From the Guidelines
A normal menstrual period for a 30-year-old woman typically lasts between 3 to 7 days, with an average flow of 30-80 milliliters of blood total. The menstrual cycle generally ranges from 21 to 35 days, measured from the first day of one period to the first day of the next, with 28 days being the average 1. During a normal period, flow is usually heaviest during the first 2-3 days and then gradually becomes lighter. The blood may vary in color from bright red to dark brown, and some small clots (smaller than a quarter) are considered normal. Most women use 3-6 regular tampons or pads per day during their heaviest flow days.
If the flow is so heavy that protection needs to be changed every 1-2 hours, soaks through bedding at night, contains large clots (bigger than a quarter), or the period consistently lasts longer than 7 days, these could indicate abnormally heavy bleeding that warrants medical attention 1. These patterns are regulated by hormonal fluctuations throughout the menstrual cycle, primarily estrogen and progesterone, which control the building and shedding of the uterine lining. It's essential to note that any significant changes in menstrual patterns should be evaluated for underlying conditions, and if necessary, treated or referred for care 1.
In cases of abnormal bleeding, treatment options may include NSAIDs for short-term treatment or hormonal treatment with low-dose COCs or estrogen, depending on the woman's medical eligibility and preferences 1. Ultimately, the management of menstrual irregularities should prioritize the woman's health, comfort, and quality of life, taking into consideration the latest clinical guidelines and recommendations.
From the Research
Normal Period Flow and Length
- A normal period flow and length can vary from woman to woman, but there is no specific information provided in the studies to determine the exact flow and length for a 30-year-old woman 2, 3, 4, 5, 6.
- However, it is known that abnormal or excessive menstrual bleeding affects one-third of reproductive-aged women, and this number increases to 70% among women on direct oral anticoagulants (DOACs) 2.
- The studies focus on the treatment and prevention of heavy menstrual bleeding and pain associated with intrauterine device (IUD) use, as well as the effects of hormonal contraceptives on menstrual health 3, 4, 5, 6.
- Hormonal contraceptives are considered a well-tolerated, non-invasive, and clinically effective treatment for abnormal and prolonged uterine bleeding, heavy menstrual bleeding, painful menstruation, endometriosis, uterine fibroids, and premenstrual dysphoric disorders 6.
Factors Affecting Menstrual Bleeding
- The use of hormonal contraceptives, such as combined oral contraceptive pills (COCPs) and levonorgestrel-releasing intrauterine systems (LNG IUS), can affect menstrual bleeding patterns 3, 5.
- COCPs have been shown to reduce heavy menstrual bleeding in women with unacceptable heavy menstrual bleeding, with moderate-quality evidence suggesting a reduction from 12% to 77% compared to placebo 3.
- The LNG IUS has been shown to be more effective than COCPs in reducing menstrual blood loss, but the evidence is low-quality 3.
Treatment and Prevention of Heavy Menstrual Bleeding
- Various medical therapies, including non-steroidal anti-inflammatory drugs (NSAIDs), anti-fibrinolytics, and hormonal contraceptives, can be used to treat and prevent heavy menstrual bleeding 3, 4.
- Vitamin B1 and mefenamic acid have been shown to be effective in treating heavy menstrual bleeding associated with copper IUD use, while tolfenamic acid may prevent heavy bleeding compared to placebo 4.
- However, the evidence for these interventions is generally low-quality, and further research is needed to generate more robust evidence 4.