What a 'normal' period looks like, and when to seek help

It wasn't until I was diagnosed with endometriosis at 35 that I learnt the bad period pain I'd experienced for more than two decades wasn't normal.

Many of us are in the dark about what's typical and what isn't when it comes to menstruation.

"It is very difficult for women to gauge what is normal for them and normal for the general population," says Dr Phoebe Holdenson Kimura, lecturer and GP at the University of Sydney.

"And some women still find it an awkward thing to talk about."

Periods can also change throughout the years, such as before and after pregnancy, which can be confusing.

We asked Dr Holdenson Kimura and Dr Pav Nanayakkara, a gynaecologist at Jean Hailes for Women's Health, to explain what a 'normal' period looks like when it comes to flow, pain, and cycle length, and when we should to speak to our GP.

Period flow

Heavy periods are one of the most common concerns Dr Holdenson Kimura sees from patients regarding menstruation.

It's tricky for people who menstruate to know how much is 'normal' because we don't typically collect and measure our period blood.

"We say about six to eight teaspoons of blood for each period is normal … [but it's usually] getting soaked up in a tampon or pad," Dr Holdenson Kimura says.

Heavy periods can be caused by hormonal issues such as PCOS (polycystic ovarian syndrome) and perimenopause, or changes within the uterus like polyps.

Signs your period might be heavier that what is considered in the typical range can include:

• Leaking, such as bleeding through clothing or onto bedsheets
• Having to change a pad or tampon every one to two hours
• Passing clots larger than a 50-cent coin
• It's interfering with your life; for example, you are unable to leave the house, or have to modify activities because of heavy bleeding.

Heavy periods that fit any of these criteria are worth investigating, Dr Holdenson Kimura says, as people can become iron deficient or anaemic as a result.

In those cases, the person might experience feeling tired, dizzy, and light-headed, she says.

In rarer instances, heavy bleeding during or outside of a period cycle might be a sign of something more going on, explains Dr Nanayakkara.

"If that's the case, we can start to look at structural causes."

Period pain

For so long, women have been presenting to healthcare professionals and told "to put up with" period pain, says Dr Holdenson Kimura.

Thankfully she says the understanding around pain and periods has improved, where we know while some mild pain and cramping might be present, anything that impacts someone's function is not normal.

"If that pain isn't settled with some basic pain relief, like Panadol or Nurofen, and it's not just happening during your cycle, or there is pain with sex or defecation [for example], those things are a sign there could be something more going on, like endometriosis," Dr Holdenson Kimura says.

It's helpful to know, however, that women with endometriosis don't always experience any symptoms.

And like period flow, Dr Nanayakkara says pain becomes abnormal when it's impacting your life.

"If you are bedridden on the day of your period, or not able to carry out usual activities, needing to take time off work or school — then that starts to head into the abnormal range."

Period cycle

A typical period cycle is between 21 and 35 days, with the bleeding lasting between two and eight days, our experts explain.

An example of what might be abnormal for you, is when your period usually comes bang on 28 days, but one month it might be 35.

"If the cycle length is changing each month, it probably warrants a review with a doctor to make sure that there isn't a pathological reason for this." Dr Nanayakkara says.

"A variance of a few days here and there is often nothing to worry about but it's always better to err on the safer side."

If your period stops suddenly, that is also worth investigating.

"There are many causes of this problem, ranging from hormonal imbalance to structural causes to early menopause," Dr Nanayakkara says.

Barriers to seeking help, and keeping a diary

As well as the taboo around periods, misinformation and cultural beliefs can prevent people with menstruation issues seeking help.

"[Some] women might be reluctant to go on medication to reduce heaviness or even stop them altogether [depending on their beliefs]; which is a very good option for some who have endometriosis or painful periods or heavy bleeding," Dr Holdenson Kimura says.

There are also those who have been told by family or peers they need to "toughen up" when it comes to period pain, Dr Nanayakkara says.

Anyone concerned their period might be outside the "normal range" should chat to their GP or a health professional, says Dr Holdenson Kimura.

They may recommend testing such as taking bloods, a cervical screening, and ultrasound.

Both of our experts recommend keeping a period diary that records information around flow, pain, and cycle, so you can track any changes or patterns, and share those with your doctor.

This is general information only. For detailed personal advice, you should see a qualified medical practitioner who knows your medical history.