by Marcelle Pick, OB/GYN NP
Answers to your questions
To begin with, let me reassure you 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.
Most of us have missed a period at one point or another — some with anticipation of a pregnancy, others because of anxiety or tension. At the clinic, we see women who menstruate like clockwork, while others report never having had a regular cycle. One thing is a given, however – shifts in hormonal balance will alter whatever pattern a woman has experienced in the past. Such shifts are especially common in perimenopause.
What is an irregular period?
At the clinic we answer questions all the time about irregular periods. 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 2-3 times in a month and involve spotting or extremely heavy flow. Alternatively, she may have heavy episodes of bleeding every 2-3 months. Irregular periods are simply what is irregular for you.
For the most part, we don’t worry at the clinic about a missed period or two over the course of a year. More variation than that may indicate to us the beginning of perimenopause or a disruption of the natural chain of hormonal events that controls menstruation. A wide variety of factors can be responsible for irregular periods, among them:
- Significant weight gain or loss
- Poor nutrition (or a diet too high in carbohydrates)
- Drug use
- 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 imbalances related to perimenopause
- Recent childbirth, miscarriage, or D&C
As you can see, there are many different ways a woman can be irregular for as many different reasons, and it can be very confusing when it happens.
Why does being stressed cause irregular periods?
When we are stressed, regardless of the source (danger, personal relationships, work, environment) our adrenal glands are designed to secrete the hormone cortisol (see our articles on adrenal fatigue). 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. We explain this in more detail in our article on post-menopausal bleeding.
By the way, it is a myth that a woman goes into menopause because her body runs out of eggs. If this were true, then women who experienced menarche (the first period in a woman’s life) earlier would enter menopause earlier. In fact, the opposite is true — early menarche is associated with late menopause. In the same vein, women who had more pregnancies and thereby fewer periods, would have menopause later, and that doesn’t happen, either. If you are experiencing increasing irregularity, you may be suffering from hormonal imbalance or entering perimenopause, and should be evaluated by a healthcare practitioner.
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. Click here to learn more about irregular periods in perimenopause.
What does it mean if I miss a period or two?
The most common type of irregular period we see at the clinic 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). More and more we are seeing patients of all ages come into the clinic who have irregular periods due to polycystic ovarian syndrome (PCOS), an easily recognizable and treatable diagnosis that often occurs with insulin resistance. In this condition, the ovaries produce a quantity of follicles that generate high levels of estrogen but never release an egg. The high estrogens stimulate the uterine lining to thicken to a point where it must slough off. Women with PCOS are not having what are considered “real” menstrual periods because they do not regularly ovulate. For more information, we recommend you start with our article on insulin resistance, where you will find other helpful thoughts about this topic.
What if I’m just spotting or not getting a period at all?
We’ve all heard stories from friends who have 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 proteins and hormones. 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 should be evaluated. Please click here for more information about amenorrhea.
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, too.
I bleed really heavily when I get my period. What does this mean?
Low progesterone, PCOS, or other hormonal imbalances 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. In this scenario, we often suggest a synthetic progestin such as Aygestin or Provera along with diet and exercise modifications to bring the bleeding back under control. We will also often suggest acupuncture for relief. If a patient has anemia, we try to stop the heavy menstrual flow and prescribe an iron supplement. Read our article for more information about menorrhagia (heavy periods).
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 we are meant to enjoy… and appreciate! For most patients, we see big improvements with the following steps:
- Healthy dietary modifications, especially decreased intake of refined carbohydrates.
- Supplementing nutritional gaps with a medical-grade multivitamin, including calcium, magnesium, and a high-quality fish oil supplement.
- Moderate exercise (this may require increasing or decreasing your current level of exercise).
- Stress relief through exercise or other relaxation techniques.
For the majority of women who make these changes, a normal menstrual cycle returns without a hitch.
If the issue stems from an anovulatory or perimenopausal condition, a doctor may prescribe birth control pills to normalize the cycle. This is often successful. Keep in mind however, that birth control pills are powerful hormones and often cause side effects. We recommend you start first with these more natural steps, including bioidentical progesterone cream, and only resort to birth control pills if your symptoms persist. If you do decide to take BCP’s for your irregular periods, you should still make sure to support your body in all the above-listed ways.