Learning From Your Menstrual Flow | with Angela Hywood

What is the colour and consistency of your period blood telling you about your health?

If you've ever been to a women's health specialist naturopath or acupuncturist, you've likely been quizzed extensively about the length, collar, and consistency of your period. Why you may wonder, are we so obsessed with your menstrual blood? Are we secretly vampires?

Keep reading to discover what your period says about your health and how to become a period whisperer.

Our periods are a great way to check in with how our bodies are doing month to month. The colour, texture and smell provide great insight into how our bodies are operating, allowing us to get more attuned and in touch with our hormones and our body’s energetics.

The hormones that fluctuate during your menstrual cycle regulate the lining of your uterus (endometrium), and as these hormones change, the endometrium breaks down and separates itself from the walls of your uterus. The blood and tissue from the breakdown and separation flow through the cervix and out through your vagina. That's when you get period blood!

The truth is, while various consistencies and shades of red are usually not pathological from a gynaecological standpoint, they can indicate an abnormality in the balance of hormones and of yin and yang in the body.

A healthy period is, on average, a cycle length between 27-34 days, with 3-5 days of moderate bleeding. Average flow should require the use of one regular pad or tampon about every 3-4 hours. Cramps, pain, clots, flooding, nausea, vomiting, PMS, headaches, bloating, and breast tenderness are abnormal and usually indicate hormonal imbalances and pelvic stagnation.

Periods should simply come and go, with no fuss, no drama, and no problems. Bright red healthy flow for 3-5 days and voila … done.

Colour: what's normal and what's not? 

“The ideal period flow colour should be crimson red, and the consistency should be pretty like what you’d see if you were bleeding from any other part of your body.”

Changes in your period blood colour are normal. Different period blood colours can tell you anything from the age of the blood to how far into your period you are. While your overall health generally affects the length of your menstrual cycle and the duration of your period, here are some reasons why period blood may vary in colour:

Bright Red to Dark Red or Dark Brown

A healthy period

A healthy blood colour ranges from bright red to darker red, depending on how new the bloodshed from the uterus is. Some people might describe their old period blood as browny black, but this can be a sign of something else (keep reading!).

Embryo implantation spotting or bleeding

Brownish pink period blood could also be spotting from an embryo implantation (pregnancy)– light bleeding that can occur in the very early stages of pregnancy, and this is called an implantation bleed. Generally, around a third of pregnant women will experience implantation bleeding.

Ovarian cysts and lochia

Lochia is natural bleeding that occurs after having a baby. It is mild-to-heavy and lasts around 6-8 weeks after birth, but you’ll know if you’ve given birth recently. This colour of period blood may also be a sign of ovarian cysts. Cysts on your ovaries can often go unnoticed, but if you’re worried or experiencing other symptoms, like pain during and after sex, or bloating of your abdomen, or crampy feelings, you should book in to see your doctor and ask for an ultrasound.

Pink to Light Pink or White

Low oestrogen levels/ low flow

You’ll most likely see pink to light pink blood at the beginning or end of your cycle, and this just means a low flow of fresh menstrual blood. If it’s the only blood you see over multiple periods, it’s a possible sign that your oestrogen levels are low. Another symptom of low oestrogen levels is vaginal dryness or a longer or shorter follicular phase. This can be a factor around the transition from peri-menopause to menopause when oestrogen will naturally lower.

Ovulatory bleeding

Outside of your regular period cycle, pink spotting can be from mid-cycle (ovulatory) bleeding, this is quite common.

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding is defined as menstrual uterine bleeding, not due to any recognisable cause and is therefore a diagnosis of exclusion. Other conditions such as uterine fibroids, endometrial polyps and systemic diseases such as reproductive cancers, should be excluded by appropriate investigations. It is very important to get it checked out by your primary gynaecologically healthcare provider, such as your GP.

Grey to Black

Older period blood

You may find yourself asking: Why is my period blood black? Similar to dark red or brown period blood, it usually means your period blood has reacted with oxygen and the majority of water in the blood has evaporated, i.e. it’s slightly older period blood that took a little longer to leave your uterus. This can indicate anaemia or poor circulation to your pelvic organ. 

Infections

Grey, yellow, green colours? This can also be a sign of an infection. Other signs of an infection include - pain, fever or unusual odour. To be on the safe side, get it checked out by your primary gynaecologically healthcare provider, such as your GP.

Miscarriage

If it’s accompanied by heavy bleeding and grey tissue, it could be a sign of a miscarriage. There are multiple reasons why you might bleed during pregnancy, so to be on the safe side, get it checked out by your primary obstetrical healthcare provider.

A Chinese Medicine Perspective at Period Flow Colours

Crimson red

The colour of the blood should ideally be crimson red. During your period, you are not only losing blood, but you are also shedding your endometrium lining.

Pale red or pink

Pale pink blood, especially with a watery consistency, indicates a deficiency, specifically of the spleen Qi.  Qi is our vital energy In Chinese medicine, the spleen is related to the digestive system and is responsible for processing the food we eat to produce Qi and blood. If the spleen is deficient, it can’t produce enough blood for a proper period, and you may experience symptoms like bloating, fatigue, and a feeling of heaviness or cramping in the legs around your period. The takeout- pale pink blood is a sign of chronic stress or burnout.  It can also mean an infection or anaemia.

You need enough density of red blood cells to make healthy blood. If your menstrual blood is watery or pink, you may have difficulty making enough red blood cells or they may not contain enough iron. Common causes of pale blood include being anaemic, eating an imbalanced diet, or poor digestion/absorption of nutrients.

From a TCM perspective, pale red blood with watery consistency usually comes from a deficiency in Spleen Qi. As the Spleen’s job is to turn nutrients from food into Qi and blood, a weak Spleen will be unable to produce enough blood for a proper period. Naturopathic and TCM fertility treatment can assist to nourish and tonify the blood to ensure the endometrial lining is thick and blood-rich in order for embryo implantation to take place for a successful pregnancy.

Bright red

Bright red blood that is thick, almost mucous-like, is usually an indication of heat (aka, think inflammation).

If your menstrual blood is bright red your body temperature may be affecting the quality of the blood. If your basal body temperatures are too high in the early part of your cycle (above 36.6 °C), your blood will tend to be brighter than normal. This may be accompanied by feeling thirsty, sore throat, yellow vaginal discharge, or pelvic pain. High body temperature also interrupts the timing of ovulation, which negatively affects your fertility.

Dark red

Dark red blood with clots indicates that there is liver Qi stagnation. The liver system is responsible for regulating the flow of Qi and blood throughout the body. Any interruption in the smooth flow of Qi can lead to stagnation symptoms around the period, especially cramps, headaches, and breast pain.  The liver is easily affected by stress, alcohol and coffee, so you may notice an appearance or increase of these symptoms during any particularly stressful months. Dark red blood can also give hints of high oestrogen, which your liver is struggling to process and eliminate.

Conversely, if your basal body temperatures are too low, your menstrual blood can take on a darker red colour. Low body temperatures can cause sluggishness in the uterine blood circulation and contraction of uterine smooth muscles hence you may experience cramps or have more blood clots. This can also be due to Liver Qi stagnation, where the smooth flow of Qi is impeded. In such cases, you may have symptoms such as PMS, breast tenderness, irritability, and the tendency to get stressed easily. Acupuncture and herbs can help to activate the Qi and blood flow, warm the meridians and dispel the cold to increase the chances of a healthy period and improved fertility.

Dark purplish red

Blood with a more purple tone and with large clots tells us that there is blood stasis. If stagnation persists over a long period, it can lead to what Chinese medicine terms "blood stasis," which usually presents as very dark, almost purplish blood with large clots. This can include conditions like endometriosis and fibroids and usually involves very intense, sharp, stabbing cramps and heavy flow.

In some cases, the blood may present as dark purplish red and usually come with large clots, intense, sharp, stabbing cramps and heavy flow. This can be seen in women with a history of fibroids, adenomyosis or endometriosis. Women with very dark menstrual blood may have difficulties with fertility and conceiving.

Consistency of Blood 

The viscosity of your blood can be important to note too, and as a rule of thumb, it's ideal if it's a bit thicker than water and flows nicely and freely.

Thick or menstrual blood with clots

Small very few clots or clumpy blood can be normal, especially when your flow is at its heaviest. If a lot of this is happening at once or your flow is heavy, it's understandable that there may be some congealed bits of thick blood and cells. This is because when blood as blood is expelled, the body releases anti-coagulates to prevent the blood from clotting so it can flow out more easily. But if your bleed is heavy, the anti-coagulates don't have enough time to work their magic, resulting in clots. They are also usually of darker colour blood, though not always.

Clots bigger than a small coin or in large quantities that you can feel as they pass can be an issue. This might be a sign of hormonal imbalance, a uterine fibroid or endometriosis.

Thin and watery period blood

This can just mean new blood flowing quickly from the uterus at the beginning of your bleed, or a light, low flow at the end of it. Fresh blood is thinner which means the anti-coagulants have done their work. But if it’s like this in the middle of your period when it’s not usually, it can also mean low oestrogen or can be a sign of anaemia. Again, being clued into how your body usually bleeds each month provides valuable context and can help you recognise when something is amiss.

Sometimes it can be indicative of malnutrition or a fallopian or ovarian tumour, if your period blood gets thinner over two or three cycles. Hormonal birth control can also cause this type of bleed.

Stringy period blood or bleed with bits of tissue

Stringiness is another type of mild tiny clotting that isn’t anything to worry about. There can also be actual tissue or part of your uterine lining coming out in your bleed.

On rare occasions, there can be something called a Decidual CasteF which is part of the mucous membrane of the uterus and can shed in small, stringy chunks or as a whole “chicken skin”-like piece in the shape of the uterus. This can be a sign of hormonal imbalance or ectopic pregnancy and is most common in women who are using hormonal birth control. Seek some further professional support if you have continued pain after this occurs.

Lastly, miscarriage tissue can sometimes be found in the period and is commonly described as grey to white. It doesn't look like a normal blood clot.

Slippery, jelly-like, or mucousy menstrual blood

Probably just because cervical mucus is mixing with the blood on its way out. No reason for alarm, especially if your period is light, the presence of cervical mucus can be enough to alter the texture or colour of your period blood.

Can naturopathy, herbs nutritional diet and acupuncture help?

So, when should you see your naturopath, functional medicine doctor or GP?

It’s important to know what is normal for your period so you can tell when something is out of the ordinary and just not right. If you’re experiencing any prolonged changes in your menstrual cycle or any of the following signs, reach out to your doctor:

• Bleeding between periods
• Significantly irregular cycles, varying in length; shorter than 24 days or longer than 38
• No period for over three months
• If you’re pregnant and notice bleeding or pain
• If you’ve experienced menopause and are bleeding again
• Unusual pain during your period

Too many women spend a lot of time ignoring the fact that they are bleeding. Even more, women don't look at or pay attention to their blood and dispose of it as quickly and discreetly as possible. Don't get me wrong, I think this is understandable given the cultural climate around menstruating that we've grown up in…. but together, we can change that!

“Our menstrual cycle is a magical complex process orchestrated by interactions between many of the body’s tissues, cells, and hormones—reflects a person’s overall health status and can be thought of as a “fifth vital sign”."

There’s so much to be learned from our bleeds, and if you can get into the habit of observing what colour and consistency your blood is each month, you’ll have a barometer for health that will become invaluable. 

You’re going to want to start having a look at your blood regularly during your cycle to see what colour and consistency it is. This is easiest when you use a pad or menstrual cup.

You can have different colours of blood throughout your bleed and it’s still totally normal. This is because the longer the period blood is exposed to oxygen once it’s been shed from the endometrium, the darker it’ll be. So the faster your uterine lining sheds, the less blood is exposed to oxygen, and the brighter red the blood will be.

The shedding of your lining is slower at the beginning of your period, and faster during the middle. So this explains why you might have a rusty red or brownish bleed in the first day or two of your period.

Hopefully, this empowers you to keep tabs on your health through your period, our magical and mystical 5^th vital sign.

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If you need some support, book a consult with Angela here, and let's start to uncover some of the reasons why you are experiencing trouble.

Love Angela

Naturopath and Founder of Floralia Wellness & Apothecary, Angela Hywood, has been specialising in women’s health, hormones and fertility for over 25 years.