Irregular Periods

Menstrual periods typically last four to seven days and occur roughly every 28 days.

Irregular menstruation is a menstrual disorder whose manifestations include irregular cycle lengths as well as metrorrhagia (vaginal bleeding between expected periods).

Primary amenorrhea is the lifelong absence of menses. This requires evaluation if menarche has not occurred by age 15. Secondary amenorrhea is characterized by cessation of previously regular menses for three months or previously irregular menses for six months. Both types warrant examination.

Irregular periods are more common among adolescents in the ages 9 to 14 and around age 50 or just before menopause. A regular menstrual cycle can be set within a year of menarche.

Irregular periods include periods that occur fewer than 21 days or more than 35 days apart, missing three or more periods in row, and menstrual flow that’s much heavier or lighter than usual.

Your period usually occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days. In fact, the average cycle length is 29 days. Lengths ranging between eight and 20 days are moderately irregular and the variation of 21 days or more is considered very irregular.

The causes of irregular menstruation vary from person  to person but the common factors are related to lifestyle, changes in hormone levels, stress, certain health conditions, medications, body weight, smoking status and more.

Other conditions that constitute “irregular menstruation” include:

• Metrorrhagia which generally refers to vaginal bleeding that occurs between the expected menstrual periods.^[15] ]
• Oligomenorrhea generally refers to infrequent menstruation; more strictly, it is menstrual periods occurring at intervals of greater than 35 days, with only four to nine periods in a year. Menstrual period patterns should have been established before the development of infrequent flow. In contrast to “irregular cycles”, the interval between one cycle and the next may be consistent but can be regarded as “irregular” compared to the cycle length of a female without oligomenorrhea.
• Polymenorrhea is the medical term for cycles with intervals of 21 days or fewer. It can be regarded as the opposite of oligomenorrhea.^[8]

Your period is considered “regular” even if it varies slightly from cycle to cycle. Examples of irregular menstruation include:

• Periods that occur fewer than 21 days or more than 35 days apart.
• Missing three or more periods in a row.
• Menstrual flow (bleeding) that’s much heavier or lighter than usual.
• Periods that last longer than seven days.
• Length of time between cycles varies by more than nine days. For example, one cycle is 28 days, the next is 37 days and the next is 29 days.
• Periods that are accompanied by severe pain, cramping, nausea or vomiting.
• Bleeding or spotting that happens between periods, after menopause or after sexual intercourse.

Your menstrual cycle may not always be predictable — and that may be OK. It’s normal to have slight variations in cycle length or have a menstrual period that seems slightly heavier or lighter in flow than your previous period. Menstrual irregularities are fairly common, and you don’t have to be able to predict your cycle to the exact day for it to be considered “normal.”

Conditions related to irregular menstruation

• Amenorrhea: A condition where your periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless you’re pregnant, breastfeeding or going through menopause (which generally occurs between ages 45 and 55). If you haven’t started menstruating by age 15 or 16 or within three years of your breasts developing, you may also have amenorrhea.
• Oligomenorrhea: A condition where your periods occur infrequently. You may go more than 35 days between periods or have six to eight periods a year.
• Abnormal uterine bleeding: Abnormal uterine bleeding is bleeding between monthly periods, prolonged bleeding or an extremely heavy period.

Symptoms and Causes

There are many causes of irregular periods, ranging from stress to more serious underlying medical conditions.

Medical conditions and irregular periods

Certain health conditions are associated with missed menstrual periods. They include:

• Endometriosis; this occurs when endometrial tissue grows outside of your uterus. The tissue often attaches itself to your ovaries or fallopian tubes. Endometriosis may cause abnormal bleeding, cramps or severe pain before and during your period.
• Pelvic inflammatory disease (PID); this is a bacterial infection that affects the female reproductive organ. It’s typically caused by an untreated sexually transmitted infection (STI). Bacteria enter your vagina and spread to your uterus and upper genital tract. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods and pelvic pain.
• Polycystic Ovary Syndrome; In polycystic ovary syndrome (PCOS), your ovaries make large amounts of androgens which are a type of hormone. This hormone prevents or delays ovulation, causing irregular periods. People with PCOS may stop menstruating completely.
• Primary Ovarian Insuffeciency; This condition occurs in women under age 40 whose ovaries don’t function as they should, causing missed or irregular periods. It can occur during treatment for cancer with chemotherapy and radiation or if you have certain autoimmune conditions.

Other causes of irregular bleeding include;

• Thyroid disorders.
• Bleeding disorders.
• Uterine or ovarian cancer.
• Lifestyle disruptions / changes such as; stress, gaining or losing a significant amount of weight, exercise routines that result in very low body fat (long-distance runners, dancers or gymnasts).
• Viruses or other illnesses.
• Pregnancy
• Breast feeding
• Birth control pills; Most birth control pills contain a combination of hormones. The pills prevent pregnancy by keeping your ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. You may have irregular or missed periods for up to six months after discontinuing birth control pills.
• Medications; like steroids and blood thinners.

• Miscarriages and ectopic pregnancies; the fertilized egg implants outside your uterus).
• Surgery, scarring or blockages in the your uterus, ovaries or fallopian tubes.

How are irregular periods diagnosed?

If you sense changes in your menstrual cycle, begin keeping records of when your periods begin and end. Note symptoms, the amount of flow or if you experience cramping, bleeding between periods or passing large clots. These are all helpful to share with your healthcare provider.

How are irregular periods treated?

The treatment for irregular periods depends on the underlying cause.

Medications are often the first treatment for irregular periods. Possible medications include, hormonal birth control, hormone therapy, pain relievers, antibiotics etc. If medication doesn’t help, your provider may recommend surgery.

Surgical treatment options depend on your condition, age and whether you want to get pregnant in the future. Surgical treatments for irregular periods include;

• Endometrial ablation;  a procedure that uses heat, cold or different types of energy to destroy the tissue that lines your uterus so you bleed less during your period. You must have a form of birth control to have this procedure. If you still wish to get pregnant in the future, you shouldn’t have this procedure.
• Myomectomy: A procedure to remove uterine fibroids, a cause of irregular bleeding.
• Uterine artery embolization; A procedure that cuts off blood supply to your uterus in order to stop uterine fibroids.
• Hysterectomy; In severe cases, surgery may be necessary to remove excess endometrial tissue growing in your pelvis or abdomen. A hysterectomy might be required as a last resort if your uterus has been severely damaged.

How can one lower their risk of having an irregular period?

• Try to maintain a healthy lifestyle by exercising moderately and eating nutritious foods. If you want to lose weight, do it gradually instead of turning to diets that drastically limit your calorie and food intake.
• Make sure you get enough rest.
• Practice stress reduction and relaxation techniques.
• Cut back on prolonged or intense exercise routines.
• Use birth control pills or other contraceptive methods as directed.
• See your gynecologist whenever required and have regular check-ups.

Contact a healthcare provider if you have painful or irregular periods and any of the following symptoms:

• Severe pain (cramping) during your period or between periods.
• Unusually heavy bleeding (soaking through a sanitary pad or tampon every hour for two to three hours) or passing large clots.
• Foul-smelling vaginal discharge.
• A period lasting longer than seven days.
• Vaginal bleeding or spotting between periods or after you’ve gone through menopause.
• Periods that become very irregular after you’ve had regular menstrual cycles.
• Nausea or vomiting during your period.
• Symptoms of toxic shock syndrome (TSS), such as fever, vomiting, diarrhea, fainting or dizziness.
• You should also see your provider if you think you might be pregnant.

Additional Common Questions

Is it normal to miss a period for two months?

Skipping one or two periods isn’t ideal, but it’s not too concerning. Take a look at any changes in your life recently. Things like stress, a new workout routine, losing or gaining weight, or changing birth control can all impact your cycle. Call your healthcare provider if you miss your period for three or more months in a row or if you experience other unusual symptoms during your next period.

How much delay in periods is normal?

Slight delays in your period are typically OK. Some people are able to predict their period to the exact day, while others can’t. Contact your provider if you notice a sudden change in the time between cycles or the duration (days) of your period, especially if it’s significant. This doesn’t always indicate a problem, but it’s a good idea to get it checked out.

Should I be worried if my period is irregular?

Irregular periods may be nothing to worry about because some variation in menstruation is normal. What’s normal for you may be different from what’s normal for your closest friends. However, certain symptoms could be a sign of a bigger problem.

Contact your gynecologist if you’re concerned about your menstrual cycle or if you’re trying to get pregnant and have unpredictable periods (this can make getting pregnant difficult). They’ll be able to tell you what’s normal and if treatment is needed.

Most causes of irregular periods aren’t serious and are treatable with medication by your healthcare provider. Keep in mind that slight variations between cycles or in the duration of your period usually aren’t a cause for worry. Everyone’s “normal” is different. If you sense something is off with your menstrual period, write down what’s changed and your symptoms so you can talk to your provider.

Menstrual patterns can be an indicator of overall health and self-perception of well-being.