Menstruation is the time of month when the womb (uterus) sheds its lining and vaginal bleeding occurs. This is known as a menstrual period.
Periods vary widely from woman to woman. Some periods are punctual, some are unpredictable. On average, a woman gets her period every 24 to 38 days. A period usually lasts about two to eight days. Irregular periods may require treatment.
What Are Irregular Periods?
You may have irregular periods if:
- The time between each period starts to change.
- You are losing more or less blood during a period than usual.
- The number of days that your period lasts varies significantly.
There are different terms for different types of irregular periods:
- Irregular Menstrual Bleeding (IrregMB): Bleeding of more than 20 days in individual cycle lengths over a period of one year.
- Absent Menstrual Bleeding (amenorrhea): No bleeding in a 90-day period.
- Heavy Menstrual Bleeding (HMB): Excessive menstrual blood loss that interferes with the woman’s physical, emotional, social, and material quality of life and can occur alone or in combination with other symptoms.
- Heavy and Prolonged Menstrual Bleeding (HPMB): Less common than HMB. It is important to make a distinction from HMB given they may have different etiologies and respond to different therapies.
- Light Menstrual Bleeding: Based on patient complaint, rarely related to pathology.
Do Irregular Periods Need Treatment?
Treatment of irregular periods depends on the cause and your desire to have children in the future. Irregular periods can be caused by many different things. Changes in your body's level of the hormones estrogen and progesterone can disrupt the normal pattern of your period. That's why young girls going through puberty and women approaching menopause commonly have irregular periods.
Other common causes of irregular periods include:
- Having an intrauterine device (IUD)
- Changing birth control pills or using certain medications
- Excessive exercise
- Polycystic ovary disease (PCOS)
- Pregnancy or breastfeeding
- Overactive thyroid or hyperthyroidism
- Thickening of or polyps on the uterine lining
- Uterine fibroids
A less common cause is severe scarring (adhesions) of the lining of the uterus, a condition known as Asherman syndrome.
How Are Irregular Periods Treated?
Usually, no treatment is needed for irregular periods caused by puberty and menopause unless they are excessive or bothersome. It is also normal for your period to stop when you are pregnant.
Treatments for irregular periods due to other causes may include:
- Correcting or treating underlying disease
- Changing your type of birth control
- Lifestyle changes, including weight loss
- Hormone therapy
Here are some treatment options:
Treating underlying disease. It is important to treat any underlying diseases that cause irregular periods. If you have irregular periods, your doctor will run blood tests to check hormone levels and thyroid function.
Polycystic ovary syndrome (PCOS) and hypothyroidism are two common causes of irregular periods in women. In general, the goal of treatment is to restore the balance of hormones in the body. Women with PCOS may be given birth control pills or other hormones to trigger a period. If they wish to get pregnant, infertility medications may be prescribed. Hypothyroidism is treated with supplementation of thyroid hormones.
Changing birth control. If you have irregular periods after three months of hormonal birth control, your doctor may recommend another type of birth control. Some women develop irregular periods when using Nexplanon, DepoProvera, or an IUD. Read the literature that accompanies your IUD to learn more about side effects.
Lifestyle changes. Some women have changes in their period because they exercise too much. Reducing the frequency and intensity of your workouts may help your period return to normal. Stress leads to many body changes, including irregular periods. Relaxation techniques and counseling may be helpful.
Extreme changes in your weight can affect your periods. Weight gain can interfere with the body's ability to ovulate, which controls your menstrual cycle. Losing weight may help resolve irregular periods. Extreme sudden weight loss can also lead to infrequent or irregular periods.
Hormone therapy (HT). An irregular menstrual cycle is often due to a lack or imbalance of certain hormones in the body. Birth control pills (oral contraceptives) often containing the hormones estrogen and progesterone are commonly prescribed to help control irregular periods. A hormone medication called progestin can also help trigger periods in women who do not get them.
Other hormone treatments may be prescribed to women with irregular periods who are having difficulty getting pregnant.
Surgery. Sometimes, scarring or structural problems in the uterus (womb) or fallopian tubes may lead to irregular periods. Surgery may be done to correct any structural problems or birth defects, particularly in women who want to have children. It may also be done to remove severe scar tissue (adhesions) in the reproductive tract.
When to Call a Doctor
Call your doctor if you have had regular, monthly periods and the pattern changes. Your doctor may perform a physical exam and order tests to rule out pregnancy or a health problem.
Call your doctor if you have any of the following symptoms:
- You miss three or more periods a year.
- You get your period more often than every 21 days.
- You get your period less often than every 35 days.
- You are bleeding more heavily than usual during your period.
- You bleed for more than seven days.
- You have more pain than usual during a period.