How Normal Is Menstrual Irregularity?

young african american woman on a mirror, black and white( — Most of us have missed a period at one point or another — some with anticipation of a pregnancy, others because of anxiety or tension.

It’s important to know that most irregular periods are benign. Missed periods, too frequent periods, spotting, or bouts of heavy clotting and bleeding are usually caused by an underlying hormonal imbalance that is easily treated.

There are women who menstruate like clockwork, while others report never having had a regular cycle. But one thing is a given: shifts in hormonal balance will alter whatever pattern a woman has experienced in the past. Such shifts are especially common in conditions such as perimenopause.

What is an irregular period?

A textbook period happens every 24-29 days, but in truth what is “regular” covers a wide range. Cycles between 23–35 days are very common. A woman may get her period only one to four times a year. Or she might have periods that occur two to three times in a month and involve spotting or extremely heavy flow.

Alternatively, she may have heavy episodes of bleeding every two to three months. Irregular periods are simply what is irregular for you.

A wide variety of factors can be responsible for irregular periods, among them:

• Significant weight gain or loss
• Over-exercise
• Poor nutrition (or a diet too high in carbohydrates)
• Smoking
• Drug use
• Caffeine
• Excessive alcohol use (interfering with how the liver metabolizes estrogen and progesterone)
• Eating disorders
• Increased stress
• Polycystic ovarian syndrome/estrogen dominance
• Uterine abnormalities (fibroids/cysts/polyps/endometriosis)
• Hormonal imbalance related to perimenopause
• Medications
• Chemotherapy
• Recent childbirth, miscarriage, or D&C
• Breastfeeding

Why does being stressed out cause irregular periods?

When we are under stress, regardless of the source (danger, personal relationships, work, environment), our adrenal glands are designed to secrete the hormone cortisol. Cortisol has a direct impact on the sex hormones estrogen, progesterone, and DHEA. Eating disorders, dieting, drug use, and reliance on stimulants like caffeine and alcohol are also interpreted by the body as kinds of stress. Poor nutrition seems to physically change the proteins in the brain so they can no longer send the proper signals for normal ovulation.

Am I in menopause if I have irregular periods?

No. Irregular periods are generally an indication of hormonal imbalance, not necessarily related to menopause. Strictly speaking, women aren’t considered menopausal until they have gone for one year without a menstrual period.

If you have not had a menstrual period for a full year and then experience bleeding, this is different from irregular periods.

Am I in perimenopause if I have irregular periods?

Not necessarily, but irregular periods are one of the most common signals of perimenopause. That’s why it’s best to check in with a healthcare practitioner.

Women entering perimenopause often have irregular periods due to an imbalance of progesterone that upsets their cycle. Because progesterone regulates the amount and length of bleeding, periods can last longer and be accompanied by very heavy bleeding (also called menorrhagia or hypermenorrhagia). However, shorter or spottier periods can also indicate perimenopause.

What does it mean if I miss a period or two?

The most common type of irregular period is anovulation, or a cycle in which a woman does not ovulate (i.e., does not release an egg). This is frequently the cause of a missed period (an anovulatory cycle) and is considered normal if it occurs only once or twice a year. Clotting is also considered normal if it is cyclic.

Sporadic episodes of poor diet, high stress, emotional trauma, illness, or strenuous physical exercise are the usual suspects behind occasional anovulatory cycles. Sometimes something as simple as a family holiday or a week with the in-laws will play havoc with a menstrual cycle. Monthly periods are quite susceptible to dips and spikes in our emotions and our health.

For the most part, once our lives return to normal, so do our periods.

On the other hand, a woman will sometimes skip her period for a few months and then start a heavy period that lasts for days or even weeks. This can be a sign that a woman is entering perimenopause (see above).

A Note About PCOS…

More and more, women of all ages are appearing in clinics with irregular periods due to polycystic ovarian syndrome (PCOS), an easily recognizable and treatable condition that frequently occurs with insulin resistance. With PCOS, the ovaries produce a quantity of follicles that generate high levels of estrogen but never release an egg. The excessive estrogen stimulates the uterine lining to thicken to a point where it must slough off. Women with this condition are not having what are considered “real” menstrual periods because they do not regularly ovulate.

What if I’m just spotting or not getting a period at all?

We’ve all heard stories from friends who’ve suddenly lost a lot of weight or begun a strenuous exercise regimen, then stopped getting their period. Anorexic women or those who exercise two to three hours a day can find their menstrual cycles diminish or stop due to a decrease in body fat. These women have low estrogen and are not ovulating. This is called stress-type hypothalamic amenorrhea, and it occurs when poor nutrition and stress alter the brain’s chemistry and hormone pathways. The brain can’t trigger the right hormones for follicle development, which make the necessary estrogens. Women with this irregularity tend to be at higher risk for bone loss (osteoporosis) and other degenerative conditions and should be evaluated.

Why does my period come twice a month?

In addition to missed periods, we also see women who get more than one period in the span of a month. The causes for this are relatively unknown, but stress and lifestyle seem once again to play a major role. Ingesting medication or other substances that disrupt the luteal phase may be a factor, as well.

I bleed really heavily when I get my period. What does this mean?

Low progesterone, PCOS, fibroids or another form of hormonal imbalance may be the culprit. If a woman has two or more successive months of heavy bleeding, a check-up is called for.

Any kind of heavy bleeding can contribute to anemia. When a patient has anemia, we try to stem the heavy menstrual flow and prescribe an iron supplement. Depending on the severity of the situation we may choose from a range of progesterone therapy options along with diet and exercise modifications to help rebalance the hormonal equation. Bioidentical over-the counter, compounded, or prescription formulations are often adequate. A more serious scenario may call for a synthetic progestin such as Aygestin or Provera to bring the bleeding back under control. We will also often suggest acupuncture for relief.

What can I do about my irregular periods?

The first step is to talk to a healthcare practitioner if you are experiencing any of the symptoms described above. It’s a good idea to do the following:

• Have a complete physical, including evaluations of thyroid function and blood pressure. Also, a complete blood count (CBC) test is quite important for the diagnosis of anemia.

• A pelvic exam is critical to rule out any uterine abnormality, a cervical polyp or fibroid, or a uterine infection. These are less common causes but should be considered. Often an ultrasound will be required to evaluate the uterus, the ovaries and the fallopian tubes. Ultrasound of the uterus is useful and painless — you may already be familiar with this technique from pregnancy. If infection is a concern, antibiotics will be prescribed.

• If you are trying to become pregnant, consult with a fertility specialist or a qualified ob/gyn practitioner for further testing.

What is the treatment for irregular periods?

Most of the time, simply decreasing our stress, improving nutrition and adding adequate nutritional supplements can provide a natural way to restore regular menstrual cycles. These steps alone give the body a much needed boost and will support the natural hormonal balance and monthly cycles.

How will my doctor treat my irregular periods?

If the issue stems from an anovulatory or perimenopausal condition, a doctor may prescribe birth control pills to normalize the cycle. This is often a very successful approach.

Natural steps that can help improve your reproductive health…

For most patients, we see big improvements with the following steps:

• Make healthy dietary modifications, especially decreased intake of refined carbohydrates.

• Bridge nutritional gaps with a medical–grade multivitamin, including calcium, magnesium, and a fish oil supplement.

• Get regular but moderate exercise (this may require increasing or decreasing your current level of exercise).

• Relieve stress through exercise and other relaxation techniques.

For the majority of women who make these changes, normal menstrual cycles soon return.