Menstruation is such a personal experience for women and yet it has been a part of all women’s lives in every land and culture for all of time. In the best case, it is a slight inconvenience that signifies the unique ability of the amazing female body to create human life. For most, it is a frequent, small burden that can occasionally cause embarrassing situations and is dreaded when it arrives during vacation. Sadly, for some it brings shame, confusion, pain, and worry and even cultural scorn. Despite this common thread that binds women together, it is often spoken of in whispers and even highly-educated women can become confused when their periods don’t follow a text-book schedule.

Young women typically start menstruating between the ages of 9-12 but it may take several years before periods settle into a predictable schedule. Similarly, as women approach the end of their reproductive years – typically in the mid 40s through the early 50s – periods often become irregular again. Throughout the interim years, most women will bleed monthly for 3-5 days and can generally count on the period starting on or around the same day of the month. This certainly isn’t the case for every woman, however, and clinicians can attest that irregular periods are one of the most common concerns reported in a women’s health care practice.

There is no denying that an unreliable cycle or one that is excessively heavy or excessively long is annoying and disruptive. However, the cause (and there are many) is rarely something dangerous. Also, it is an issue that can usually be well-managed with lifestyle modifications, medications or both. Regardless of whether your periods were once “normal” and then changed or you have had lifelong irregular periods, a consistently irregular period requires an appointment with your provider to try to identify the cause. After a simple visit and some blood work, you’ll have some answers and you can then decide if and how you would like to manage the irregular periods.

Some common causes of irregular menstruation are: pregnancy, abnormal thyroid function, too-low or too-high body weight, anxiety/depression, extensive long-distance travel, a marked increase in exercise or breastfeeding. There are many more potential causes but these are less common: polycystic ovarian syndrome, premature menopause, a physical abnormality (such as abnormal development of the uterus or tissue that completely blocks the vaginal opening), chronic disease (like diabetes), hormone irregularities other than thyroid function, medications, or blood clotting disorders.

What are some of the concerns of an irregular period?

Again, generally this is an annoying situation rather than a medically concerning one but there are a few potential problems that need intervention. Many women worry that if they are not bleeding regularly, then there might be “old blood” in the uterus that needs to come out. In fact, if a woman goes longer than about three months without a period, there is some concern that the lining of the uterus – which is supposed to shed or bleed out during a period – might become overly thickened; not quite the same as “old blood” but similar enough to make it a valid concern. If this continues to happen over many years, the overly thickened lining becomes a risk for abnormal cell growth and that, in turn, can be a risk for cancer.

If you have irregular periods, you may also worry about fertility. This, too, is a reasonable concern; if a woman is not menstruating regularly, she may not be ovulating regularly and, therefore, might have difficulty conceiving. For women who are trying to conceive, providers will work to identify the cause of the irregular periods, normalize the cycle, and add medications to promote ovulation, when necessary. It is imperative to understand that abnormal periods do not definitely indicate reduced fertility, however, and it should never be considered a reliable form of birth control. Even a women who rarely sees menstrual blood could be ovulating quite regularly.

Okay, then what?

Even if you feel shy about discussing all the details your menstrual cycle, you can be certain that the providers here at Physicians and Midwives Collaborative Practice could not possibly be surprised by what you’re sharing. Our only goal is to make sure there are no significant problems (like an undiagnosed chronic illness), help you to either prevent or achieve pregnancy, and prevent the uterine lining from becoming overly thickened by irregular bleeding. Apart from that, the choice of how you would like to manage the periods is up to you after you’ve been given all the information you need to make the decision.

Certainly, after other situations (like thyroid function) are addressed, the most common choice for managing irregular menstruation is to use some type of hormonal birth control (the pill, patch or ring). These put your body on a very regular schedule by adding hormones that are almost identical to the ones your body creates on it’s own. The difference is the consistency of the dosing which translates into a very consistent bleed. Many people are happy with this and some are not. Another option is to simply accept the irregular cycles and keep track of the time between periods. If you go more than twelve weeks with no period, your provider can “induce” a period with a short course of hormone (usually progesterone) to prevent an overly thickened lining. Another choice is to have an IUD placed (one containing a small amount of progesterone which, again, keeps the uterine lining thin). This differs from the other hormonal birth control options in that it works locally in the uterus without affecting the overall systemic cycle. With or without a medical intervention, time is another frequently effective path toward resolution as many women find their body figures things out on its own.

So, while it’s clearly preferable to have a light, painless and regular period, it’s not at all uncommon for menstruation to be less friendly and more unpredictable. There’s no need to rush into clinic for one missed period (though you should take a pregnancy test), but you will likely benefit from an office visit if the periods continue to be abnormal. With a good management plan, you can leave the scheduling snafus up to your smart phone and rely on your body for convenient timing and cooperation.