The typical menstrual cycle ranges from 24 to 38 days. Irregular periods encompass any deviations or abnormalities in the menstrual cycle, such as differences in cycle length, frequency, duration, or intensity.
In the past, terminologies like menorrhagia, metrorrhagia, polymenorrhea, hypermenorrhea, oligomenorrhea, and dysfunctional uterine bleeding were used to describe irregular periods. However, newer terms have been introduced to offer a more precise classification of irregular periods.
Abnormalities in Frequency
- Frequent: Bleeding period at intervals <24 days
- Infrequent: Bleeding period at intervals >38 days
- Absent: Primary amenorrhea (absence of menarche by age 15) or secondary amenorrhea (absence of spontaneous menstrual bleeding for 6 months in a patient who previously had menstrual bleeding).
Irregular Bleeding
Depending on the patient’s age, irregular bleeding is defined as:
- Cycle length variance >9 days for ages 18 to 25
- Cycle length variance >7 days for ages 26 to 41
- Cycle length variance >9 days for ages 42 to 45
Prolonged Menstrual Bleeding
Menstrual bleeding that consistently lasts longer than 8 days.
Consult your doctor as soon as you notice a cause of concern with your periods, such as prolonged severe cramping before, during, or after a period, unusual heavy bleeding or passing huge clots, foul-smelling vaginal discharge, periods that consistently longer than 7 days, vaginal bleeding, or spotting before or after menopause, and periods that start to become irregular after having regular menstrual cycles.
Causes of Irregular Periods
The common causes of irregular periods include puberty whereby period can be irregular for the first 2 years and the beginning of menopause which typically happens between the ages of 45 and 55. Prolonged usage of certain medications like steroids and anticoagulant medicines (blood thinners) can make periods become irregular, longer, and occasionally heavier.
There are also several underlying medical conditions that can cause irregular periods such as PCOS, endometriosis, thyroid disorders, and cancers.
Polycystic ovary syndrome (PCOS) is a hormonal issue that can lead to infrequent or lengthy periods in women. Endometriosis, a condition whereby endometrial tissue grows outside the uterus, can cause period pain that potentially disrupts daily activities, pain during or after sex, pelvic pain and may make it difficult to conceive.
Thyroid disorders include hypothyroidism (thyroid gland does not produce enough hormones) and hyperthyroidism (thyroid gland overproduces thyroid hormones). Sometimes, irregular periods can signify a more serious underlying condition, such as cervical cancer and uterine cancer.
Lifestyle factors that cause irregular include stress, extreme exercise, and significant weight loss. The stress hormone, cortisol, can cause irregular, mild, or absent periods depending on how the body handles stress. Extreme exercise can cause hormonal changes that lead to periods that are lighter in flow than regular periods. Missing periods due to extreme exercise is called exercise-induced amenorrhea.
Hypothalamic amenorrhea happens when the hypothalamus reduces or stops the release of the hormone that regulates menstrual cycle known as gonadotropin-releasing hormone (GnRH).
Hypothalamic amenorrhea is commonly associated with factors such as low body weight (typically defined as being 10% below the ideal weight), a low body fat percentage, eating disorders like anorexia nervosa or bulimia nervosa, emotional stress, intense physical exercise, and specific medical conditions or illnesses.
Diagnosis of Irregular Periods
Your healthcare practitioner will enquire about your medical history and conduct a physical examination.
| Pregnancy test | Conducted for women whose menstrual periods have stopped. |
| Blood tests | Conducted to measure the levels of oestrogen, progesterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), thyroid hormones, and prolactin. |
| Hysteroscopy | A procedure to examine the insides of the uterus by using a tiny camera to identify and address specific sources of irregular bleeding. |
| Endometrial biopsy | A tissue sample from the lining of the uterus (endometrium) is obtained for further examination. |
| MRI (magnetic resonance imaging) scan | Conducted particularly when there is a suspicion of hypothalamic or pituitary gland abnormalities in the brain. |
Treatments for Irregular Periods
The treatment options will depend on the underlying cause.
| Lifestyle changes | Reduce stress, maintain a healthy weight, get adequate sleep, exercise moderately (limit strenuous exercise), practice relaxation and stress-reduction methods, attend regular medical check-ups. |
| Medications | Nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed to help alleviate menstrual pain. Metformin may be prescribed to manage insulin resistance in PCOS. |
| Hormone therapy | Hormone therapy is usually recommended to help regulate menstrual bleeding, reduce pain, and restore hormonal balance. Approaches include birth control pills, intrauterine device (IUD), hormonal patches, vaginal rings, or progesterone (progestin) therapy. |
| Surgical interventions | Surgical interventions may be necessary in certain cases to treat underlying structural issues that are causing irregular periods, for example, uterine fibroids removal or treatment of endometriosis lesions. |
Make an Appointment at Gleneagles Hospitals
If you have questions about irregular periods, get in touch with us to book an appointment today for a consultation, or visit our Obstetrics and Gynaecology Department at your nearest Gleneagles Hospital.
