, so you may be required to lose or gain weight through diet or exercise, manage stress, reevaluate your exercise patterns, or other treatment may be needed. However most of the time it is reversible, so there’s no need to panic! Just be sure to address if your period does go missing, as it’s a sign your health isn’t quite as on track as we’d want it to be. An absent period does put you at greater risk of nutrient deficiencies, hormonal imbalances, and bone fractures or weakening, and while it may take time to restore a healthy, regular cycle, the sooner you address the cause, the more quickly you’re likely to recover.

Key things to look out for in a healthy cycle

Still confused as to which key indicators to keep an eye out for that signal you have a healthy menstrual cycle? These five signs are positive indicators your period is healthy:

1. Your menstrual cycle is regular and predictable, and occurs around every 26-35 days. The main thing is that your cycle length is consistent for you.

2. You’re not experiencing pain during your period (though slight discomfort, cramping and bloating is okay!)

3. You’re only bleeding during the period phase of your cycle, which ideally lasts for 3-8 days. The first few days should be your heaviest flow, with the latter being just a light flow or spotting. If you’re experiencing very heavy or extended bleeding or extremely light periods from start to finish, your hormones may not be functioning optimally or other health conditions and deficiencies might be at play.

4. Your bleed is crimson red in colour, with no big clots or mucus appearing in it. Large or excessive clotting can indicate stagnant blood or fluids have been sitting in your uterus or the blood flow is inadequate, which may cause pain or other complications.

5. Your premenstrual symptoms are minimal and don’t cause huge disruption to your life. If your PMS symptoms are manageable and don’t take over your body or mind in the lead up to your period, this is a good sign. However, if you’re experiencing severe pain, headaches, nausea, digestive discomfort or extreme emotions in the days prior to your period, you may have an imbalance in your hormone production or an underlying health condition.

Why is a healthy cycle and period so important?

A healthy period is a good indicator that your reproductive health and hormone production are functioning properly. It’s a signal that you’re nourishing and caring for your body well enough that all critical processes are operating as they should be. 

Having a regular, healthy cycle also means that you’re more likely to be fertile and able to conceive, should this be a priority for you. Women with regular menstrual cycles who understand the stages their body progresses through are more able to pinpoint when they’re ovulating and at their most fertile, to improve their chances of falling pregnant. Or, on the other hand, if you’re trying not to fall pregnant, it’s also a good idea to understand where you’re at in your cycle.

A healthy period signifies your hypothalamus and pituitary glands are communicating with your brain and ovaries to support your health and the functioning of your body. It reflects that your body is in “homeostasis” or balance, and that your oestrogen- progesterone- testosterone ratios are healthy. A healthy period also supports bone health, thyroid function and healthy metabolism, so as you can see it plays an important role in many aspects of your health, as well as being a good reflection of where your body is at.

If you’re concerned about an absent or abnormal cycle or period, get in touch with your health professional or contact the ETPHD team today to understand how to support healthy, functioning hormones and provide your body with the nourishment and care it needs to feel its best.