What Causes Irregular Periods and When to See a Doctor

Experiencing irregular periods can be frustrating and concerning. If you are wondering why your menstrual cycle is unpredictable, you are not alone. Approximately 14-25% of women of reproductive age experience irregular menstrual cycles, according to research on Clinical Endocrinology & Metabolism. Understanding the causes of irregular periods and knowing when to seek medical attention can help you take control of your reproductive health.

What Are Irregular Periods?

An irregular period, also known as menstrual irregularity or abnormal menstruation, occurs when your cycle deviates from the normal pattern. A typical menstrual cycle ranges from 21 to 35 days, with menstruation lasting 2 to 7 days. Your periods may be considered irregular if you experience:

• Menstrual cycles shorter than 21 days or longer than 35 days
• Missing three or more consecutive periods (amenorrhea)
• Menstrual flow that is significantly heavier or lighter than usual
• Periods lasting longer than 7 days
• Severe period pain or cramping that interferes with daily activities
• Bleeding or spotting between periods

Common Causes of Irregular Periods

1. Polycystic Ovary Syndrome (PCOS)

PCOS is one of the most common causes of irregular menstruation, affecting approximately 6-12% of women during their reproductive years. Research in Human Reproduction demonstrates that PCOS disrupts normal ovulation due to hormonal imbalances, particularly elevated androgens and insulin resistance. Women with PCOS often experience infrequent periods, missed periods, or prolonged menstrual bleeding.

2. Thyroid Disorders

Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can significantly impact menstrual regularity. A study published on Thyroid Research found that thyroid dysfunction affects menstrual patterns in up to 23% of women with thyroid disease. The thyroid gland produces hormones that regulate metabolism and interact closely with reproductive hormones.

3. Stress and Mental Health

Chronic stress, anxiety, and depression can disrupt the hypothalamic-pituitary-ovarian axis, the communication system that regulates your menstrual cycle. Research in Psychoneuroendocrinology shows that elevated cortisol levels from prolonged stress can suppress normal ovulation and lead to irregular or missed periods.

4. Extreme Weight Changes

Significant weight loss, weight gain, or eating disorders like anorexia and bulimia can cause menstrual irregularities. Studies indicate that having a body mass index (BMI) below 18.5 or experiencing rapid weight changes can disrupt hormone production necessary for regular ovulation and menstruation.

5. Excessive Exercise

While regular physical activity is healthy, excessive exercise combined with low body fat percentage can lead to hypothalamic amenorrhea. Research published in Sports Medicine demonstrates that female athletes, particularly those in endurance sports, gymnastics, and dance, have higher rates of menstrual dysfunction.

6. Hormonal Birth Control

Starting, stopping, or switching hormonal contraceptives can temporarily cause irregular bleeding or spotting. Different types of birth control, including pills, patches, IUDs, and implants, affect menstruation differently. Some methods may cause lighter periods or stop menstruation altogether.

7. Perimenopause

The transition to menopause, typically beginning in a woman’s 40s, causes hormonal fluctuations that lead to irregular periods. According to research on Menopause: menstrual irregularity is one of the earliest signs of perimenopause, occurring on average 4-8 years before menopause.

8. Uterine Fibroids and Polyps

These noncancerous growths in or on the uterus can cause heavy menstrual bleeding, prolonged periods, and irregular menstrual patterns. Studies show that fibroids affect 20-40% of women during their reproductive years, with higher prevalence in certain populations.

9. Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus, affecting approximately 10% of reproductive-age women according to data from the World Health Organization. This condition can cause irregular bleeding, severe cramping, and pelvic pain.

10. Medications

Certain medications can interfere with menstrual regularity, including:

• Anticoagulants (blood thinners)
• Antipsychotic medications
• Chemotherapy drugs
• Corticosteroids
• Antidepressants

When to See a Doctor for Irregular Periods

While occasional menstrual irregularity may not be cause for concern, certain symptoms warrant medical evaluation. You should schedule an appointment with a healthcare provider if you experience:

Immediate Medical Attention Needed:

• Bleeding so heavy you soak through a pad or tampon every hour for several hours
• Periods lasting longer than 7 days consistently
• Severe pelvic pain that does not improve with over-the-counter pain medication
• Fever and severe pain during menstruation
• Sudden irregular periods after having regular cycles

Schedule an Appointment If:

• You have not had a period for 90 days and you are not pregnant
• Your periods suddenly become irregular after being regular
• You are experiencing periods more frequently than every 21 days
• You have spotting or bleeding between periods
• You are trying to conceive and have irregular cycles
• You experience symptoms like excessive hair growth, severe acne, or unexplained weight gain (possible PCOS signs)
• You are concerned about your menstrual health

Diagnosis and Treatment Options

When you visit your healthcare provider for irregular periods, they will typically conduct:

Comprehensive Medical History: Discussion of your menstrual patterns, lifestyle factors, medications, and symptoms

Physical and Pelvic Examination: Assessment of reproductive organs for abnormalities

Laboratory Tests: Blood work to check hormone levels (estrogen, progesterone, thyroid hormones, prolactin), pregnancy test, and evaluation for PCOS or other conditions

Imaging Studies: Ultrasound to examine the uterus and ovaries for fibroids, cysts, or other structural issues

Treatment depends on the underlying cause and may include:

• Hormonal birth control to regulate cycles
• Thyroid medication for thyroid disorders
• Lifestyle modifications including stress management, nutrition counseling, and exercise adjustments
• Treatment for underlying conditions like PCOS or endometriosis
• Surgical interventions for fibroids or polyps when necessary

Taking Control of Your Menstrual Health

Irregular periods are more than just an inconvenience. They can signal underlying health conditions that deserve attention. Tracking your menstrual cycle, noting symptoms, and maintaining open communication with your healthcare provider are essential steps in managing your reproductive health.

Research consistently shows that early intervention leads to better outcomes for many conditions causing irregular menstruation. Do not dismiss persistent irregularities as normal—your menstrual health is an important indicator of your overall well-being.

If you are experiencing irregular periods or have concerns about your menstrual health, the experienced team at IVANA MD is here to help. We provide comprehensive women’s health care with personalized attention to your unique needs.

Schedule your women’s health appointment with IVANA MD in Missouri City, TX.

Call: (346) 585-4077

Location: 4220 Cartwright Road, Suite 201 Missouri City, Texas 77459

References

1. Kolstad K, Fredriksen PM, Mamen A, et al. Prevalence and characteristics of menstrual disorders in a population-based sample of Norwegian women. Journal of Clinical Endocrinology & Metabolism. 2021;106(10):e4169-e4180.
2. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction. 2018;33(9):1602-1618.
3. Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Thyroid Research. 2010;3(1):3-12.
4. Schliep KC, Mumford SL, Vladutiu CJ, et al. Perceived stress, reproductive hormones, and ovulatory function: a prospective cohort study. Psychoneuroendocrinology. 2015;76:91-100.
5. De Souza MJ, Nattiv A, Joy E, et al. 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad. British Journal of Sports Medicine. 2014;48(4):289.
6. Mountjoy M, Sundgot-Borgen J, Burke L, et al. The IOC consensus statement: beyond the Female Athlete Triad—Relative Energy Deficiency in Sport (RED-S). Sports Medicine. 2014;44(4):487-497.
7. Harlow SD, Gass M, Hall JE, et al. Executive summary of the Stages of Reproductive Aging Workshop + 10: addressing the unfinished agenda of staging reproductive aging. Menopause: The Journal of The North American Menopause Society. 2012;19(4):387-395.
8. Stewart EA, Cookson CL, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology. 2017;124(10):1501-1512.
9. Zondervan KT, Becker CM, Missmer SA. Endometriosis. New England Journal of Medicine. 2020;382(13):1244-1256.
10. World Health Organization. Endometriosis. WHO Fact Sheet. March 2023. Available at: https://www.who.int/news-room/fact-sheets/detail/endometriosis
11. American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 651: Menstruation in girls and adolescents: using the menstrual cycle as a vital sign. Obstetrics & Gynecology. 2015;126(6):e143-e146.
12. Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertility and Sterility. 2008;90(5 Suppl):S219-S225.
13. Mu F, Rich-Edwards J, Rimm EB, Spiegelman D, Missmer SA. Endometriosis and risk of coronary heart disease. Circulation: Cardiovascular Quality and Outcomes. 2016;9(3):257-264.
14. Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstetrics & Gynecology. 2009;113(5):1104-1116.
15. Carmina E, Lobo RA. Use of fasting blood to assess the prevalence of insulin resistance in women with polycystic ovary syndrome. Fertility and Sterility. 2004;82(3):661-665.

This blog post is for informational purposes only and does not replace professional medical advice. Always consult with a qualified healthcare provider for diagnosis and treatment of irregular periods or other health concerns.

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