Vaginal discharge and menstrual bleeding are natural body processes in women. These secretions can directly be an indicator of female health. While these secretions and discharge are primarily normal, sometimes, these can be abnormal and cause various health problems. In this article, we will focus on vaginal and menstrual discharge, what is considered normal, and what may be a reason for concern.
Vaginal Discharge and its Implications
Vaginal discharge is a normal, physiological process that helps to keep the vagina clean, maintain pH, and free from infection.1 The amount and type of discharge varies from one woman to another and changes throughout the menstrual cycle. During ovulation, for example, the amount of discharge may increase and become more stringy.
Types of Vaginal Discharge 2
|Clear and stretchy||Resembles raw egg whites; indicates ovulation and fertility||Normal|
|White and thick||• Thick, white discharge without a strong odor
• Can occur at various points in the menstrual cycle, especially the Luteal phase
|Milky or creamy||• May occur during different phases of the menstrual cycle
• If accompanied by itching, burning, or a strong odor, it may suggest a yeast infection
|Normal (unless accompanied by symptoms|
|Yellow or green||• Unusual colors may indicate infection, particularly if accompanied by a foul odor||Abnormal|
|Brown or bloody||• Brown or bloody discharge; can occur at the beginning or end of the menstrual period
• Could be spotting between periods
• If persistent, heavy, or accompanied by other symptoms, medical attention is recommended
|Normal (unless persistent, heavy, or accompanied by other symptoms)|
|Grey||Indicates bacterial infection||Abnormal|
|Frothy or foamy||• Maybe a sign of trichomoniasis, a sexually transmitted infection caused by a parasite; medical attention is necessary||Abnormal|
How to track Cervical Mucus and basal body temperature to identify the phases of the menstrual cycle?
- Vaginal discharge from the Cervical Mucus can be observed daily based on the mucus stretch, colour and sensation 3. The variation throughout the cycle can be used to track the phases of the menstrual cycle.
- Just after the periods, during the early follicular phase, it is dry and hardly any mucus is observed. As you approach the late part of the follicular phase, a damp feeling may be present and can be observed on the underwear, but no mucus is seen.
- As a female approaches ovulation, clear, stretchy mucus secretion resembling raw egg white maybe be observed on the underwear or the tissue after using the washroom. This also coincides with the increase in basal body temperature 4 (lowest body temperature reached during rest, typically measured in the morning after waking up).
- Later, during the luteal phase, the cervical mucus becomes creamy, milky and less noticeable closer to menstruation.
- These key features can be used to monitor the menstrual cycle in female athletes with regular menstrual cycle.
How can this knowledge help female athletes?
- Tracking vaginal discharge can help detect any infections in the reproductive tract very early on and get timely treatment. This can help in avoiding missing training days and any dip in performance due to infections.
- Cervical Mucus can be monitored via vaginal discharge and recorded. This serves as a cost-effective way to track the phases of the menstrual cycle when combines with monitoring basal body temperature. This knowledge can be used to tailor the training according to the menstrual cycle for better adaptations, recovery and to prevent injuries.
Menstrual bleeding is the shedding of the uterine lining that occurs once a month in response to hormonal changes. The amount of blood loss can vary from one woman to another. Some women may experience heavier bleeding than others. The menstrual flow and color can be an indicator of health.
Different Menstrual Bleeding Patterns 5
|Type of Menstrual Bleeding||Description||Normal/Abnormal|
|Light Flow||Normal hormonal fluctuations, stress, and low body weight can cause light flow.||Normal|
|Heavy Flow||Average blood flow over four to five days, with a blood loss of about 40 ml (3 tablespoons) is seen. In some women, it can be up to 5 tablespoons.||Normal|
|Prolonged Bleeding||When periods last longer than seven days or when more blood than usual is lost||Abnormal; Should seek medical attention|
|Mid-cycle Spotting||Spotting during Ovulation is considered normal. In any other case, it is advisable to seek medical help. *Note||Normal|
|Small Clots||Small clots, usually around the size of a quarter or smaller, are generally considered normal.||Normal|
|Large Clots with abnormal symptoms||If the clots are excessively large, occur frequently, or are accompanied by severe pain, it is advisable to consult a healthcare professional.||Abnormal; Should seek medical help|
*Note– Spotting is light bleeding outside of regular period and can be identified by seeing small spots or stains of pink, brown, or red color on the underwear or toilet paper. It is generally seen mid-cycle during ovulation in some women as the estrogen level peaks and can last for upto 1-3 days. In case you experience a heavy bleeding or prolonged bleeding between periods, it could be due to an underlying problem (PCOS, endometriosis, hormonal imbalance, cysts and fibroids in the uterus), so consult a gynacologist.
It’s important for female athletes to keep track of their menstrual discharge. Vaginal and menstrual discharge can serve as an easy indicator of female health and can be a simple yet effective tool.
- Bishop GB. Vaginal Discharge. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 172. Available from: https://www.ncbi.nlm.nih.gov/books/NBK281/
- Thijssen, A., Meier, A., Panis, K., & Ombelet, W. (2014). ‘Fertility Awareness-Based Methods’ and Subfertility: a systematic review. Facts, views & vision in ObGyn, 6(3), 113–123. https://pubmed.ncbi.nlm.nih.gov/25374654
- Najmabadi, S., Schliep, K. C., Simonsen, S. E., Porucznik, C. A., Egger, M. J., & Stanford, J. B. (2021). Cervical mucus patterns and the fertile window in women without known subfertility: a pooled analysis of three cohorts. Human reproduction (Oxford, England), 36(7), 1784–1795. https://doi.org/10.1093/humrep/deab049
- Leader, A., Wiseman, D., & Taylor, P. J. (1985). The prediction of ovulation: a comparison of the basal body temperature graph, cervical mucus score, and real-time pelvic ultrasonography. Fertility and sterility, 43(3), 385–388. https://doi.org/10.1016/s0015-0282(16)48436-0
- Dasharathy, S. S., Mumford, S. L., Pollack, A. Z., Perkins, N. J., Mattison, D. R., Wactawski-Wende, J., & Schisterman, E. F. (2012). Menstrual bleeding patterns among regularly menstruating women. American Journal of Epidemiology, 175(6), 536–545. https://doi.org/10.1093/aje/kwr356
I am Vedashree Bhat. I am in the second year of my MSc in Sports Nutrition. I am really intrigued by the connection between Biochemistry, Physiology, and Nutrition. I love exploring how these areas interact and impact our health. My aim is to take all the research and scientific knowledge and turn it into practical advice that anyone can use to improve their well-being and performance through nutrition.