Causes and Treatment of Irregular Period

Menstrual periods typically last four to seven days and occur roughly every 28 days. Irregular periods are characterized by cycles that are shorter than 21 days or longer than 35 days, missing three or more periods in a row, or having menstrual flow that is significantly heavier or lighter than usual.

Overview

What are irregular periods?

Most women and people assigned female at birth (AFAB) have menstrual periods that last four to seven days, typically occurring every 28 days. However, normal cycles can range from 21 to 35 days, with the average being 29 days. Irregular periods (or irregular menstruation) can be caused by hormonal changes, stress, certain health conditions, medications, and other factors.

Examples of irregular periods include:

Periods occurring fewer than 21 days or more than 35 days apart.
Missing three or more periods in a row.
Menstrual flow that is much heavier or lighter than usual.
Periods lasting longer than seven days.
Cycle lengths varying by more than nine days (e.g., one cycle is 28 days, the next is 37 days, and the next is 29 days).
Periods accompanied by severe pain, cramping, nausea, or vomiting.
Bleeding or spotting between periods, after menopause, or after sexual intercourse.
Soaking through one or more tampons or sanitary pads in an hour.

Slight variations in cycle length and flow are normal and do not necessarily indicate a problem.

Conditions Related to Irregular Menstruation

Amenorrhea: Absence of periods for 90 days or more, unless due to pregnancy, breastfeeding, or menopause. It also includes not starting menstruation by age 15 or 16, or within three years of breast development.

Oligomenorrhea: Infrequent periods, occurring more than 35 days apart or only six to eight times a year.

Dysmenorrhea: Painful periods with severe cramps.

Abnormal Uterine Bleeding: Bleeding between periods, prolonged bleeding, or very heavy periods.

Symptoms and Causes

What causes irregular periods?

Irregular periods can result from various factors, including:

Medical Conditions:

Endometriosis: Endometrial tissue grows outside the uterus, causing abnormal bleeding and pain.
Pelvic Inflammatory Disease (PID): A bacterial infection of the reproductive system, often due to untreated STIs.
Polycystic Ovary Syndrome (PCOS): High levels of androgens prevent or delay ovulation, causing irregular periods.
Primary Ovarian Insufficiency: Ovaries stop functioning properly before age 40, often due to cancer treatments or autoimmune conditions.
Thyroid or Pituitary Disorders: Hormonal imbalances from thyroid or pituitary issues.
Bleeding Disorders: Conditions affecting blood clotting can cause heavy menstrual bleeding.
Uterine or Ovarian Cancer: Certain cancers can alter menstrual patterns.

Lifestyle Factors:

Stress.
Significant weight changes.
Intense exercise routines.
Illnesses.

Other Causes:

Birth Control Pills: Can cause irregular periods when starting or stopping.
Medications: Such as steroids or anticoagulants.
Pregnancy Complications: Including miscarriage or ectopic pregnancy.
Surgery or Scarring: Affecting the uterus, ovaries, or fallopian tubes.

Diagnosis and Tests

How are irregular periods diagnosed?

Keep a record of your menstrual cycle, noting start and end dates, symptoms, flow amount, cramping, and any unusual bleeding. Your healthcare provider will ask about your cycle and medical history, conduct a physical exam, and may order tests such as:

Pelvic Ultrasound: To detect fibroids, polyps, or ovarian cysts.
Endometrial Biopsy: To diagnose endometriosis, hormonal imbalances, or precancerous cells.
Hysteroscopy: Allows examination inside the uterus for causes of abnormal bleeding.

Management and Treatment

How are irregular periods treated?

Treatment depends on the underlying cause:

Medications:

Hormonal Birth Control: Manages irregular or heavy bleeding due to conditions like PCOS or fibroids.
Tranexamic Acid: Treats heavy menstrual bleeding.
Pain Relievers: For mild to moderate pain or cramps.
Hormone Therapy: Helpful for perimenopausal symptoms.
Antibiotics: For infections causing irregular bleeding.
Gonadotropin-Releasing Hormone Agonists: Control heavy bleeding and shrink fibroids.

Surgery:

Endometrial Ablation: Destroys uterine lining tissue to reduce bleeding.
Myomectomy: Removes uterine fibroids.
Uterine Artery Embolization: Cuts off blood supply to fibroids.
Hysterectomy: Removes the uterus in severe cases.

Prevention

How can I reduce the risk of irregular periods?

Maintain a healthy lifestyle with moderate exercise and nutritious food.
Ensure adequate rest.
Practice stress reduction techniques.
Avoid excessive or intense exercise.
Use birth control as directed.
Change tampons or pads every four to six hours.
Regularly see your gynecologist and primary care provider.

Living With

When should you see a provider about irregular periods?

Severe pain during or between periods.
Heavy bleeding (soaking a pad/tampon every hour).
Foul-smelling discharge.
Periods lasting longer than seven days.
Bleeding between periods or after menopause.
Sudden irregularity after previously regular cycles.
Nausea or vomiting during periods.
Symptoms of toxic shock syndrome (TSS).

Common Questions

Is it normal to miss a period for two months? Missing one or two periods isn’t typically concerning, but monitor for changes in lifestyle factors. Contact your provider if you miss three or more consecutive periods or have unusual symptoms.

How much delay in periods is normal? Minor delays are generally okay, but significant or sudden changes should be discussed with your provider.

When are irregular periods more common? Irregular periods are common when starting menstruation (ages 9-14) and during perimenopause (around age 50).

Should I worry about irregular periods? Some variation is normal. Contact your gynecologist if you’re concerned, especially if trying to conceive. Your provider can help determine if treatment is needed.

Note: Irregular periods often aren’t serious and can be treated. Slight variations are normal, but consult your healthcare provider if you notice significant changes.

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