Each month women across the world have to deal with the uncomfortable effects of menstruation. Although women may only experience certain symptoms or varying degrees of conditions, it is important to recognize the characteristics of a normal menstruation cycle. The average length of a cycle is 28 days. However, “the cycle length may range from 20 to 45 days and still be considered normal.” Younger women in particular may find that their menstrual cycles are irregular the first few years. The typical menstruation period lasts from three to five days, though many women experience either shorter or longer periods. The most common characteristics associated with menstruation include: vaginal discharge, blood flow, vaginal odor, cramps, bloating, tenderness in breasts, difficulty sleeping, and moodiness.1 Although several of these symptoms are typical of PMS (i.e., premenstrual syndrome), they often persist throughout menstruation as well.
In addition to varying menstruation cycles and durations, it is normal for all women to exhibit vaginal odor, vaginal discharge, and blood flow during menstruation. Odor is strongest while perspiring and once ovulation begins and is caused when perspiration mixes with the bacteria from your skin. Wearing cotton underwear and a pantiliner, even once menstruation has ended will help to prevent vaginal odor.2
During menstruation, blood flow can be light, moderate, or heavy. By the end of menstruation approximately four tablespoons to a cup of blood will be lost. This flow, which consists of blood and tissue, occurs in various forms of reds and browns. Clotting commonly occurs as well.1 In addition to the blood flow, women also release small amounts of clear or white vaginal discharge called leukorrhea.3 This discharge may alter in color and consistency during menstruation by becoming heavier and whiter (similar to an egg white consistency). Leukorrhea is a normal element of the menstruation cycle and helps to keep the vagina clean.2 However, other types of vaginal discharge can be dangerous. Therefore, it is important to learn the difference between leukorrhea and its more dangerous cousins in an effort to prevent vaginal discharge that can be harmful in the future.
Unhealthy Vaginal Discharge
Unhealthy vaginal discharge is generally associated with bacterial infections. Although there are several forms of such infections, each is associated with an unpleasant odor, vaginal irritation, itching, and painful urination. The most common type of unhealthy vaginal discharge is bacterial vaginosis.4 This discharge can be caused by the organism Gardnerella, an anaerobic bacteria,6 which forms in the absence of oxygen. However, Gardnerella is only one of many bacteria that can be associated with bacterial vaginosis; others include Prevotella, Bacteroides, Mycoplasma, Mobiluncus. Bacterial vaginosis can be detected by clear, milky white, or gray discharge and vaginal odor. The discharge can be light or heavy. However, symptoms are worse near menstruation and after having unprotected sexual intercourse. When the vaginal fluid is mixed with semen, the odor intensifies. Although women who are not sexually active can develop bacterial vaginosis, it is more common in women who have had multiple sexual partners. Women may also be more apt to develop this condition after engaging in sexual intercourse with a new partner.4 Douching and poor feminine hygiene also increase the likelihood of developing this bacterial discharge and others. Many women who have bacterial vaginosis do not even notice the symptoms. Even in the absence of physical symptoms, however, bacterial vaginosis can be detected during a physical exam and treated with antibiotics.6
A yeast infection is another form of a bacterial infection that affects many women and is caused by the fungus Candida. In fact 75% of women will incur at least one yeast infection during their lives.2 Vaginal discharge associated with yeast infections is white with a cottage cheese consistency.6 Like bacterial vaginosis, there are several reasons one may develop a yeast infection. Hormone changes, wearing tight fitting clothing or wet bathing suits for extended periods of time, diabetes, being overweight, and the use of antibiotics seem to be linked with yeast infections. Taking antibiotics not only destroys harmful bacterial but useful bacteria as well, which disrupts the body’s balance. However, antibiotics can still be effective in treating unhealthy vaginal discharge.6 Not only are yeast infections common, but approximately five percent of women develop such infections four or more times a year.1 This condition is known as RVVC (recurrent vulvovaginal candidiasis). “Although RVVC is more common in women who have diabetes or problems with their immune systems, most women with RVVC have no underlying medical illnesses.”1 Whether a yeast infection is reoccurring or infrequent, women are encouraged to see their health care providers if an infection is suspected. Yeast infections can be cured through the use of oral pills, vaginal suppositories, and vaginal creams. Although anti-yeast creams are effective in curing yeast infections, they do not cure other types of vaginal infections.6 Additionally, some creams may weaken latex condoms and diaphragms.
Another major type of vaginal infection is trichomoniasis. Women experiencing this condition will exhibit similar symptoms found in yeast infections and bacterial vaginosis. However, vaginal discharge associated with trichomoniasis is typically yellowish green.6 Trichomoniasis is a sexually transmitted disease with an increased risk of contraction for women who have had more than one sexual partner. Men rarely exhibit symptoms, which increase the probability of reinfection for women. Like women experiencing bacterial vaginosis some women may appear asymptomatic. Therefore, taking safety precautions during sexual intercourse can reduce the risk of trichomoniasis. Both men and women can be treated with antibiotics.
The final common type of bacterial infection that affects one in five women is a urinary tract infection.4 Although vaginal discharge does not occur, irritation during urination is present. Cloudy and foul smelling urine, blood in urine, lower back pain, urinating in small amounts, and the need to urinate frequently are common symptoms of a urinary tract infection. Urinary tract infections affect both men and women but women are more likely to develop them. Due to the fact that women have a shorter urethra, bacteria can infiltrate the bladder more easily. Women are also more prone to urinary tract infections if they have had one previously, if their mothers or sisters have had one, are sexually active, or past menopause.1/6 Urinary tract infections can be treated with antibiotics after tests are taken from a health care provider.
To help ensure the prevention of many of the vaginal infections discussed above, douching and using heavily fragranced soaps and sprays are discouraged. The vaginal area should be kept clean by using mild soap outside the vaginal area. Wearing loose fitting clothing, cotton underwear, and pantiliners are encouraged. Other ways to reduce the risk of developing yeast and other bacterial infections include: practicing safe sex, wiping from the front to the back, reducing stress levels, and keeping diaphragms and medication applicators clean.6
Other Abnormal Conditions
In addition to recognizing unhealthy forms of discharge and other infections due to bacteria, there are other elements of menstruation that women should monitor. One major cause for concern is the absence of menstruation, which is also known as amenorrhea.7 Adolescent girls typically begin their first menstrual cycle between the ages of 11-16. Therefore, if a girl has not begun menstruating by the age of 16, she should consult her physician. This type of condition is known as primary amenorrhea.1 Other women experience oligomenorrhea, which is light or infrequent menstruation. This condition is more common in young girls who have recently begun menstruating.1 Secondary amenorrhea occurs when women who previously experienced normal menstrual cycles have ceased to menstruate for at least three cycles.1 Extreme weight loss due to a serious disease, stress, eating disorders, and excessive exercise are potential causes of this absence.7 Difficulties with reproductive organs and hormonal problems can also affect the menstrual cycle in this way.7
Although women experience varying degrees of symptoms, extreme levels should be recognized. If bleeding is excessively heavy (an average loss of blood is two ounces), occurring between menstruation periods, or periods are occurring too close together, a woman may be experiencing menorrhagia.1 However, it is not uncommon for young girls who have recently started the menstruation cycle to spot between periods. Extremely long periods, those lasting longer than ten days, are also characteristic of this condition. This condition is also known as DUB (i.e., dysfunctional uterine bleeding). Hormonal imbalances, fibroids and polyps could also cause these symptoms.7
Cramps, another common condition of menstruation, should only cause concern if they are frequent, severely painful, and cannot be relieved with over the counter pain medication, such as ibuprofen or aspirin.7 Dysmenorrhea, the cause of such cramping, can either be caused from very “extreme uterine muscle contractions” or other medical conditions, such as uterine fibroids and endometriosis. These extreme contractions usually begin two to three years after menstruation has started and can last up to 32-48 hours after bleeding has begun.1 Treatment for both dysmenorrhea and menorrhagia is dependent upon further investigation by a physician.
Toxic Shock Syndrome
Women should also be cognizant of any sudden or major changes in their bodies during menstruation when using tampons. TSS (i.e., toxic shock syndrome) is a rare but dangerous condition that is caused by toxins of certain types of bacteria and is associated with tampon use.5 In fact, approximately half of TSS cases are from women using tampons and teenagers and women under 30 have an increased risk of developing TSS. Other cases of TSS have also been linked to infections following surgeries, insect bites, and burns. The most common symptoms of TSS are vomiting, diarrhea, high temperature, dizziness, muscle aches, feeling faint, and a sunburn-like rash. TSS also causes a loss of blood pressure (called hypotension) which leads to dizziness, fainting, and ultimately may lead to a loss of function of the entire organ systems (gastro-intestinal, nervous, respiratory, etc.). If this condition develops, a health care professional should be contacted immediately. Additionally, it is important to choose the lowest necessary tampon absorbency level and to change the tampon every four to eight hours (or more if necessary). Alternating the use of tampons with feminine pads will help to decrease the risk of TSS.5 However, in women who are predisposed or susceptible to TSS, even the correct, conservative use of tampons is not a surefire way of preventing TSS. If you are predisposed to TSS consult your physician for more information on the best preventative methods.
Putting it All Together
After reading about these characteristics one may still be questioning whether her menstrual cycle is normal and healthy. Answering several questions will help to determine this answer. Has your cycle undergone any major changes? Although menstruation may not occur exactly on the 28th day each month (unless you are using birth control pills), it is important to fall within the range of 20-45 day cycles consistently. Are your periods extremely heavier or lighter than usual? It is common for the flow level to fluctuate during a menstrual period but it should be somewhat consistent from month to month. If you experience cramps during PMS, are they debilitating? Yes cramps can be annoying and painful but they should not prevent you from getting out of bed or participating in normal life activities each month. Finally, is your vaginal discharge and odor heavy and strong? If your discharge is clear and not overly foul outside of your ovulation and menstruation period, it is a good indication that the discharge is healthy. Considering all of these factors will assist women in determining if their menstrual cycles are normal and healthy. However, all women should actively seek to prevent vaginal discharge that is outside the norm, get regular physical examinations, and question medical professionals if concerns arise. Taking these precautions will help to promote a woman’s health.
About the Author
R.L. Fielding has been a freelance writer for 10 years, offering her expertise and skills to a variety of major organizations in the education, pharmaceuticals and healthcare, financial services, and manufacturing industries. She lives in New Jersey with her dog and two cats and enjoys rock climbing and ornamental gardening.