Irregular Periods

Periods are said to be irregular when there are significant changes in the length of the menstrual cycle, variations in the duration of periods, or fluctuations in the menstrual flow (bleeding).

The average length of the menstrual cycle is typically around 28 days, although a range of 21-35 days is considered normal. The duration of periods can vary among females, typically lasting 2 to 7 days. Normal menstrual bleeding ranges from 30-40 milliliters or approximately 2 to 3 tablespoons. Any abnormalities in the length, duration, or flow of periods are clinically classified as menstrual irregularities.

What are irregular periods?

Patterns of irregular periods include:

• Menstrual cycle longer than 35 days or shorter than 21 days
• Menstrual periods that last longer than 7 days
• Heavy bleeding or prolonged bleeding during menstruation
• Lighter menstrual flow than usual
• Complete absence or skipping of periods
• Unpredictable menstrual cycles
• Dysmenorrhea, characterized by painful cramps during periods, often accompanied by nausea and vomiting
• Spotting or bleeding between periods
• The need to change pads or tampons more frequently than usual.

It is important to understand that your menstrual cycle may not always be predictable, and that is perfectly normal. Slight variations in cycle length or variations in the flow of your menstrual period, such as it being slightly heavier or lighter than your previous period, are common and do not necessarily indicate a problem.

What are the types of irregular periods?

Irregular periods can manifest in various forms. Here are some common types of irregular periods:

Amenorrhea

Amenorrhea refers to the complete absence or stoppage of periods. It can be further categorized into two types:

• Primary amenorrhea: This occurs when a girl is over 16 years of age and has not yet experienced her first period. It can be caused by genetic or chromosomal abnormalities.
• Secondary amenorrhea: This refers to the absence of periods for consecutive 3 months or more in females who previously had regular menstruation. It can be attributed to various factors such as stress, pregnancy, lactation, and others.

Oligomenorrhea

Oligomenorrhea is characterized by infrequent and inconsistent periods, with a menstrual cycle longer than 35 days or having fewer than 9 periods in a year. Individuals with oligomenorrhea may also experience lighter menstrual bleeding than usual.

Polymenorrhea

Polymenorrhea involves having more frequent periods than normal. The length of the menstrual cycle is shorter than 21 days, and periods occur with greater frequency.

Menorrhagia

Menorrhagia refers to abnormally heavy or prolonged bleeding during menstruation. Females with menorrhagia may need to change pads or tampons every hour. They may also pass large blood clots, and their periods may last longer than the usual 7 days.

Metrorrhagia

Metrorrhagia is characterized by irregular or unpredictable bleeding in between periods. This bleeding can occur at any time during the menstrual cycle and may be light or heavy in nature.

What causes irregular periods?

There are various factors that can lead to irregular periods. These include underlying diseases, hormonal imbalances, side effects of medications, lifestyle, and some physiological conditions.

Physiological conditions

Pregnancy

Pregnancy itself causes complete cessation of menstruation. However, in some cases, during early pregnancy, irregular bleeding or spotting may occur, which can be mistaken for periods. Irregular bleeding during pregnancy can be attributed to hormonal fluctuations, cervical changes, implantation, ectopic pregnancy, or other underlying disorders.

It is important to note that once conception has taken place, menstruation does not occur. Irregular bleeding during pregnancy is often misinterpreted as periods by some females.

Puberty

Irregular periods are common and completely normal after the onset of menstruation during puberty. It takes time for periods to become regular and establish a specific pattern for each female. For one or two years after puberty, irregular periods may occur and gradually become more regular.

Perimenopause

Menopause typically occurs between the ages of 45 and 55. During the ten-year range leading up to menopause, known as perimenopause, periods can become irregular and inconsistent. This is a common occurrence as the body undergoes changes and the functions of the reproductive system start to decline.

Medical conditions and diseases

Hormonal imbalance

The menstrual cycle is regulated by the interplay of various hormones. The release of gonadotropin-releasing hormone (GnRH) stimulates the pituitary gland in the brain to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

These hormones act on the ovaries, promoting the development and release of an egg and triggering the production of estrogen and progesterone. These hormones, in turn, prepare the uterus for a possible pregnancy.

The coordination between the brain and the ovaries forms the brain-ovarian axis, which governs the entire menstrual cycle. This axis is also influenced by other hormones in the body, such as thyroid hormones and others. Any disruption in hormone levels can lead to irregular periods.

Hormonal imbalances can be caused by various conditions, including polycystic ovary syndrome (PCOS), hyperthyroidism or hypothyroidism, stress, obesity, intense exercise, and other factors. These conditions can impact hormone production and regulation, resulting in menstrual irregularities.

Primary ovarian insufficiency

It is also known as premature ovarian failure, a condition in which the ovaries stop functioning before the age of 40. The primary symptom of this condition is irregular menstrual periods. As the condition progresses, other symptoms may emerge, including hot flashes, night sweats, confusion, and irritability.

In primary ovarian insufficiency, the ovaries do not produce an adequate amount of hormones, particularly estrogen, leading to anovulation, missed periods, and further irregularities.

Uterine abnormalities

The uterus, as the primary organ of the female reproductive system, can be affected by structural or functional abnormalities that can disrupt the normal menstrual cycle. These uterine abnormalities include:

• Uterine polyps: These are small growths that develop from the uterine lining.
• Uterine fibroids: These are benign (noncancerous) growths that develop in the uterine wall and can interfere with its normal function.
• Uterine septum: This refers to a wall or septum that divides the uterus into two separate cavities.
• Uterine adhesions: Past surgeries, trauma, or infections can cause the growth of scar tissue within the uterus.
• Endometrial hyperplasia: This condition involves excessive growth of the inner uterine wall (endometrium).

All of these conditions can interfere with the shedding of the uterine lining during menstruation, leading to skipped or irregular periods.

Endometriosis

Endometriosis is characterized by the growth of uterine tissue outside the uterus. This abnormal presence of uterine tissue in other locations leads to the excessive production of hormones, such as prostaglandins, and disrupts the hormonal balance.

It also affects the communication between the brain and ovaries, known as the brain-ovarian axis. Endometrial lesions can cause inflammation and scarring in the pelvic area, which can affect the function of the reproductive organs and result in irregular periods.

Polycystic ovary syndrome (PCOS)

PCOS is characterized by the presence of multiple cysts in the ovaries and the abnormal production of excessive amounts of androgen, a male hormone. The increased levels of androgen can delay or prevent ovulation.

When ovulation does not occur, it can result in the absence of regular menstrual periods.

Ovarian/uterine cancer

Cancer of the ovaries or uterus disrupts the proper functioning of the reproductive system, including the menstrual cycle. Irregular periods can be one of the manifestations of ovarian or uterine cancer.

Pelvic inflammatory disease (PID)

PID is an infection of the reproductive system caused by bacteria. It leads to inflammation of the pelvis and can result in scarring, which can interfere with normal menstrual cycles.

Alongside the physical effects, PID can also cause hormonal imbalances and pelvic pain, further contributing to menstrual irregularities.

Diabetes mellitus

Uncontrolled or poorly managed diabetes can disrupt hormonal balance. In type 1 diabetes, insulin is not produced, while in type 2 diabetes, cells do not respond effectively to insulin.

These low insulin levels can disrupt the balance of other hormones, including estrogen and progesterone. Additionally, diabetes can damage nerves, including those that control the menstrual cycle.

Proper management of diabetes is essential to maintain hormonal balance and support regular menstrual cycles.

Bleeding disorders

Bleeding disorders are conditions that affect the body’s ability to form blood clots or regulate bleeding. Two main bleeding disorders that can impact menstruation are von willebrand disease and platelet function disorders.

In both conditions, clot formation is inadequate, leading to prolonged and heavier menstrual bleeding that may not stop at the normal time.

Thyroid disorders

The thyroid gland, located in the neck, produces hormones called thyroxine and triiodothyronine that regulate various bodily functions.

In hypothyroidism, there is a lack of hormone production, while in hyperthyroidism, there is excessive hormone production. Both conditions can disrupt hormonal balance and impact menstrual regularity.

Eating disorders

Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder, can have significant effects on menstrual cycles.

In anorexia nervosa, patients severely restrict their food intake, leading to weight loss and nutritional deficiencies. Bulimia nervosa involves episodes of excessive eating followed by self-induced vomiting, and binge eating disorder is characterized by consuming large quantities of food.

These disorders and associated weight fluctuations and nutritional deficiencies can disrupt the regulation and production of reproductive hormones, resulting in irregular periods. 

Medications and contraception

Hormonal contraceptives

Hormonal birth control pills contain estrogen and progesterone, or progesterone alone in the form of progestin. These synthetic hormones are administered externally to prevent pregnancy. While hormonal contraceptives are generally safe and effective, they can occasionally cause hormonal disturbances and irregular periods.

Medications

It is important to note that every medication can have side effects. Certain medications have the potential to disrupt hormonal balance and result in irregular periods. Examples of such medications include anti-psychotics, anti-epileptics, and anti-coagulants. Steroids are also known to contribute to irregular periods.

Lifestyle habits

Certain lifestyle habits can lead to hormonal imbalances that disrupt the normal menstrual cycle and result in irregular periods. These lifestyle habits include:

• Stress: High levels of stress can affect the hormonal balance in the body and contribute to irregular periods.
• Sudden weight loss/gain: Rapid changes in weight, whether through intentional or unintentional means, can disrupt hormone production and regulation, leading to irregular periods.
• Intense exercise: Excessive and intense exercise can affect hormone levels, particularly if the body fat percentage drops too low, causing irregularities in the menstrual cycle.
• Sleep disturbances: Lack of adequate sleep or disrupted sleep patterns can impact hormone production and regulation, leading to irregular periods.
• Poor diet: A diet lacking essential nutrients or an imbalance in macronutrients can affect hormone levels and disrupt the menstrual cycle.

All of these lifestyle factors can contribute to deviations from the normal menstrual cycle and ultimately cause irregular periods.

What are the adverse effects of irregular periods on the body?

Long-term irregular periods can have several possible adverse effects on the body, including:

Anemia: Irregular periods, especially those with excessive bleeding or prolonged bleeding, can lead to iron deficiency anemia. The loss of blood during irregular periods can result in fatigue, dizziness, and shortness of breath.

Infertility: Irregular periods caused by conditions such as polycystic ovary syndrome (PCOS) or hormonal imbalances can disrupt ovarian function and hinder ovulation, leading to fertility issues.

Psychosocial impact: Hormonal imbalances that underlie irregular periods can have widespread effects on other body functions, resulting in symptoms such as acne, hirsutism (excessive hair growth), low mood, anxiety, and irritability.

Osteoporosis: Estrogen plays a crucial role in regulating bone health. Hormonal imbalances or other conditions that decrease estrogen levels can lead to poor bone health and reduced bone density, increasing the risk of osteoporosis and fragile bones.

Endometrial hyperplasia: Irregular periods can sometimes contribute to the overgrowth of the uterine lining (endometrium). While endometrial hyperplasia is a noncancerous condition, it can increase the risk of developing uterine cancer.

Infrequent ovulation: Irregular periods, particularly in cases of oligomenorrhea (infrequent and inconsistent periods), may indicate infrequent ovulation. Regular menstrual cycles and the release of eggs depend on regular ovulation and the synthesis of progesterone.

How do irregular periods affect pregnancy?

Irregular periods can pose challenges when it comes to achieving pregnancy. Here are some ways in which irregular periods can affect pregnancy:

Difficulty in predicting ovulation: Irregular periods make it challenging to predict ovulation accurately, which is crucial for determining the fertility window. The unpredictable nature of irregular periods can make it difficult to estimate the optimal time for conception.

Fertility issues: Hormonal imbalances, such as those seen in conditions like polycystic ovary syndrome (PCOS), thyroid disorders, and other hormonal disorders, can disrupt the normal hormonal levels necessary for ovulation. This can result in ovarian dysfunction and irregular or halted ovulation, impacting fertility.

Reduced frequency of ovulation: Women with irregular periods may experience infrequent or irregular ovulation due to hormonal disruptions. This reduces the number of opportunities for conception throughout the year and can pose challenges for achieving pregnancy.

Higher risk of miscarriage: Some studies suggest that women with irregular periods may have an increased risk of miscarriage compared to those with regular menstrual cycles. The underlying hormonal imbalances and irregular ovulation patterns may contribute to this higher risk.

Tracking pregnancy progress: For women who become pregnant with irregular periods, estimating gestational age accurately and effectively can be challenging. The irregularity of menstrual cycles can make it difficult to determine the duration of the pregnancy and may require additional monitoring and assessments.

How to diagnose the reasons behind irregular periods?

Diagnosing the underlying reasons or causes of irregular periods requires a proper medical checkup. Your doctor will take a complete and detailed medical history, asking you about the health of your menstrual cycle, including the duration, length, and intensity of your periods. This will be followed by a physical examination to help rule out other contributing factors. Lastly, certain examinations may be advised to confirm the diagnosis. These may include:

Pelvic ultrasound: An ultrasound is a non-invasive imaging test that can detect structural abnormalities such as uterine fibroids, polyps, or ovarian cysts, which may contribute to irregular bleeding and periods.

Endometrial biopsy: During an endometrial biopsy, a small sample of tissue from the lining of the uterus is collected and examined under a microscope. This procedure helps diagnose conditions such as endometriosis and hormonal imbalances.

Hysteroscopy: Hysteroscopy is a minimally invasive procedure in which a thin, lighted tube called a hysteroscope is inserted into the uterus. This allows the healthcare provider to visualize the inside of the uterus and diagnose and treat certain causes of abnormal bleeding, such as polyps, fibroids, or other structural abnormalities.

How to manage irregular periods?

Managing irregular periods requires proper treatment of the underlying cause. Symptomatic relief can provide instant results, but addressing the underlying factors proves more beneficial.

Lifestyle changes

This involves making certain healthy modifications in daily routines, such as:

• Maintaining a healthy weight: Achieving and maintaining a healthy weight can help regulate hormone levels and improve overall menstrual health. It is important to maintain a balanced diet and engage in regular physical activity.
• Eating a well-balanced diet: Consuming a nutritious and balanced diet is essential for hormonal balance and overall health. Include a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats in your diet.
• Exercising regularly: Engaging in regular physical activity can help regulate hormone levels, reduce stress, and improve overall well-being. Choose activities that you enjoy and aim for at least 150 minutes of moderate-intensity exercise per week.
• Getting proper sleep: Adequate sleep is important for hormonal regulation and overall health. Aim for 7-9 hours of quality sleep each night and establish a consistent sleep schedule.

Hormonal therapy

Hormonal birth control methods are available in the form of pills, injections, and vaginal rings. These hormonal contraceptives help regulate the menstrual cycle and hormonal levels.

In cases where hormonal imbalances contribute to irregular periods, synthetic forms of hormones such as progestin or estradiol may be prescribed to maintain proper hormone levels in the body. However, it is important to consider the possible risks associated with hormonal therapy.

Medications

• GnRH agonists: Gonadotropin-releasing hormone agonists are given to mimic the role of natural GnRH. They stimulate the release of FSH and LH from the brain when natural GnRH release is disrupted.
• Analgesics: Acetaminophen or ibuprofen may be prescribed to relieve pain and discomfort associated with periods.
• Antibiotics: If irregular periods are due to pelvic inflammatory disease or other infectious disorders, antibiotics may be prescribed to eliminate the infection-causing microorganisms.
• Thyroid medications: In cases of hyperthyroidism or hypothyroidism, medications are given to manage thyroid disease.
• Tranexamic acid: A medication prescribed to treat heavy menstrual bleeding. It is taken in the form of a pill at the start of the menstrual period to control excessive bleeding.

Surgical treatment

In certain cases, surgical intervention may be necessary. When non-surgical treatments have failed or when specific conditions are present, certain surgical procedures may be considered. These procedures include myomectomy, dilation and curettage, endometrial ablation, and hysterectomy.

• Endometrial ablation: This surgical procedure involves the removal of the uterine lining. It is typically recommended for females who experience heavy bleeding and do not wish to have children in the future.
• Myomectomy: Myomectomy is the surgical removal of uterine fibroids or leiomyomas. It is a preferred option for women who plan to have children in the future, as it preserves the uterus while removing the overgrowths.
• Dilation and curettage (D&C): D&C involves the scraping of the uterine lining to remove excessive tissue overgrowths, fibroids, or polyps.
• Hysterectomy: Hysterectomy is considered a last resort when other procedures have failed. It involves the removal of the uterus, which leads to the cessation of menstrual periods.

How to prevent irregular periods?

Irregular periods can be managed and their occurrence minimized by adopting certain preventive measures:

• Maintaining a healthy lifestyle
• Exercising daily
• Following a balanced and nutritious diet
• Maintaining good menstrual hygiene
• Getting an adequate amount of sleep
• Reducing stress levels
• Practicing meditation.

When to seek medical advice?

Irregular periods can sometimes be considered normal, but in other cases, they may indicate an underlying disease or condition. If you notice any of the following, it is advisable to consult a healthcare professional:

• Sudden onset of irregular periods
• Periods lasting less than 21 days or longer than 35 days
• Excessive bleeding during periods or passing of blood clots
• Difficulty in conceiving or fertility concerns
• Periods that occur more frequently than usual
• Periods accompanied by symptoms such as nausea, vomiting, and severe cramps.

Menstrual Portal also offers free online consultation, regarding all your menstrual health concerns.

Frequently asked questions

Do irregular periods mean infertility?

Irregular periods do not necessarily mean infertility. In most cases, irregular periods are caused by hormonal imbalances or other underlying factors that can be addressed and treated.

However, in some cases where hormonal levels and ovarian function are significantly affected, fertility may be compromised.

Which foods are best for irregular periods?

Certain foods can help support hormonal balance and maintain good reproductive health. These include whole grains (such as wheat and rice), fruits, omega-3 fatty acids (found in fish and walnuts), lean proteins (such as beans and lentils), iron-rich foods (including red meat and green vegetables), and herbal teas.

Can folic acid regulate periods?

There is limited evidence suggesting that folic acid may have a slight impact on lengthening the menstrual cycle. However, it is important to note that folic acid is primarily known for its role in preventing neural tube defects in the developing fetus and is recommended for pregnant women.

Is it normal to miss periods for two or three months?

It is not considered normal to miss a period for two or three months, especially if you have previously had regular menstrual cycles. Missing multiple periods can indicate an underlying hormonal imbalance or other health conditions.

Are there any natural remedies that can help regulate menstrual cycles?

Yes, there are natural remedies that may help regulate menstrual cycles, such as herbal supplements, a healthy diet, and adequate sleep. However, their effectiveness can vary and it’s advisable to consult with a healthcare professional before trying any natural remedies.

Are there any alternative treatments or therapies available for managing irregular periods?

Yes, there are alternative treatments and therapies available for managing irregular periods. These can include herbal remedies, acupuncture, dietary supplements, and lifestyle modifications.