Irregular Periods- By Dr. Allison Polender

What’s worse than getting your period every month?  Not getting it or not being able to predict its arrival!  Ask any woman whose period  comes at random times, and she will confirm how difficult it is to plan life around an irregular menstrual cycle.  What can cause this?  This blog post will discuss some of the reasons.

“Doctor, my periods are always right on time!  Why did I miss my period this month?”

If this is the first time you have missed your monthly menstrual cycle, it is time to see your gynecologist for an evaluation.

Pregnancy — you say you’ve been taking your birth control pills every day?  Using condoms every time?  Sometimes, even with careful precautions, pregnancy can occur.  Your gynecologist will test your blood or urine to see if this could be the reason of your missed period.

Breastfeeding — Are you breast feeding?  Breastfeeding is another time when the ovaries are not producing hormones in a monthly cycle.  When the new mother either slows down or stops breastfeeding, the ovaries begin to produce hormones again.  The first month after your period starts up may bring with it irregular bleeding.

Missed Ovulation — Once in a while, the ovary does not release an egg.  This results in either a missed period, or irregular spotting.  Missing an ovulation can be due to stress, excessive exercise / dieting,  or unknown causes.  If it only happens once or twice, it is not harmful, and the ovary usually begins ovulating again normally the following month.

Hormonal imbalance — A number of different hormonal changes can result in missed periods.  Thyroid disorders are the most common cause and their presence can be detected with a blood test.  Others could include irregularities in the pituitary hormones.  These can also be detected with blood tests.

Medications — A few types of birth control pills and intrauterine devices (IUDs) cause the lining of the uterus to become very thin.  This is a normal response to the hormones contained within these medications / devices.  When the uterine lining is very thin, when it comes time for a period, there isn’t any blood or tissue to be expelled.  So some women taking these birth control pills or who have IUDs in place don’t get a period at all.

Uterine  Polyps or Fibroids — Polyps are the overgrowth of the cells lining the uterine cavity.  Fibroids are non-cancerous growths within the muscle wall of the uterus.  Both polyps and fibroids can cause spotting or bleeding mid-month, and can be evaluated with a pelvic ultrasound. 

Menopause — Many women experience changes in their menstrual cycle up to 5 years before periods stop permanently.  This is a time called “Perimenopause”, when the ovaries stop producing hormones on a monthly cycle.  These menstrual cycle changes can result in menses coming closer together than usual, sometimes even 2 weeks apart for some women.  Other women skip menstrual cycles altogether.  Hormone level blood tests during this time are not  always reliable and often  gynecologists request that women keep a diary of their bleeding for a more accurate diagnosis. 

“Doctor, my periods have NEVER been regular.  What could be wrong?”

Most pre-teens or teens experience irregular bleeding for the first year or two after they start their period.  If this bleeding pattern continues beyond the first few years after periods start, it is time to see a gynecologist for some testing.

Polycystic  Ovarian Syndrome (PCOS) — This syndrome is characterized by either lack of menstrual bleeding or very irregular menses over many years.  Many women with this syndrome also have increased hair growth over their face, chin, or body, or suffer from acne.  This diagnosis is made with blood hormone testing and a pelvic ultrasound. 

Other hormonal imbalances — Both a low body mass index (low weight for your height) and a high body mass index (high weight for your height) can cause long-term menstrual irregularities.  In some cases, women that exercise for long periods of time every day—for example, marathon or triathlon trainers —may experience menstrual irregularities over years.   In very rare cases, the source of irregular menses can come from other causes such as adrenal abnormalities.

In summary, you should seek the advice of your gynecologist when experiencing irregularities with your period, as the cause may be a health condition that should be treated.

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