Blog of the Society for Menstrual Cycle Research

Menstrual Variations…

September 13th, 2012 by Heather Dillaway

To follow Alexandra Jacoby’s recent post about talking more about menstruation (especially about the things we’re not allowed to talk about), I’m finally going to write about something that has been bothering me for a long time. Here it is:

Why don’t we talk about the important variations in our menstrual cycles?

In puberty our periods are all over the place, sometimes light, sometimes heavy, sometimes crampy, sometimes not.

If we have babies and have vaginal birth, we can bleed on and off for over a month and it’s totally normal.

Even in a normal month, we can have spotting for a day in the middle of the month.

Sometimes our periods are shorter or longer than normal, seemingly for no reason. (Although there’s probably always a reason.)

Then you hit your late 30s and – boom! – your periods might get heavier, or come faster. I was at lunch the other day with a friend and we started talking about the “late 30s gush” (her phrase, I can’t take credit). How come nobody talks about that when it’s totally normal?

As you age, it’s normal for periods to get shorter or longer or heavier or lighter, and even to come at different times than they did before.

Some women have terrible cramps and PMS, some don’t have any pain or bloating or other signs.

Some women who use hormonal birth control methods (e.g., the Pill, the Patch, Depo, etc.) don’t even know what their “normal” periods would be like and, rather, get used to whatever normal is on that method. Some menopausal women don’t even know they’re officially menopausal since they’re still on birth control or another hormone therapy (thus, don’t know whether they would have had their last menstrual cycle by now).

What we think of as a “heavy” period in puberty is different from a “heavy” period in young adulthood or midlife. Our definition of “heavy bleeding” changes as we experience the variations in our own menstrual cycles.

Some people are comfortable with pads, some with tampons, and some with menstrual cups. Some use a combination of all three. All of us switch what we use across our life course.

The meanings of monthly menstruation are variable too. If you’re trying not to conceive, it is welcome. If you’re trying to conceive, it’s unwelcome. If you’re not thinking about fertility at all, you could be indifferent, positive or negative about your period when it comes. If you have a disability or you are older or younger you might feel very different about menstruation. Perhaps your culture allows you to rest during menstruation and that could be good or bad for you. Perhaps you hide it, perhaps you don’t, perhaps you don’t want it on vacation but you do want it before vacation. Perhaps you do want your heavy days on the weekend, perhaps they come in the middle of the week (or vice versa). Bottom line, every month we could all feel differently about it.
Some people hit menopause in the early 40s, some not until their late 50s or even early 60s. Yet still totally normal.

Even if you have a partial hysterectomy, you could still get signs of your monthly cycle even if you aren’t officially bleeding.

And our own “normal” (what we are accustomed to) inevitably changes as we go through our life course, and we are often caught off guard by the menstrual experiences we have (as Alexandra discusses in the blog post I mention above).

How come we don’t have more conversation about this, when ultimately it would help all of us?

About a year ago I was talking to my own nurse practitioner about this and she admitted it would have been helpful for her to know what variations to expect in her own cycle. She, too, would have like to know about how menstruation would vary over her life.

So, who wants to talk to me about menstrual variations? Who’s ready? I’m ready…

  

9 Responses to “Menstrual Variations…”

  1. Laura Wershler says:

    Great subject, Heather. It strongly supports what I HAVE been talking about for 30 years, the value of learning to observe, chart and interpret my own menstrual cycle events. Imagine if we taught all girls to chart their cycles from menarche on. If all women charted, we would find more women talking about their cycles, sharing stories and experiences. Trading tips on how to manage heavy bleeding. Charting shows patterns, informs the changes we experience, and can help identify problems that often have solutions.

    I agree that there is a broad range of normal, but some menstrual cycle happenings are telling us that things may not be completely normal. Long, irregular cycles may be caused by low thyroid function. Anovulatory cycles, apparent to those who chart, are not good for our bones. Heavy bleeding may mean too much estrogen and not enough progesterone, with potential ill effect to our health. The more we talk about what’s normal for us, the more we will come to realize that menstrual cycle awareness and knowledge – body literacy – has much to contribute to our overall health and wellness.

    • HeatherD says:

      You’re right, Laura, that it’s pretty hard to know what “normal” is even for yourself if you don’t spend time tracking it. I think, though, that it’s also hard to figure out what’s “abnormal” even for ourselves, especially once we know that some variations ARE normal….

  2. What we are really lacking are population-based data from randomly chosen women within a general whole population. Then we could say we know what is normal for a population. We do have publications on a few studies of population-based women’s menstrual cycle experiences and these women are of different ages. However, all of this information is only at one point in time.

    However, we don’t have, with those randomly sampled women, documentation of what changes occur over their lives. For that we need prospectively collected information. To the best of my knowledge there are no scientific publications on that. Only with that collected-over-time data can we really say what are the normal changes in cycles for women across their lives.

    Once we start asking questions we quickly realize how what we know is biased by our own and the experiences of those with whom we dare talk about periods and flow and cramps. And how little we know that is really based on scientific study.

    The Canadian Multicentre Osteoporosis Study, thanks to questions added by epidemiologist, Nancy Kreiger and myself, has collected information about women’s cycles from about 500 initially premenopausal women at baseline, five and 10 years. Those data have not yet been analyzed–I have permission to do this analysis but need funding and a Masters or PhD student to work with me on them. Anyone interested?

    • HeatherD says:

      I would love to know how my life course matches up with others over time, and how to assess mine based on some baseline. The data you have sound amazing. I’d be happy to try to round up a grad student…

  3. That would be fantastic HeatherD.
    Whoever applies to do this analysis needs to have very good database and statistical analysis skills and some appreciation of epidemiological methods.
    For the first time in many years I have some hope to see these data tell us important new information for women.
    Jerilynn

  4. Laura Wershler says:

    This would be a fantastic collaboration with a worthwhile outcome. Hope it comes to fruition.

  5. Alexandra says:

    Heather,

    You’ve totally inspired me.
    Totally!

    I’m ready to talk variations.

    Of course, this means I must start paying systematic attention! in order to recognize my normals.

    -Alexandra

  6. Paula Derry says:

    I think that the work of the Tremin research project should be more widely known. The Tremin research project, headed for many years by SMCR’s own Ann Voda and Phyllis Mansfield, has been in continuous existence since the 1930s collecting prospective data on the menstrual cycle. Tremin has documented that that the cycle varies a great deal between women and within a woman over time, in terms of regularity, patterning, etc., of cycles throughout the lifespan. For example, Tremin showed that although postmenopausal women are often told they should absolutely never menstruate again, in 5-10% of the population this does occur for no apparent pathological reason. Most of the data was epidemiological, but a set of papers first-authored by Linda Kittell was qualitative, documenting bleeding and other experiences during the menopausal transition. Ann Voda also discusses patterning during this time of life in her book “Menopause, Me and You.”

  7. Unfortunately, for the most part (there were some urinary hormone studies in latter years) Tremin only has cycle interval data and nothing about ovulation. It is ovulation that is the most variable part of women’s cycles. And that is hard, yes VERY HARD to study over the longer term.

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