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Some women’s menstrual cycles run like clockwork, predictably starting every four weeks and lasting around five days or so. If your period does not follow this pattern, should you be concerned? Not necessarily. "Normal" menstrual cycles can range from as little as 21 days to as long as 35 days, with menstrual flow at about 2 to 3 teaspoons per cycle, says Jonathan Espana, MD, an ob-gyn at the Pavilion for Women at Texas Children’s Hospital and the Women’s Specialists of Houston. But if your periods are way off that mark, your body could be trying to tell you something.
"An irregular cycle is never really considered normal," Dr. Espana says. The exceptions are in the few years after a girl’s first period and in the years leading up to menopause. Periods can be unpredictable at those times.
According to Anne Gonzalez, MD, an ob-gyn at Memorial Hermann Memorial City Medical Center in Houston, "an occasional irregular cycle can be normal and does not necessarily warrant evaluation in a healthy woman unless it persists." For instance, missing one period because of stress may be okay, but not having a period for three to six months is abnormal and needs medical attention, Dr. Gonzalez says. Of course, if you are sexually active, pregnancy could be the reason for your irregular cycle.
What Causes Irregular Menstrual Cycles?
There are multiple reasons why your cycle may be irregular, but the most common cause is the ovaries’ failure to release an egg every month. However, changes in diet, weight, exercise, stress, travel, and work (like going from a day shift to a night shift) can also mess with your periods, says Laura Whiteley, MD, of the Memorial Hermann Medical Group.
In some cases, irregular periods may be a symptom of a bigger health issue, including:
Thyroid or bleeding problems
Uterine fibroids
Ovarian cysts or polycystic ovarian syndrome
Other health problems that may trigger changes in your menstrual cycle include diabetes, cancer, drug and alcohol abuse, and HIV infection.
Irregular Periods: When to Call the Doctor
Watch out for cycles that have been fairly predictable and then become unpredictable, Espana says. "Having excessive bleeding, bleeding in between periods, or any other abnormality of the cycle that was not present before could be the beginning of a problem," he explains.
You should call your doctor if:
You bleed for more than seven days in two consecutive months
The bleeding is heavy enough to make you feel weak or have a rapid heartbeat
The bleeding is so heavy that you soak through a pad every hour
You bleed heavily between your normal cycles
You have excessive pain or cramps while you are bleeding
You think you may be pregnant and bleeding
Also seek medical attention if you have any bleeding after menopause. "Postmenopausal bleeding is not normal and should always be evaluated by a doctor," Gonzalez warns.
How Are Irregular Periods Treated?
"Hormonal contraception is the first-line treatment for irregular bleeding," Gonzalez says. Options include pills, vaginal rings, patches, devices that are implanted under the skin, and IUDs (intrauterine devices) containing hormones.
If medication does not work, she adds, a procedure called endometrial ablation can be performed in women who no longer want to become pregnant. The operation removes a thin layer of the lining of the uterus and can stop menstruation completely or reduce blood flow significantly. As a last resort, hysterectomy may be necessary to solve the problem.
Dr. Whiteley has this advice for women concerned about their periods: "Do not be afraid to share your concerns with your doctor. I guarantee we have heard it all before — no need to be embarrassed!"
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