Guide to tracking and monitoring your periods

Monitoring your menstrual cycle not only helps you learn what is normal for your body but also identifies any abnormalities (unusual bleeding, heavier flow, pain severity etc) which you can discuss with your doctor to determine if any treatment is required. Main things to look out for:

1. Length: the length of your period cycle (menstrual cycle):

   1. Count from the first day of your period to the day before your next period starts.
   2. Average length is 28 days but the cycle can range from 21 days to 35 days, it’s different from person to person.
   3. Number of days in your cycle may also vary from month to month
   4. During your period (bleed), it’s normal to bleed from between 2 and 7 days.
   5. Women on average lose about 20 to 90 ml of blood during a period.
   6. Girls start their periods at the average age of 12. However, girls can start their period from age 8 upwards and as late as 16 years old.
   7. Women stop menstruating at menopause which occurs around the age of 51. You’ve reached menopause when you haven’t had a period in one year.

2. Colour: blood that stays in the uterus and vagina will react to oxygen (oxdizie). The longer the blood stays inside and oxidizes the darker it gets. Light blood loss either during or in between periods is called spotting. Spotting can be of any colour and may have different meaning based on the colour.

   Period Blood Colours Explained

   Normal colours seen in period blood are:

   1. Bright Red blood: indicates fresh blood and a steady flow. Blood passes out of your body at a faster rate and has less time to oxidize and go darker Some women may experience bright red colour throughout their period but in most cases the blood goes from bright red to a darker colour during the period cycle.

   2. Pink blood: Common during the beginning or end of your period when the bleeding is lighter. Pink vaginal discharge could be a sign of low estrogen levels or sign of perimenopause. Significant weight loss or unhealthy diet could lead to pink blood during other phases of your cycle. Pink blood could also be a sign of anemia due low iron levels as iron gives the blood its red colour.

   3. Black blood: Can appear at the start or end of a period cycle. Usually is old blood that has taken longer to leave the uterus or vagina and has had more time to oxidize. Older blood from the deeper parts of the uterine line is shed later.

      Blockage in vagina: May also be a sign that a foreign object such as a second tampon, contraceptive device, sex toys etc is still stuck and forgotten in your vagina. See your physician if you experience one or more of the additional symptoms along with your black blood:

      1. Foul smelling discharge
      2. Itching or swelling or discomfort in or around the vagina
      3. Fever
      4. Trouble urinating

   4. Dark Red/Brown blood: Similar to black blood, dark red or brown is a sign of old blood appearing at the beginning or end of a period cycle. Brown blood or spotting can sometimes be early sign of pregnancy Brown blood is common in the weeks after you give birth, postpartum vaginal discharge called lochia contains a mix of blood, mucus and uterine tissue. Lochia is heavy at first but gradually subsides until it goes away.

   5. Orange blood: Blood that mixes with cervical fluid appears orange in colour. Orange blood could also be a sign infection like bacterial vaginosis or a sexually transmitted infection such as trichomoniasis which is caused by a parasite. If you have orange blood along with other symptoms such as vaginal itching, foul smelling discharge or discomfort, consult a doctor

   6. Grey Blood: is usually a sign of infection like bacterial vaginosis and the colour may be harder to identify. So if you think it could be bacterial vaginosis look out for other possible symptoms such as

      1. Itching in and around the vagina
      2. Foul smelling vaginal odour
      3. Burning sensation while you pee
      4. Bacterial vaginosis is usually treated with antibiotics, so it is important you consult a doctor.
      5. If you see grey discharges containing clots during pregnancy then that could be a symptom of miscarriage.

3. Frequency: periods are not always regular every month for each woman. Factors such hormonal fluctuations, food, stress, birth control etc can affect the menstrual cycle

   1. Fluctuation by a couple of days each month is considered normal However, variance average of over 7 days over a 12 month period is irregular
   2. Fewer than 9 periods in a year is considered irregular
   3. If you had regular periods but no period for 3 consecutive months and aren’t pregnant it could mean you have secondary Amenorrhea

4. Amount of bleeding:

   1. On average 20 ml to 90ml (1-5 tablespoons) of menstrual blood discharge is normal
   2. Lower than 20 ml (only needing light/medium tampons for 2-3 days) or thin and watery consistency could be a sign of hormonal imbalance. Consult your doctor
   3. Higher than 90ml or bleeding lasting that 7 days could be a sign of menorrhagia (Heavy Menstrual Bleeding). “Heavy” bleeding can be indicated by the necessity to change tampons or pads after less than 2 hours or if you pass clots that are the size of a quarter or larger. Untreated menorrhagia can cause anaemia, therefore consult a doctor.

5. Pain:

   1. Mild cramping and discomfort is normal.
   2. Many women have painful periods also called dysmenorrhea.
   3. Menstrual cramps (dysmenorrhea) is a throbbing pain or cramping pain in the lower abdomen just before and during your period.
      1. Pain starts 1-3 days before your period, peaks 24 hours after the onset of your period and subsides in 2-3 days.
      2. Pain can radiate to your lower back and thighs
   4. To help ease period can you can try:
      1. Exercise increases hormones like progesterone and dopamine that diminish pain. Try including cardio and strength training or even do some gentle exercises such as yoga and meditation.
      2. Using a hot water bottle or heating pad on your lower abdomen. You can make your own heating pads
      3. Take a hot bath or use a hot towel.
      4. Reduce stress
      5. Having an orgasm
      6. Drinking enough water, especially hot water.
      7. Avoid caffeine,salty, fatty foods, carbonated beverages and sugar
      8. Drinking chamomile tea and other hot liquids
      9. Increase magnesium in your diet.
      10. Getting an abdominal, side and back massage and aromatherapy.
      11. Use scented candles at home
      12. Acupuncture may help relax the nervous system

If you are in severe pain and have very heavy bleeding please see a doctor.