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The correlation between our menstrual cycles and our lifelong health is so significant that in 2006 the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) published a report called “Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign,” making women’s health symptoms our sixth vital sign, after temperature, blood pressure, heart rate, respiratory rate, and pain.

Paula Hillard, MD, of Stanford University School of Medicine, stated it beautifully, “The menstrual cycle is a window into the general health and well-being of women, and not just a reproductive event”; changes in your menstrual cycle are “the first sign that something else could be going on.”

Becoming familiar with the dance of your cycle helps you start to understand how it’s affecting your mood, energy, sleep, appetite, weight, focus, sex drive, hair, skin, even your digestion. You get a sense of what your “optimal” and normal cycles are like and discern when symptoms of imbalance are creeping in. You even start to understand those symptoms not as body betrayal, but as an innately intelligent response to changing conditions within.

First, there’s no such thing as a perfect period. You don’t have to menstruate every 28 days like clockwork to be normal, you don’t have to bleed at the full moon to be spiritually aligned, and even mild, occasional cramps or other mild symptoms can be perfectly normal. There’s a range of normal, which varies from woman to woman and by age.

If your cycle is generally within the parameters set out here, then normal is what’s normal for YOU. The big things to look for are major deviations from these parameters, big or persistent shifts from your own typical normal, and anything affecting your quality of life (work, fertility, sex, play, etc.).

Here are some questions that can help you suss out whether your hormones and cycles are happily in balance:

What is a normal menstrual cycle length?

Although some women describe their periods coming “like clockwork” every 28 days, this is the exception. Based on several long-term studies of thousands of women around the world, most women’s menstrual cycles are between 26 to 34 days.

Menstrual-cycle lengths also vary with the seasons of our life. In our teens, it’s normal for our periods to be anywhere from 23 to 90 days apart. In our reproductive years, it’s normal for them to be anywhere from 24 to 38 days apart (the average length is 29 days). And, as we edge toward menopause, our cycles can be as short as 24 days apart or go AWOL for 3 to 4 months at a time.

In addition, it’s normal for your cycle to change pattern over the course of a year, and to vary by as much as 6 days from month to month. If your cycle length, time of ovulation, or hormonal signs vary by a few days each month, and you’re not having problems with your cycle or gynecologic health, then no sweat—that’s just your normal.

What’s a normal period length?

Between 3 to 7 days.

What’s an acceptable amount of bleeding?

No more than six pads or tampons per day. The heaviest flow day is usually day two of your period, but this varies.

How about pain?

During a healthy cycle you’ll experience no more than occasional mild cramps or pelvic tension; no need for medications, hot water bottles, or other comfort measures. You will experience no more than mild breast “fullness”—but no breast pain, cysts, or cyclic lumps — and no headaches or migraines. More discomfort than this is a flag that you may have other gynecological issues, such as polycystic ovarian syndrome, or PCOS.

What about moodiness?

Mild shifts in mood, energy, sleep, cravings, and desire for social connection are normal; these should not, however, feel extreme, disruptive, or out of control to you. Again, if your cycle is linked to moods that are disrupting your life, it’s a sign that you may want to investigate further.

For more on how to use menstrual symptoms to get to the bottom of what’s going on with your hormones, cycles, and gynecologic health, check out my new book, Hormone Intelligence. There I explain all the ways you can become your own best hormone-whisperer. You don’t have to be a medical doctor to be your own best medical detective; you just need to become familiar with how your own body works. Knowing what’s normal for your own cycle is an excellent place to start.

Excerpted from Hormone Intelligence: The Complete Guide to Calming Hormone Chaos and Restoring Your Body’s Natural Blueprint for Well-Being by Aviva Romm, MD, and reprinted with permission from HarperCollins. Copyright 2021.

Aviva Romm
Aviva Romm, MD

Aviva Romm, MD is an award-winning integrative-medicine physician and herbalist with practices in West Stockbridge, Mass., and New York City. Her most recent book is Hormone Intelligence.

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