Irregular Periods Explained
As a board-certified OB/GYN and fertility specialist, I talk about periods, fertility, and women's health every single day. Today, I want to dive deep into the topic of irregular periods - how to know if yours are irregular, what causes it, and what you should do about it.
Menstrual Cycle Basics
First, let's start with the basics of how your menstrual cycle works. Your reproductive system involves your brain, your ovaries, and your uterus. Your brain, specifically the hypothalamus and pituitary gland, sends signals to your ovaries to stimulate egg growth and hormone production. Your ovaries then produce hormones like estrogen and progesterone, which prepare the uterine lining (the endometrium) for potential implantation of an embryo each month. If no pregnancy occurs, the uterine lining sheds - and that's what we know as your period. In a normal, regular cycle, this happens about every 28 days, give or take a few days. Many women experience irregular periods, which can be caused by a variety of factors.
Is Your Period Irregular? What Can Cause Irregular Periods?
So how do you know if your periods are irregular? An irregular period is generally defined as a cycle that is shorter than 21 days or longer than 35 days. You may also have irregular periods if the flow is unusually light or heavy, or if you skip periods altogether. Irregular cycles can be caused by things like stress, hormonal imbalances, thyroid disorders, PCOS, or other underlying conditions. Let's dive a little deeper into what can cause irregular periods. From the uterus, issues like polyps, fibroids, or endometrial overgrowth can lead to abnormal bleeding that's not a true period. On the ovarian level, conditions like PCOS (polycystic ovarian syndrome) can disrupt the normal ovulation process and lead to irregular cycles. At the pituitary level, hormonal imbalances in prolactin or thyroid hormones can impact the signals being sent to the ovaries. At the hypothalamic level, factors like malnutrition, eating disorders, chronic stress, or other medical conditions can essentially "turn off" the brain's ability to properly regulate the menstrual cycle. If you're concerned that your periods are irregular, the first step is to track your cycles for a few months. Note when your period starts and ends, how heavy the flow is, and any other symptoms you experience. This will help you and your doctor determine if there's a pattern to your irregularity. From there, your doctor may recommend some testing, like bloodwork to check your hormone levels (FSH, LH, estrogen, progesterone, prolactin, thyroid hormones, etc.), an ultrasound to look at your ovaries and uterus, or even an endometrial biopsy to rule out uterine abnormalities or cancer. The goal is to identify the underlying cause so it can be properly treated.
What Is The Treatment?
Treatment for irregular periods depends on the cause, but may include lifestyle changes, medications, or other therapies. For example, if the issue is related to PCOS, treatment may involve medications to regulate ovulation, supplements to improve insulin sensitivity, or even birth control pills to stabilize the cycle. If it's a thyroid or pituitary issue, addressing the hormonal “imbalance” is key. In cases of hypothalamic dysfunction, where the brain isn't properly regulating the menstrual cycle, treatment may involve medications to stimulate ovulation or even fertility treatments like ovulation induction or IVF. For anatomical issues in the uterus, surgical procedures may be recommended to remove polyps, fibroids, or correct other abnormalities. The most important thing is to work closely with your doctor to get to the root of the issue and get your cycles back on track.
I know dealing with irregular periods can be frustrating, but please don't hesitate to reach out for help. Your reproductive health is so important, and there are solutions available. One key thing to note is that if you're trying to get pregnant, irregular periods are a big red flag. If you're under 35 and your periods are irregular, you shouldn't wait a full year before seeing a fertility specialist. And if you're over 35, you shouldn't wait more than 6 months. Irregular cycles can be a sign of underlying fertility issues, so it's crucial to get evaluated right away if you're trying to conceive. Even if you're not trying to get pregnant, irregular periods shouldn't be ignored. Your period is a vital sign.
