The average amount of blood lost is from six to ten ounces, but it varies greatly among women who are otherwise normal and in good health. Some women regularly lose what seems to be an alarming quantity of blood at each period without suffering any apparent ill effect. Others lose so little that they are scarcely aware of their menses.
As a rule the menstrual flow is more profuse among women in warm climates than in cold regions. English women, for example, frequently menstruate profusely while in India, and upon their return to England note a marked decrease in the amount of the discharge. The same is often true of American women who move from Southern to Northern states, while removal from a low to a high altitude usually results in a more profuse flow.
The quantity of the menstrual discharge is affected also by diet, living conditions and by any form of mental or physical excitement or stimulation.
Accordingly, the highly strung, richly nourished women living in luxurious circumstances are likely to menstruate more freely than those less favored who are overworked and poorly nourished.
A shock or great grief, or any great emotional experience; a sea voyage or a long railroad journey may bring on a period before it is due, while the regularity of the periods may be much disturbed, temporarily, by a marked change of climate or altitude, a serious illness or a decided change in one’s daily régime.
The function may be entirely suspended for several months or a year in women who suddenly take up hard work or violent exercise, and persist with it regularly. In such cases the periods gradually recur and finally become normal and regular.
The menstrual period is frequently attended by evidences of marked mental and physical disturbances. While many women are fortunate enough to suffer little or no inconvenience during menstruation, the vast majority are more or less wretched and miserable at this time, although in good health in all other respects. Many are tired, have less endurance than usual and are likely to take cold easily. Headaches with a sense of fullness, dizziness, and heaviness are common accompaniments. Backache is a frequent source of discomfort, while abdominal pain, varying from an uncomfortable sense of dragging heaviness to almost unendurable agony, is the rule rather than the exception. And there may be pain in the hips and thighs as well.
This state of wretchedness is sometimes increased by a loss of appetite, nausea and even vomiting. At the same time there are changes in the breasts which are much the same as, though slighter than, those occurring during pregnancy. They are firmer, may be somewhat increased in size, and many women experience a burning, tingling sensation, soreness and even pain. The nipples are turgid and prominent and the pigmented areas grow darker for the time being.
The skin over the rest of the body sometimes changes in appearance and pimples are common; some women are pale and others are flushed during their periods.
These physical disturbances accompanying menstruation vary so widely in different women, and in the same women at different times and under different conditions, that it is not possible to draw a classical picture of the condition. But all of the symptoms above described will persist with more or less severity throughout the entire menstrual life of one woman, while perhaps only one or two of them will occasionally disturb another. Whatever discomfort there may be usually begins from one day to a week before the discharge appears; is at its height during the following day and from that time subsides steadily, until the normally comfortable state is regained. In fact, many women feel better at the end of their periods and during the days immediately following than at any other time during the cycle.