Overview

Irregular periods are menstrual cycles that come too often, too far apart, or at unpredictable times. In adults, a normal cycle usually lasts 21 to 35 days, counted from the first day of one period to the first day of the next, and bleeding usually lasts up to 7 days. A cycle that is often shorter than 21 days, longer than 35 days, or very different in length from month to month is considered irregular.

Periods are often irregular in the first few years after they start and in the years before menopause. At other times, a change in the cycle is worth checking with a doctor.

Symptoms

• Cycles shorter than 21 days or longer than 35 days
• Cycle length that changes by more than about a week from month to month
• No period for 3 months or more without pregnancy
• Bleeding that lasts more than 7 days
• Very heavy bleeding, such as soaking a pad every hour or passing large clots
• Bleeding or spotting between periods or after sex
• Seek prompt care for very heavy bleeding with dizziness or fainting, or for severe pelvic pain

Causes & Risk Factors

• Pregnancy, which is the first thing to rule out when a period is late
• Polycystic ovary syndrome (PCOS)
• An underactive or overactive thyroid
• A high level of the hormone prolactin
• Stress, weight gain or loss, and very intense exercise
• Perimenopause, breastfeeding, and hormonal birth control
• Fibroids or polyps in the uterus, which mainly cause heavy or irregular bleeding

Complications

• Iron-deficiency anemia from heavy or frequent bleeding
• Difficulty getting pregnant when ovulation is irregular
• Thickening of the uterine lining when periods are rare for a long time, which needs treatment
• Bone thinning when low estrogen stops periods for a long time
• A higher risk of type 2 diabetes when the cause is PCOS

Diagnosis

The doctor asks about the cycle pattern, bleeding, weight changes, stress, medicines, and other symptoms, and a period-tracking app or calendar is very helpful. A pregnancy test is usually the first step. Blood tests may check thyroid hormone (TSH), prolactin, other reproductive hormones, and a complete blood count for anemia. A pelvic ultrasound looks at the ovaries and the lining of the uterus and can find fibroids or polyps.

Treatment

• Treating the cause, such as thyroid medicine or medicine to lower prolactin
• Healthy weight changes, balanced meals, and regular activity, especially with PCOS
• Hormonal treatment, such as combined birth control pills or progestin, to regulate cycles and protect the uterine lining
• Metformin for some women with PCOS and insulin resistance
• Iron tablets when heavy bleeding has caused anemia
• Removal of polyps or fibroids when they are the cause
• Treatment to help ovulation for women who are trying to conceive

Prevention

• Tracking periods each month to spot changes early
• Keeping a healthy weight and avoiding extreme diets
• Balancing exercise with enough food and rest
• Managing stress and getting enough sleep
• Seeing a doctor early for any lasting change in the cycle

Irregular periods are assessed and treated by the Obstetrics & Gynecology department at AlHayat Medical Center.

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