What Causes Irregular Periods? Diagnose and Treatment

Menstrual cycles don’t always run like clockwork. A few women get their period every 28 days, but menstrual cycles can range from 21 to 35 days and last for two to seven days. Your menstrual cycle is irregular if its longer than 38 days or if the menstrual flow is heavier or lighter than usual.

Menstrual irregularities are normal, but they often cause worries. Sometimes they can also indicate a serious medical problem. Read on to learn about the various causes, symptoms, and treatment options for irregular periods.

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To define abnormal or irregular menstruation, let us first understand what normal menstruation is. Menstrual cycles are not the same for all women; it depends on your age.

Tweens and teens

Girls typically get their period at the age of 12 to 13. Though their cycle may be irregular initially, it falls into a regular pattern within two years.

Women of reproductive age

For women in the age group of 18 to 50 years, the cycle lasts between 28 to 35 days, and the menstrual period lasts for two to seven days.

Postmenopausal women

Any bleeding is considered abnormal in postmenopausal women.

Types of menstrual irregularities

There are four main types of menstrual irregularities. These include –

1. Amenorrhea

Primary amenorrhea is defined as the absence of menses by age 15 in the presence of healthy growth and secondary sexual characteristics. When someone who has been having periods regularly, suddenly stops having periods for three months at a stretch, it is called secondary amenorrhea.

2. Polymenorrhea

Polymenorrhea is a type of uterine bleeding in which the woman’s cycle is shorter and more frequent than usual.  Menstrual cycles that are shorter than 21 days can indicate a hormonal dysfunction.

3. Bleeding between cycles

Some women have regular cycles, but they also experience bleeding between cycles. This inter-menstrual bleeding is usually related to ovulation issues.

4. Menorrhagia

Menstrual periods with abnormally heavy or prolonged bleeding is known as menorrhagia. Menorrhagia Symptoms include bleeding so heavy that it soaks through a pad or tampon within two hours or clots that are larger than an inch. Excessive bleeding can lead to anemia or iron deficiency.

Causes of menstrual irregularities

There can be several reasons why your periods are heavy or irregular. These include –

1. Birth control

Hormonal birth control pills can cause irregular bleeding and spotting between periods. Intrauterine devices can cause heavy bleeding. Some other medications, like hormone medicines, and anticoagulants, can also cause heavy bleeding.

2. Polycystic ovary syndrome (PCOS)

This hormonal disorder occurs when the ovaries or adrenal glands overproduce male hormones, and the body has insulin resistance. A common sign of PCOS is irregular periods. You may sometimes miss your period, and when you get your period, you have heavy bleeding.

3. Pelvic inflammatory disease (PID)

Pelvic inflammatory disease is an infection in one or more upper reproductive organs like the uterus, ovaries, and fallopian tubes. It occurs when bacteria that are sexually transmitted spread, from the vagina to the uterus, ovaries, or fallopian tubes. PID can lead to abnormal uterine bleeding between menstrual cycles, especially during or after intercourse.

4. Uterine fibroids

Uterine fibroids are non-cancerous muscular growths that develop on the walls of the uterus. They can cause heavy and prolonged periods.

Uterine fibroids are non-cancerous growths in the uterus. They can cause heavy and prolonged menstrual periods. Sometimes the bleeding is so heavy that it can lead to anemia. Fibroids can also lead to pain in the lower back and legs.

5. Endometriosis

Endometriosis is a condition in which the endometrial tissue (the tissue that lines the inside of the uterus) grows on your ovaries, bowel, and tissues lining your pelvis. Endometriosis causes heavy menstrual cramps and heavy and prolonged periods. It can also lead to gastrointestinal pain, pain during sex, painful bowel movements, and infertility.

6. Thyroid problems

The thyroid hormone regulates the menstrual cycle. Thyroid problems can lead to menstrual irregularities (1). An underactive thyroid can lead to increased cramping and heavy bleeding. High levels of thyroid hormone can cause shorter and lighter periods.

7. Cervical or endometrial cancer

A common symptom of cervical and endometrial cancers is abnormal menstrual bleeding. A person with this condition may bleed between menstrual periods, and after sexual intercourse. You may also experience heavier and longer periods.

8. Bleeding disorders

Bleeding disorders like leukemia, platelet disorders, clotting factor deficiencies, or von Willebrand disease can affect clotting and cause heavy menstrual bleeding.

9. Anovulation

Anovulatory cycles are menstrual cycles where ovulation doesn’t take place. When ovulation doesn’t occur, it leads to a lack of progesterone, which causes heavy periods.

10. Adenomyosis

Women who have adenomyosis can experience heavy, painful, and irregular periods. Thes symptoms occur due to the movement of the uterine lining into the uterine muscle, damaging the blood vessels in the womb, and thus causing bleeding at irregular times.

11. Ectopic pregnancy

A pregnancy that develops outside the uterus, usually the fallopian tube, is known as ectopic pregnancy. Women with ectopic pregnancy have irregular bleeding and pelvic pain.

12. Stress and lifestyle factors

Gaining or losing a large amount of weight in a short span, dieting, changes in exercise routines, travel, illness, or other disruptions in your daily routine can impact your menstrual cycle.

When should you seek medical help?

A few irregular periods in a year are normal. However, you should consult your doctor if you experience any of the following –

  • You get our periods less than 21 days or more than 35 days apart.
  • You have bleeding between periods, after sex, while pregnant or after menopause.
  • Your periods last for more than seven days.
  • You soak through one pad or tampon per hour for several hours.
  • You develop severe pain during your period.
  • You develop a fever.
  • You develop abnormal discharge or odor.

How are menstrual irregularities diagnosed?

When you notice any sudden changes in your menstrual cycle, you must note when your period starts and when it ends. Also, you must keep a record of the flow or have passed any big blood clots. Note down any other symptoms that you may have experienced. When you visit your doctor, he/she will ask you about your menstrual cycle, unusual symptoms, and medical history. He will perform a pelvic examination to see if your vagina or cervix is inflamed and may order tests based on your symptoms. These include:

  • Blood test
  • Pap smear
  • Endometrial biopsy
  • Hysteroscopy
  • Pelvic ultrasound
  • Sonohysterogram
  • Pregnancy test

Treatment for menstrual irregularities

Your doctor will treat menstrual irregularities depending on your health, underlying conditions, reproductive history, and the reason for the abnormalities. The treatment can include:

  • Oral contraceptives
  • Hormone replacement injections
  • Nonsteroidal anti-inflammatory drugs
  • Iron supplements

In some serious cases, your doctor may also suggest medical procedures to treat menstrual abnormalities. These include:

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  • Surgery
  • Hysteroscopy
  • Dilation and curettage
  • Endometrial ablation
  • Endometrial resection
  • Hysterectomy

Final thoughts

Menstrual irregularities are common and mostly harmless. However, in some cases, they can indicate a more severe problem like PCOS, PID, endometriosis, thyroid problems, and even cervical cancer. A few irregular periods during a year are regular, but you must consult a doctor if you notice some serious symptoms during your periods.

Your doctor will perform a pelvic examination and order other tests based on your symptoms like a pap smear, pelvic ultrasound, endometrial biopsy, hysteroscopy, and sonohysterogram.

Treatments include medications like oral contraceptives, NSAIDs, hormone replacement injections, and medical procedures like D and C, endometrial ablation, endometrial resection, and hysterectomy.

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