Article Summary

Irregular periods happen quite frequently; while in many instances they don't require treatment, they could represent a condition that should receive some form of intervention. The time frame for a typical menstrual cycle ranges from 21 to 35 days, and there can be minor variations each month, which would still be classified as a "normal" cycle. 

However, if your cycle becomes greatly varied either in terms of timing (i.e., fewer than 21 days or more than 35 days apart) or intensity (i.e., the amount of bleeding experienced), these are indicative of an irregular cycle and warrants investigation. Other examples of irregular menstruation include spotting between periods, post-coital bleeding and post-menopausal bleeding. 

What are Irregular Periods?

A typical menstrual period usually runs about 4-7 days and can be anticipated to come back approximately every 28 days; however, the time frame to be considered "normal" will range between 21 and 35 days. Although you may have variations from one cycle to another, your menstrual cycle would still be labelled as regular as long as it continues to follow a similar, general pattern. 

Periods that deviate significantly from the average cycle (periods that occur less than 21 days or more than 35 days apart, going without a menstrual cycle for three months in a row, heavy bleeding, light bleeding, prolonged bleeding (longer than 7 days), and excessive variation within each menstrual cycle) are labelled as irregular. 

Spotting between periods, experiencing bleeding following intercourse, or experiencing bleeding post-menopause would all also qualify as irregular menstruation. Other related conditions include  

  • amenorrhoea (when no menstrual period comes for at least 90 days outside of pregnancy or menopause)  

  • oligomenorrhoea (when a woman has menstrual periods fewer than six to eight times a year)  

  • dysmenorrhoea (severe menstrual cramps/pain) 

Common Signs and Symptoms of Irregular Periods

Recognisable signs and symptoms of irregular menstruation include a noticeable change in the pattern of your cycle. Examples include: 

  • Menses arrive earlier or later than anticipated. 

  • Cycles are unpredictable from month to month. 

  • Menses are substantially heavier or lighter than normal. 

Other symptoms to monitor for include: 

  • severe cramping or pelvic pain before or during menses 

  • nausea and/or vomiting during menses 

  • passing large clots. 

  • heavy bleeding resulting in soaking a sanitary product (pad/tampon) within an hour or two 

  • presence of foul-smelling vaginal discharge 

  • spotting between menses or following sexual intercourse

Causes of Irregular Periods

Possible reasons for irregular periods are numerous and may be categorized as either medically based or lifestyle-based.  

Medical reasons for irregular periods may include: 

  • Endometriosis is the growth of tissue similar to the uterine lining outside of the uterus, causing pain and abnormal bleeding.  

  • Pelvic inflammatory disease (PID), which is an infection of the female reproductive organs commonly caused by untreated STIs.  

  • Polycystic ovarian syndrome (PCOS): PCOS prevents or delays ovulation as a result of excess androgen production. 

  • Primary ovarian insufficiency: Ovaries fail to produce eggs properly before the age of 40. 

  • Disorders affecting the thyroid and pituitary glands can disrupt hormone signals that regulate the menstrual cycle. 

  • Disorders that affect bleeding or clotting can result in extremely heavy menses. 

  • Certain cancers, such as uterine and ovarian cancer, can also alter the pattern of menses. 

Lifestyle factors that contribute to irregular periods may include: 

  • extreme amounts of stress 

  • major fluctuations in body weight 

  • very low body fat as a result of extensive or prolonged exercise (such as long-distance running or gymnastics). 

  • illnesses, including viral infections 

  • on/off use of hormonal contraceptives 

  • taking medications such as steroids or anticoagulants 

  • complications from pregnancy, such as miscarriage or ectopic pregnancy 

  • scarring or blockage of the uterus, ovaries, or fallopian tubes 

Reasons for Irregular Periods in Different Age Groups

Irregular menstrual cycles do not occur at equal frequencies throughout all stages of life. During puberty (approximately between ages 9 and 14), it is normal for cycles to be unpredictable as the body undergoes the transition to its new hormonal state. Typically, it will take several years for a consistent cycle to emerge. 

In addition to issues during puberty, irregular cycles among adult women are primarily the result of lifestyle issues, hormonal imbalance, or medical conditions such as polycystic ovary syndrome (PCOS) and endometriosis. Perimenopause, which begins approximately at age 50 and continues until menopause, creates natural fluctuations in hormone levels, which create unpredictability in menstrual cycles. Women undergoing perimenopause may experience lighter or heavier and shorter or longer menses before ceasing menses altogether.

Risk Factors for Irregular Periods

There are a number of factors that increase a woman's likelihood of developing irregular menstrual cycles. Conditions that have been identified as increasing this risk include: 

  • PCOS 

  • Endometriosis 

  • Thyroid disease 

  • Bleeding disorder 

Additionally, women who are either in their initial years of menstruation (puberty) or near perimenopause tend to experience irregular cycles as well due to the fluctuating hormone levels present at these stages.  

Finally, women with lifestyles that involve: 

  • high level of stress 

  • extremes in body weight (either underweight or overweight) 

  • excessive or prolonged exercise 

  • poor nutrition 

May also find themselves experiencing irregular menstrual cycles. Temporary disruptions in menstrual cycles can also occur as a result of starting or stopping. Hormonal contraceptives (this disruption can last for up to six months).

How are Irregular Periods Diagnosed?

Women should contact their healthcare provider if they begin to notice a change in their menstrual cycle. To assist in the diagnosis process, keep track of the date your cycle began and ended each month, along with any accompanying symptoms (cramping or spotting). This data is helpful when discussing the issue with your doctor. 

To obtain a complete picture of your overall health status, your doctor will ask you about your entire medical and menstrual history and perform a general physical exam (including a pelvic exam). Based on your specific situation, additional testing may be required to determine the reason(s) behind your irregular cycle. Some possible diagnostic procedures include: 

  • Ultrasound is used to diagnose fibroids, polyps and cysts on the ovaries. 

  • An endometrial biopsy is the removal of a small piece of the uterine lining to test for endometriosis and Hormonal imbalance while screening for pre-cancerous cell development. 

  • Hysteroscopy allows for a direct visual examination of the interior surface of the uterus, allowing for identification and treatment of abnormalities responsible for abnormal bleeding. 

Irregular Periods Treatment Options

Depending upon the underlying cause(s) for your irregular menstrual cycles, treatment options will vary widely. Most commonly, prescription medications will be recommended to address the problem. Possible prescription treatments for irregular menstrual cycles include: 

  • Birth control pills, vaginal rings, injections, and IUDs will help to regulate menstrual cycles, in addition to helping with symptoms associated with PCOS, endometriosis, and uterine fibroids. 

  • Tranexamic acid will decrease heavy menstrual bleeding. Must be started at the beginning of each cycle. 

  • Over-the-counter pain relievers (ibuprofen/paracetamol) will help alleviate menstrual cramps. 

  • Hormone replacement therapy will provide relief for women experiencing irregular periods due to perimenopause. 

  • Antibiotics will treat any infectious cause of irregular bleeding. 

  • GnRH agonists will decrease the size and bleeding associated with uterine fibroids. 

Should medication be ineffective in addressing your irregular menstrual cycles, surgical options may need to be explored. Surgical options for treating irregular menstrual cycles include: 

  • Endometrial ablation will destroy the uterine lining to reduce bleeding. This may not be an option for women who plan to bear children. 

  • Myomectomy will remove uterine fibroids. 

  • Uterine artery embolisation will cut off the blood supply to fibroids. 

  • A hysterectomy will remove the uterus and eliminate the possibility of future pregnancy. 

How to Prevent Irregular Periods

While prevention is not always possible when it comes to irregular menstrual cycles due to medical causes, some actions can be taken to promote menstrual regularity.  

  • Maintaining a balanced diet combined with moderate exercise will help maintain hormone regulation, thereby minimising the chance of irregularities in your menstrual cycle.  

  • Limiting extreme exercise routines that lead to extreme caloric restriction may prevent dropping below optimal body fat percentages.  

  • Gradually losing weight rather than restricting calories excessively will help avoid disrupting hormones that regulate menstrual cycles.  

  • Adequate rest and practice of stress-reducing activities such as deep breathing and mindfulness can help minimise the effects of stress on hormone regulation. 

  • Use birth control as instructed and replace sanitary products regularly (every 4-6 hours) to minimise the risk of infection. Regularly schedule appointments with your gynaecologist/primary care physician so that any developing conditions can be detected early on. 

When Should You See a Gynecologist?

Schedule an appointment with a healthcare provider if you experience any of the following: 
 

  • Severe cramping before, during and between menses 

  • Unusually heavy bleeding that results in saturating a sanitary product (pad/tampon) within an hour for two to three hours consecutively 

  • Passing clots larger than a coin 

  • Bleeding between menses or immediately following sexual activity 

  • A single menses lasting greater than seven days 

  • Presence of foul-smelling vaginal discharge 

Also seek evaluation if you are attempting conception but have unpredictable cycles, believe you are pregnant, or note any rapid changes to a previously regular cycle.

Find a Gynecologist Near You

If you are experiencing persistent menstrual or reproductive health concerns, you can consult a gynecologist at an NMC location near you. Explore our gynecology services across the UAE:

Conclusion

Irregular menstrual cycles are extremely prevalent and most commonly the result of controllable Lifestyle factors or treatable medical conditions. While minor variations in menstrual cycles are rarely anything to worry about, major or minor changes in cycle length, pattern, flow, and pain levels should always be evaluated by a qualified healthcare provider. Tracking your menstrual cycle, maintaining a healthy lifestyle and scheduling routine evaluations with your gynaecologist are the best methods available today to stay ahead of your menstrual health.