Learn about the causes of irregular periods, including the impact of stress. Discover natural remedies for regulating menstrual cycles.

Irregular Menstrual Cycle

Dr. Saad Ullah Siddiqui Clinic

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Saad Ullah Siddiqui

Overview

An irregular menstrual cycle is defined as any change in length, frequency of onset, or volume of menstrual flow from the woman&rsquo;s regular menstrual cycle<a href="#accordion">[1]</a>. 
&nbsp;

The menstrual cycle involves a delicate dance of hormones in a woman&#39;s body. Certain hormone levels must rise and fall to achieve ovulation. The regular menstrual cycle (counting from the first day of one menstrual period to the first day of the next cycle) ranges between 21-35 days and lasts for 3-7 days<a href="#accordion">[1]</a>. Women typically lose 5-80 ml of blood during a regular menstrual cycle[1]. A longer or shorter cycle, a flow that&#39;s lighter or heavier than normal, and missing three or more periods in a row, all constitute an irregular menstrual cycle<a href="#accordion">[4]</a>.

Irregular menstrual cycle is common in teenage girls and perimenopausal women. However, due to the varying definition across researchers, the exact prevalence of menstrual irregularity is unclear.

Approximately 85% of women aged 21-25 years experience menstrual irregularity<a href="#accordion">[1]</a>. A small-scale study conducted in Ethiopia, among 620 undergraduate students, reported an estimated 32.6% of participants to be suffering from irregular menstrual cycles [1]. Menstrual irregularity was associated with anemia, alcohol use, reduced sleep (&lt; 5 hours), perceived stress, iodine deficiency disorder, and being underweight<a href="#accordion">[1]</a>.

Recently, researchers at Pak Red Crescent Medical College conducted a cross-sectional study among women visiting the gynecology outpatient department at the hospital<a href="#accordion">[10]</a>. Approximately 26% of the females experienced some form of menstrual abnormality, with dysmenorrhea being the most common menstrual disorder[10]. Moreover, 14% of women had frequent or infrequent menstrual cycles<a href="#accordion">[10]</a>.

While slight variations in the menstrual cycle are common from time to time, persistently irregular menstrual cycles may point to an underlying condition. 
&nbsp;

Irregular menstrual cycles can be classified into various subtypes depending on the type of irregularity: 
&nbsp;

<h5>Menstrual Irregularities Based On Bleeding</h5>

<ul>
	<li>Menorrhagia - Heavy menstrual bleeding or bleeding lasting longer than 7 days. Menstrual flow is 90 ml or more per cycle.</li>
	<li>Hypomenorrhea - Extremely light or scanty periods with less than 30 ml blood loss per cycle. 
	&nbsp;</li>
</ul>

<h5>Menstrual Irregularities Based On Duration And Frequency</h5>

<ul>
	<li>Polymenorrhea (frequent menses) - Menstrual interval of less than 21 days.<a href="#">[9]</a></li>
	<li>Oligomenorrhea (infrequent menses) - Menstrual interval of more than 37 days but less than 90 days.</li>
	<li><a href="https://merisehat.pk/disease/amenorrhea-97217">Amenorrhea </a>- This is defined as an absence of periods. Amenorrhea is considered normal during pregnancy, breastfeeding, or menopause.&nbsp; It can be further divided into: 
	 
	 
	1.&nbsp;Primary Amenorrhea - If a girl&rsquo;s menstrual period has not started by 15 years of age, it is called primary amenorrhea. Genetic abnormalities and abnormalities of the reproductive organs are common causes. While the conditions may be present at birth, symptoms do not become noticeable until puberty. 
	2.&nbsp;Secondary Amenorrhea - If a previously menstruating female misses her period for 3 consecutive months or more, it is defined as secondary amenorrhea. Pregnancy is the most common cause of secondary amenorrhea. Other common causes include polycystic ovary syndrome (PCOS), ovarian insufficiency, eating disorders, stress, and prolactin-secreting pituitary tumors. 
	&nbsp;</li>
</ul>

<h5>Menstrual Irregularities And Pain</h5>

<ul>
	<li><a href="https://merisehat.pk/disease/dysmenorrhea">Dysmenorrhea </a>- This is defined as painful periods. 
	&nbsp;</li>
</ul>

Note: The various types of menstrual irregularities are not exclusive and can occur simultaneously. For example, it&#39;s common for menorrhagia and dysmenorrhea to occur together. 
&nbsp;

Signs and Symptoms

An irregular menstrual cycle is one where<a href="#accordion">[3]</a> <a href="#accordion">[8]</a>:

<ul>
	<li>The period lasts longer than 7 days</li>
	<li>The period is heavier than normal, requiring frequent changes of pad or tampon</li>
	<li>The time between each period changes</li>
	<li>Three or more consecutive periods are missed</li>
</ul>

&nbsp;

Prolonged or heavy bleeding is called menorrhagia. It is characterized by the following signs and symptoms<a href="#accordion">[3]</a> <a href="#accordion">[7]</a>:

<ul>
	<li>Menstrual bleeding lasting for more than 7 days</li>
	<li>Changing tampon or pad more than once per hour</li>
	<li>Large blood clots in menstrual flow</li>
	<li>Painful periods (dysmenorrhea)</li>
</ul>

Due to the heavy flow, women can experience symptoms of anemia, such as fatigue, pale skin color, dyspnea, and dizziness. 
 
Note: Contact your doctor if you miss 3 or more periods in a row, have heavy and painful bleeding, or constantly have longer or shorter cycles<a href="#">[5]</a>. 
&nbsp;

Causes

The following are some common causes of irregular menstrual cycles:&nbsp;<a href="#accordion">[2]</a> <a href="#accordion">[4]</a> <a href="#accordion">[6]</a> 
&nbsp;

<h5>Hormonal Imbalance</h5>

Altering levels of the hormones estrogen and progesterone are responsible for disrupting the normal menstrual cycle. Therefore, during puberty and menopause, women often have irregular periods. Moreover, breastfeeding hinders ovulation, causing amenorrhea.

High levels of stress, poor nutrition, rapid weight loss or weight gain, and excessive exercise can also alter the normal hormonal balance, leading to an irregular menstrual cycle.

Note: Women nearing menopause (perimenopausal) may experience light or heavy bleeding. Sometimes, women may also experience post-menopausal bleeding. This can indicate an underlying pathology. 
&nbsp;

<h5>Medications</h5>

Birth control pills work by preventing ovulation. Starting or stopping birth control pills can lead to irregular periods. Insertion of an intrauterine device (IUD) can also lead to heavy bleeding. Steroids and anticoagulants can also affect menstrual cycles. 
&nbsp;

Underlying Medical Condition(s)

In addition to non-medical conditions, several underlying medical conditions can cause irregular periods. Some of the most common ones are:

<ul>
	<li>Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder that affects women of reproductive age. It can cause irregular periods, as well as other symptoms such as weight gain, excess hair growth, and acne.</li>
	<li>Thyroid Disorders: Thyroid disorders, such as hypothyroidism or hyperthyroidism, can cause irregular periods due to the impact on hormones that regulate the menstrual cycle.</li>
	<li>Uterine Fibroids: Uterine fibroids are noncancerous growths in the uterus that can cause heavy or prolonged bleeding, and sometimes irregular periods.</li>
	<li>Endometriosis: Endometriosis is a condition in which tissue that normally lines the inside of the uterus grows outside of it, causing pain, heavy bleeding, and irregular periods.</li>
	<li>Pelvic Inflammatory Disease (PID): PID is an infection of the reproductive organs that can cause irregular periods, as well as pain and discomfort.</li>
	<li>Premature Ovarian Failure (POF): POF is a condition in which the ovaries stop functioning properly before the age of 40, leading to irregular or missed periods.</li>
	<li>Bleeding Disorders: This can lead to heavy periods.</li>
	<li>Ovarian Or Uterine Cancer: Cancers can alter the menstrual cycle by causing missed periods or heavier-than-usual bleeding.</li>
</ul>

&nbsp;

<h5>Other Causes</h5>

<ul>
	<li>Pregnancy</li>
	<li>Asherman Syndrome - This is a rare cause of irregular menstrual cycle. It is characterized by severe scarring of the uterine lining.</li>
	<li>Ectopic Pregnancy - The fertilized egg implants outside the uterus, most commonly in the fallopian tube. This can lead to heavy bleeding during pregnancy.</li>
	<li>Eating Disorders - These include binge eating disorder, anorexia nervosa, and bulimia nervosa.</li>
	<li>Uncontrolled Diabetes - Both type 1 and type 2 diabetes can alter the menstrual cycle.</li>
	<li>Obesity - Excessive fat produces an increased amount of estrogen in the body. This disrupts the normal menstrual cycle, leading to irregular or heavy periods.</li>
</ul>

&nbsp;

Note: If you are experiencing irregular periods, it&#39;s important to speak with a healthcare provider to determine the underlying cause and appropriate treatment 
&nbsp;

There are no specific screening tests for irregular menstrual cycles. The patient&rsquo;s clinical history helps doctors reach a diagnosis. 
&nbsp;

Diagnosis

A complete medical history and a physical examination need to be done to evaluate irregular menstrual cycles. The doctor will inquire about the length of the past few menstrual cycles, normal menstrual flow, any underlying medical conditions, family history of menstrual abnormalities, and any other signs and symptoms. They may also ask about&nbsp;discharge from the breast, hot flushes, adult acne, and facial or chest hair. During the physical examination, the doctor will examine the woman&rsquo;s face, neck, breasts, and abdomen. A pelvic examination may also be conducted.

To confirm the diagnosis and determine the underlying cause, the following tests may be conducted: 
&nbsp;

Blood Tests - This helps check for pregnancy, anemia, bleeding disorders, and thyroid function.

Pap Smear - A pap smear can help detect cancer of the cervix and any infections.

Pelvic Ultrasound - A pelvic ultrasound allows doctors to visualize the uterus, ovaries, and fallopian tubes.

Endometrial Biopsy - A sample of the uterine tissue is taken to analyze it under the microscope. It helps with the evaluation of cancers and endometriosis.

In a few cases, MRI (magnetic resonance imaging) may be conducted to check the functionality of the hypothalamus and pituitary gland. 
&nbsp;
<quillbot-extension-portal></quillbot-extension-portal>

Treatment

The treatment of irregular menstrual cycles depends on the underlying cause. Here are some common causes and potential treatments: 
&nbsp;

Hormonal Imbalances: Irregular cycles can be caused by hormonal imbalances, such as those caused by Polycystic Ovary Syndrome (PCOS). Treatment for hormonal imbalances may include hormonal birth control, hormone therapy, or medications to regulate insulin levels.

Thyroid Problems: Thyroid disorders can also cause irregular menstrual cycles. Treatment may include thyroid hormone replacement therapy.

Weight Changes: Rapid weight gain or loss can disrupt menstrual cycles. Maintaining a healthy weight through diet and exercise may help regulate cycles.

Stress: High levels of stress can also cause irregular cycles. Strategies for managing stress, such as meditation or counseling, may help regulate cycles.

Reproductive Issues: Irregular cycles may also be caused by reproductive issues such as uterine fibroids or endometriosis. Treatment may include surgery, medication, or other procedures. 
&nbsp;

Note: It&#39;s important to consult with a healthcare provider if you experience irregular cycles to determine the underlying cause and appropriate treatment. 
&nbsp;

Treatment may vary on the patient&rsquo;s overall health, the cause of irregular menstruation, and the reproductive history or plans. Any underlying medical issues, such as thyroid dysfunction, must also be addressed by the doctor: 
&nbsp;

<ul>
	<li>Medications - Doctors may prescribe medications that can either reduce blood loss (includes NSAIDs, such as naproxen or ibuprofen, and tranexamic acid), treat anemia (iron supplements), hormone replacement injections or oral contraceptives to reduce the period and regulate the cycle. Metformin may be administered to women with PCOS. Pain relievers can help with dysmenorrhea. In case of infections, doctors may prescribe antibiotics.</li>
	<li>Dilation And Curettage (D&amp;C) - This procedure involves removing tissues from inside the uterus and hence aids in diagnosing and treating certain uterine conditions including heavy bleeding. &nbsp;&nbsp; &nbsp;</li>
	<li>Hysterectomy - This involves surgical removal of the uterus and cervix. It is conducted in severe cases as a last resort to remove excess endometrial tissue in the pelvis or abdomen.</li>
	<li>Endometrial Ablation - The endometrial lining is destroyed to stop or reduce menstrual flow. Most people cannot conceive after the procedure.</li>
	<li>Myomectomy - This involves surgical removal of the uterine fibroids. However, the fibroids may regrow after the surgery.</li>
	<li>Uterine Artery Embolization - This involves cutting off the blood supply of the uterus to stop the growth of the uterine fibroids.&nbsp;</li>
	<li>Lifestyle Changes - These measures are aimed at helping the patient maintain a healthy weight and incorporate healthy practices such as clean eating and regular exercise into the person&rsquo;s daily life.&nbsp; 
	&nbsp;</li>
</ul>

While irregular menstrual periods are not usually harmful, they may raise the risk of complications, such as: 
&nbsp;

Infertility: Irregular periods can make it more difficult to conceive, as they make it harder to predict ovulation and fertile days.

Endometrial Cancer: Women who have irregular periods or who go for long periods without having a period may have an increased risk of endometrial cancer, as the lining of the uterus can build up over time.

Anemia: Heavy or prolonged bleeding during irregular periods can lead to iron-deficiency anemia, which can cause fatigue, weakness, and other symptoms.

Osteoporosis: Estrogen helps keep bones strong. A lack of ovulation decreases estrogen levels in the body. Thus, the bones become weak, increasing the risk of osteoporosis.

Mental Health Issues: Irregular periods can be a source of stress and anxiety, which can lead to mental health issues such as depression or anxiety.

Cardiovascular Disease: Similar to osteoporosis, a lack of estrogen also increases the risk of cardiovascular diseases. 
&nbsp;

Note: Seek medical guidance if you encounter any of the following symptoms:

<ul>
	<li>Abnormal discharge or foul smell discharge.</li>
	<li>A high fever during periods.</li>
	<li>Symptoms of anemia include headache, dizziness, pale skin color, and may also cause fainting.</li>
	<li>Symptoms of toxic shock syndrome. 
	&nbsp;</li>
</ul>

The following factors increase the risk of menstrual irregularities: 
&nbsp;

Age: Women who are approaching menopause may experience irregular periods as their hormonal balance changes.

Body Weight: Women who are underweight or overweight may experience irregular periods due to hormonal imbalances.

Stress: High levels of stress can interfere with the hormonal fluctuations that regulate the menstrual cycle, leading to irregular periods.

Exercise: Over-exercising or engaging in strenuous physical activity can cause irregular periods, especially if it leads to weight loss or low body fat.

Smoking: Smoking has been linked to menstrual irregularities and can disrupt the normal hormonal balance.

Family History: Women with a family history of menstrual irregularities may be more likely to experience them as well. 
&nbsp;

The following measures can help prevent menstrual irregularities: 
&nbsp;

Maintain A Healthy Weight: Maintaining a healthy weight through a balanced diet and regular exercise can help regulate hormonal balance and reduce the risk of irregular periods.

Manage Stress: Managing stress through practices such as yoga, meditation, or deep breathing exercises can help regulate hormonal balance and reduce the risk of irregular periods.

Quit Smoking: Quitting smoking can improve overall health and reduce the risk of menstrual irregularities.

Monitor Menstrual Cycles: Keeping track of menstrual cycles and any irregularities can help detect patterns and identify potential triggers for irregular periods.

Practice Good Self-Care: Practicing good self-care habits, such as getting enough sleep, staying hydrated, and eating a balanced diet, can help regulate hormonal balance and reduce the risk of irregular periods. 
&nbsp;

Key Points

<ul>
	<li>The regular menstrual cycle (counting from the first day of one menstrual period to the first day of the next cycle) ranges between 21-35 days and lasts for 3-7 days.</li>
	<li>A longer or shorter cycle, a flow that&#39;s lighter or heavier than normal, and missing three or more periods in a row, all constitute an irregular menstrual cycle.</li>
	<li>Irregular menstrual cycle is common in teenage girls and perimenopausal women.</li>
	<li>While slight variations in the menstrual cycle are common from time to time, persistently irregular menstrual cycles may point to an underlying condition.</li>
	<li>Prolonged or heavy bleeding is called menorrhagia.</li>
	<li>Altering levels of the hormones estrogen and progesterone are responsible for disrupting the normal menstrual cycle. Therefore, during puberty and menopause, women often have irregular periods.</li>
	<li>Treatment may vary on the overall health, the cause of irregular menstruation, and the reproductive history or plans. Any underlying medical issues, such as thyroid dysfunction, must also be addressed by the doctor. 
	&nbsp;</li>
</ul>

[1] Zeru, A.B., Gebeyaw, E.D. & Ayele, E.T. Magnitude and associated factors of menstrual irregularity among undergraduate students of Debre Berhan University, Ethiopia. Reprod Health 18, 101 (2021).

[2] Irregular periods: Causes, pregnancy, and more. Medical News Today.

[3] Pietrangelo A. What causes heavy periods? Healthline.

[4] Abnormal menstruation (periods): Types, causes & treatment. Cleveland Clinic.

[5] NHS choices. Irregular Periods.

[6] Period problems. Period problems | Office on Women's Health.

[7] Abnormal uterine bleeding. ACOG.

[8] Irregular periods: Possible causes of a missed period. WebMD.

[9] Patient education: Absent or irregular periods (Beyond the Basics). UpToDate.

[10] Farhan, Ibne & Akhtar, M. & Abid, R.. (2020). Prevalence of menstrual disorders in woman of reproductive age group. Pakistan Journal of Medical and Health Sciences. 14. 194-196.

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