Menstrual bleeding patterns among regularly menstruating women

Am J Epidemiol. 2012 Mar 15;175(6):536-45. doi: 10.1093/aje/kwr356. Epub 2012 Feb 20.


Menstrual bleeding patterns are considered relevant indicators of reproductive health, though few studies have evaluated patterns among regularly menstruating premenopausal women. The authors evaluated self-reported bleeding patterns, incidence of spotting, and associations with reproductive hormones among 201 women in the BioCycle Study (2005-2007) with 2 consecutive cycles. Bleeding patterns were assessed by using daily questionnaires and pictograms. Marginal structural models were used to evaluate associations between endogenous hormone concentrations and subsequent total reported blood loss and bleeding length by weighted linear mixed-effects models and weighted parametric survival analysis models. Women bled for a median of 5 days (standard deviation: 1.5) during menstruation, with heavier bleeding during the first 3 days. Only 4.8% of women experienced midcycle bleeding. Increased levels of follicle-stimulating hormone (β = 0.20, 95% confidence interval: 0.13, 0.27) and progesterone (β = 0.06, 95% confidence interval: 0.03, 0.09) throughout the cycle were associated with heavier menstrual bleeding, and higher follicle-stimulating hormone levels were associated with longer menses. Bleeding duration and volume were reduced after anovulatory compared with ovulatory cycles (geometric mean blood loss: 29.6 vs. 47.2 mL; P = 0.07). Study findings suggest that detailed characterizations of bleeding patterns may provide more insight than previously thought as noninvasive markers for endocrine status in a given cycle.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Adolescent
  • Adult
  • Estradiol / blood
  • Female
  • Follicle Stimulating Hormone / blood*
  • Health Surveys
  • Humans
  • Linear Models
  • Luteinizing Hormone / blood*
  • Menstrual Cycle / blood*
  • Menstrual Cycle / physiology
  • Menstruation / physiology*
  • Metrorrhagia
  • Models, Statistical
  • Ovulation / blood
  • Ovulation / physiology
  • Ovulation Detection
  • Progesterone / blood*
  • Prospective Studies
  • Self Report
  • Young Adult


  • Progesterone
  • Estradiol
  • Luteinizing Hormone
  • Follicle Stimulating Hormone