Many women experience irregular periods — whether it’s a short-lived issue or an ongoing health concern. Irregular periods don’t always mean that something is seriously wrong; however, they can be indicative of underlying conditions that require monitoring.
To understand what an irregular cycle may look like, we’ll first explain what a normal cycle looks like for most women.
Normal periods begin when girls reach puberty — which can happen as a pre-teen or teen. The average age in the U.S. is 12. Everybody is different; although, there are signs that can indicate a girl may start menstruation — developing breasts and the growth of pubic and armpit hair.
Menstruation is the shedding of the endometrium, which is the lining of the uterus. The endometrium develops each month in preparation of nourishing a fetus; however, if fertilization doesn’t happen, the endometrium must shed. Along with mucus from the vagina, the endometrium makes up the menstrual flow, or period.
HOW LONG DOES IT LAST?
The average menstrual cycle last 28 days; however, it can vary, especially for the first few years after a young woman has her first period. Some women have cycles that are as short as 21 days and as long as 35 days. Sometimes, these irregular length periods are completely normal — although they do sometimes require medical attention, especially if they are shorter or longer. The actual bleeding or flow may last from 2 to 7 days.
The menstrual cycle starts on the first day of one period and ends on the first day of the next one. Half way through, on day 14, most women ovulate. This can cause some minor discomfort, or for some women, spotting or bleeding. Most women don’t have noticeable symptoms of ovulation though.
When you miss more than three periods in a row, it’s called amenorrhea. There are two main classifications, primary or secondary:
- Primary amenorrhea: happens when menstruation never starts at puberty.
- Secondary amenorrhea: happens later in life and is usually due to a physical cause — the periods were once normal and regular but become abnormal and irregular or absent.
What are the causes?
Amenorrhea can be caused by several things — sometimes not concerning, and sometimes needing medical attention.
- Pregnancy: women don’t ovulate when they are pregnant, so the period temporarily stops.
- Breast Feeding: breastfeeding can delay the return of your period after pregnancy.
- Eating Disorder: if you have anorexia and/or bulimia, your body weight may get too low to sustain a pregnancy. To protect your body, your reproductive system shuts down because it is malnourished.
- Obesity: Being overweight can cause amenorrhea as the excess fat cells get in the way of the ovulation process.
- Overexercise/Strenuous Exercise: excessive exercise may stop your period as the body fat may be too low.
- Thyroid Disorder: underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism) may cause periods to stop.
- Ovulation Abnormality: very irregular or frequently missed periods can cause ovulation abnormalities.
- Birth Defect, Anatomical Abnormality or Other Medical Condition: if your period hasn’t started by age 16, there may be an underlying birth defect, anatomical abnormality or other medical condition.
- Polycystic Ovary Syndrome (PCOS): PCOS is an endocrine disorder that can cause enlarged ovaries that have follicles — small collections of fluid — in each ovary. It can cause infrequent or prolonged periods, excess hair growth, obesity and acne.
- Pelvic Inflammatory Disease (PID): a relatively common infection of the reproductive organs that can lead to irregular periods and bleeding.
- Uterine Fibroids: uterine fibroids for are noncancerous growths on the uterus that can cause heavy or prolonged menstrual periods.
WHEN SHOULD YOU SEE A DOCTOR?
It can be difficult to decide is something is just a little off or if there is a more serious problem you should see your doctor about. As a general rule, if you’re worried about something to the point of asking family and friends about it, and/or researching online, you should make an appointment.
We suggest making an appointment if:
- You miss more than three periods, and you are not pregnant
- Periods become irregular after a history of being normal
- Period last for more than seven days
- Your flow is so heavy that you bleed through a pad or tampon within one to two hours
- The pain is crippling and means you need to take time off of school or work
- You have bleeding between periods (even if it is light)
HOW IS AMENORRHEA DIAGNOSED?
Your caretaker will give a complete medical exam and discuss your medical history with you. Your doctor will look at the possibility of menstrual disorders, medical conditions or medications that could be causing or worsening the problem. It’s important to see a doctor early, so a treatment plan can be established.
Treatment will be determined based on age, health, severity of the condition, tolerance to medication/procedures and your preference. There are a variety of different treatments, including hormone treatment, oral birth control pills, dietary changes and calcium supplementation and sometimes even surgery.
WHAT CAN YOU DO?
Can you prevent amenorrhea? Not really — you can only prevent amenorrhea related to dietary issues, such as under or over eating.
That said, we do recommend consistently keeping track of your periods. Phone apps and traditional calendars are a great way to track. Here’s what you should keep track of:
- The date your period starts and stops in addition to a note of how many total days it lasted.
- How heavy is your flow? Is it normal for you? Heavier? Lighter?
- Take note of any spotting between periods.
- Changes in your mood or attitude — especially sad or overwhelmed? More irritable than usual?
- Is the pain normal or more severe than usual? Does it make you feel nauseated or sick?
Recording your periods can be a helpful tool when talking to your healthcare provider — whether for a specific visit or a routine annual exam. Your healthcare provider will easily be able to see if something is abnormal or needs further examination.
How Women’s Healthcare of Morgantown Can Help
Women’s Healthcare of Morgantown can help you if you’re concerned about your periods. We see patients with problems at all stages of life and offer personal and compassionate care. If you need to schedule an appointment, give us a call at 304-599-6353 or on-line at whcofmorgantown.com.
We also have a free ebook on annual exams that can help you prepare for your annual visit with great tips for staying healthy.