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Because menstrual patterns vary greatly from woman to woman and there is no strict definition of a "perfect menstruation", it can be hard to determine whether your menstrual flow is abnormally heavy, abnormally long, contains too much tissue, or has an abnormal color. 

In order to help you determine whether your menstrual flow is physiological or pathological, and whether you should see a doctor, here is a checklist to help you. 

Cycle Length

You may have a regular flow, but if it comes with an interval of more than 38 days, it is abnormal. If the interval between two cycles is less than 24 days, it also needs an evaluation.

Cycle Regularity 

Minor variations are common and acceptable, but a grossly irregular cycle means there is a problem with ovulation. Hormonal imbalances due to polycystic ovaries or thyroid disorders along with adolescence and the perimenopause could be responsible for this. A variation of more than 20 days within a phase of 90 days is considered to be abnormal and needs evaluation.

Flow Duration

A normal menstrual period should last between three and eight days. Flow that lasts more than eight days is considered abnormal. A longer flow duration is associated with hormonal disturbances, uterine fibroids, polycystic ovaries or other complicated pathologies. Likewise, if your cycle length is on average less than three days, it also requires an in depth assessment.

Flow Amount 

Excess flow could lead to weakness and anemia. But how do you know that your flow is too heavy?

You can assess it by counting the number of sanitary pads used. Do you have to change more than one pad within one hour? Do you use more than five pads in a day? Or is there any passage of large clots or a need to change the pads at night? Then your flow is heavy and you need a medical checkup. Likewise, scanty flow also could be due to thyroid disorders or tuberculosis. You may need an endometrial biopsy, a hormonal function evaluation and an ultrasonography of the lower abdomen when you have an abnormal flow pattern.

Flow Consistency 

Like everything else, the consistency of menstrual flow varies from each woman to woman. Normally it is blood-stained discharge on day one, gradually becomes bright red on day two to three and then onwards becomes a pale in color before stopping. The passage of one or two small blood clots is not unusual. But large clots [> 1 inch] in all cycles denote your cycle is heavy and needs an evaluation.

Bleeding In Between Periods

Bleeding in the intermenstrual period, bleeding after sex or continuous spotting are always considered abnormal. There could be infections, erosions or polyps and even cancers of the cervix. You need an urgent checkup and a local examination to rule out any polyp or cancerous lesions.

Pain During Menstruation

Painful menstruation is termed dysmenorrhoea and it is quite common among young girls. Simple analgesics can reduce this pain and in some instances contraceptive pills work wonders. But the appearance of dysmenorrhoea in women who are beyond adolescence could be due to a large uterus, fibroids or ovarian tumors. A clinical examination and an ultrasound are needed for the evaluation of dysmenorrhoea in adult women.

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