Overview 

Periods usually start during puberty, which is between the ages of 10 and 16 years, continuing until reaching menopause when a woman is between 45 and 55 years old.

Some women have what is known as abnormal uterine bleeding or irregular periods. There is abnormal uterine bleeding when:

• There is bleeding or spotting between periods
• There is bleeding after sexual intercourse
• Menstrual bleeding lasts longer than normal
• Heavy bleeding during your period
• Bleeding after reaching menopause

To determine whether your menstruation schedule is regular, count from the last day of your previous period and stop counting on the first day of your next. Repeat doing this for three months. If the number of days between stopping and starting the period is significantly different each month, then you have an irregular cycle.

Irregular periods or oligomenorrhea may occur if there is a hormonal imbalance, a change in contraception method, hormonal changes during menopause, and endurance exercises.

Treating irregular menstrual periods during puberty and menopause may not be necessary, but if they occur during a woman’s reproductive years, medical advice may be necessary.

Symptoms of irregular periods

A typical menstrual cycle lasts around 28 days but may vary from 24 days to 35 days, depending on the individual. Most women experience between eleven and thirteen menstrual periods in one year. Bleeding usually lasts from 2 to 7 days.

At the start of menstruation, it may take up to 2 years to establish a regular cycle. After puberty, most women’s menstruation becomes regular. The length of time between each period is almost similar.

For some women, however, the time between periods and the amount of blood being shed may vary considerably. This is known as irregular menstruation.

The first sign of irregular menstruation is when the cycle goes longer than 35 days, or if the cycles vary in length.

If the flow of blood changes, or if blood clots bigger than 2.5 centimeters in diameter appear, it is also considered an irregular period.

Causes

Several factors increase the chance of irregular menstruation. Most relate to hormone production. Two hormones impact menstruation – estrogen, and progesterone. These hormones regulate the menstrual cycle.

Hormonal influences

Hormonal balance is influenced by changes in a person’s life cycle, such as puberty, menopause, childbirth, pregnancy, and breastfeeding. During puberty, the body undergoes major changes. It takes several years for the estrogen and progesterone to strike a balance. Irregular periods are common at this time.

Before menopause, women usually have irregular periods, with varying amounts of blood being shed and acne problems. Menopause occurs when twelve months have passed since a woman’s last menstrual period. After menopause, a woman will no longer experience menstrual periods.

Menstruation ceases during pregnancy, and most women do not have their menstrual periods while they are breastfeeding.

The use of contraceptives can cause irregular bleeding. Heavy bleeding may result from the implantation of an intrauterine device. Contraceptive pills, on the other hand, can cause in-between periods spotting.

A woman who uses contraceptive pills for the first time may experience small bleedings that are generally shorter and lighter than her normal periods. These small bleeds usually go away after a few months.

Other changes that are associated with irregular menstrual periods include:

• extreme weight loss
• extreme weight gain
• eating disorders such as bulimia or anorexia
• emotional stress
• endurance exercise such as running the marathon

several disorders are also linked to missed or irregular periods.

Complications of irregular periods

Irregular menstrual periods may indicate a health problem. Some of these problems can lead to further problems, including fertility issues and the following:

• Polycystic ovarian syndrome (PCOS) – It is a condition where a number of small and fluid-filled sacs or cysts develop in the ovaries. A woman with PCOS does not ovulate, which means that she does not release an egg every month. Symptoms of PCOS include irregular or no periods, acne problems, obesity, and excessive hair growth. Women with PCOS have very high levels of testosterone or androgen, two male sex hormones. PCOS is believed to have affected between 10 percent to 20 percent of women of reproductive age. 
• A thyroid disorder – The thyroid gland produces hormones that affect the body’s metabolism. It can cause irregular periods.
• Cervical or uterine cancer – It is a cancer of the womb. In rare cases, it may cause bleeding between periods or during sexual intercourse.
• Endometriosis – It is a condition in which the cells that are normally found inside the uterus – endometrial cells – grow outside of it. In short, the lining of the inside of the uterus is found outside of it. Endometrial cells are those that are shed every month during menstruation. Endometriosis will likely affect women during their childbearing years. The growth of cells in endometriosis is not cancerous. But while the condition could have no symptoms, they could be painful and may lead to other more serious problems.
• Pelvic inflammatory disease – It is an infection of the female reproductive system. It is the most common complication of sexually transmitted infections in women, apart from AIDS.

Diagnosis and Treatment

If you notice any change in your menstrual cycle, you should keep an accurate record of the beginning and end of your periods, including the blood flow amount and if you pass blood clots bigger than 2.5 centimeters in diameter. You should take note of other symptoms, such as bleeding between menstrual periods and menstrual pain or cramps.

When you see your doctor, expect him to ask you about your menstrual cycle and medical history. Your doctor will perform a physical examination, including a pelvic exam and at times a Pap test. Your doctor might also order other tests, such as:

• Blood tests to rule out anemia and other medical disorders
• A pelvic ultrasound exam to check for polyps, uterine fibroids, or an ovarian cyst
• Vaginal cultures to rule out infections
• An endometrial biopsy, in which a sample of tissue is removed from the lining of the uterus to diagnose endometriosis, cancerous cells, or hormonal imbalance. 

Treatment

The treatment for irregular periods, if needed, will depend on the cause.

Puberty and menopause – Irregular periods occurring during puberty or as the woman approaches menopause do not usually require treatment.

Birth control – If the cause of irregular bleeding is the use of contraception, and if it continues for several months, the woman should talk to her doctor about other options.

PCOS and obesity – In cases of PCOS or overweight women, losing weight may help in stabilizing menstruation. A lower body weight means that the body does not need to produce extra insulin, leading to lower testosterone levels and a better chance of ovulating.

Thyroid problems – Treatment for thyroid problems is likely to be prescribed by the doctor. The treatment may include medication, surgery, or radioactive iodine therapy.

Stress and eating disorders – Psychological therapy may help if the cause of the irregular period is emotional stress, sudden weight loss, or an eating disorder. This may include stress management, relaxation techniques, and talking to a therapist.

Medication

If diabetes is the cause of the irregular periods, the doctor may recommend taking metformin, a medicine that lowers insulin for type 2 diabetes. This medicine may help ovulation to become normal and also regular periods.

Taking a low-dose birth control pill containing estrogen and progesterone may help decrease the production of androgen and help correct abnormal bleeding. 

Also, taking progesterone for 10 to 14 days each month will help regulate periods.

Preventing irregular periods

The following self-care may help in preventing irregular periods:

• Maintaining a healthy lifestyle by eating nutritious foods and exercising moderately. If you need to lose weight, do it gradually instead of turning to diets that drastically limit your food and calorie intake.
• Get enough rest every day
• Learn how to reduce stress and practice relaxation techniques.
• If you are an athlete, you should cut back on intense or prolonged exercise routines. Irregular periods may be the result of excessive sports activities.
• Use contraceptive methods, such as birth control pills, as directed by your doctor.
• Change sanitary napkins or tampons every four to six hours to avoid infections or toxic shock syndrome

Risks of Having Irregular Periods

An occasional missed period or irregular period may still be normal. However, not having a regular period may increase your risk of endometrial cancer.

Women with the polycystic ovarian syndrome, overweight, with thyroid problems, athletes who perform extreme exercise routines are at higher risk of having irregular periods. 

When to Seek Medical Attention

If you are in your mid-to-late 20s and have been having regular periods for many years, but suddenly your menstrual cycle stops behaving like clockwork, and you are sure you are not pregnant or nowhere near your menopause, there could be a problem. It is time to see your gynecologist. Your gynecologist will be able to determine the cause of the irregular periods and help you figure out the proper treatment course. Your doctor may prescribe oral contraceptives to regulate your cycle or other methods of treatment to bring your cycle back to normal.

Table of Medications

• tranexamic acid
• Lysteda
• drospirenone / ethinyl estradiol
• ethinyl estradiol / norethindrone