Highly Irregular

It can be very inconvenient to have irregular periods but it helps to understand the causes, implications and solutions.

What is an irregular period cycle?

On average, a woman’s menstrual cycle lasts 28 days, but cycles can vary from 25-35 days. After puberty, most women develop a regular menstrual cycle, with around the same length of time between periods. Menstrual bleeding usually lasts 2-7 days, with the average being 5 days.

Irregular periods refer to menstruation that occurs outside the normal expected pattern. This includes:

• Bleeding or spotting between periods or after sex
• Heavy flow such that you need to change your tampon or pad every hour or two, or when you have to wear both a pad and a tampon at the same time
• Prolonged bleeding that lasts longer than 7 days
• Periods occurring more than once a month
• Periods not occurring for more than 2 consecutive months

Causes

Gynaecological conditions can occur anywhere along the reproductive tract and include cervical polyps, cervical dysplasia, endometrial polyps, fibroids and ovarian cysts. • Treatment Endometrial polyps, fibroids and cysts detected via ultrasound scan should be carefully evaluated and may need to be removed.

Polycystic ovary syndrome (PCOS) is a condition where ovulation (release of an egg) may not take place as often as normal. Many egg follicles which appear as small cysts (small, fluid-filled sacs) are found in the ovaries. The usual symptoms of PCOS are irregular or light periods or no periods at all. The production of hormones is unbalanced, and you could have higher levels of testosterone than normal.

• Treatment Hormone treatment, diabetes medication and, for overweight women, weight loss.

Hormone disorders such as thyroid dysfunction are a possible cause of irregular periods. The thyroid gland, found in the neck, produces hormones that maintain the body’s metabolism (the chemical processes your body uses to turn food into energy).

• Treatment Aims to return the level of hormones in your blood to normal.

Contraceptives An intrauterine system (IUS) which releases hormones, or contraceptive pills may cause spotting between periods. Small bleeds, known as breakthrough bleeds, are common when the contraceptive pill is first used. They usually stop within a few months.

• Treatment If you are experiencing irregular bleeding that is not settling, discuss changing to other methods of contraception.

Lifestyle factors Extreme weight loss or gain, excessive exercise or stress can all upset the hormonal balance and cause irregular bleeding.

• Treatment Relaxation techniques, stress management or counselling may be recommended.

Pregnancy Sometimes, apparently irregular periods may actually be pregnancy-related bleeding

• Treatment A pregnancy test and an ultrasound scan will confirm or rule out pregnancy, especially if you are in pain, which could mean you’re having an ectopic pregnancy or a miscarriage.

Effects on fertility

Typically, women who do not ovulate regularly have irregular periods, or in the worst case, they may not get their periods at all.

If you have irregular ovulation, your chances of pregnancy will be less, since ovulation is occurring less frequently and there are fewer opportunities for fertilisation.

Irregular ovulation also means that your hormones aren’t working well. This can lead to other issues, like an overly thin uterus (where the fertilised egg needs to implant), and abnormally low levels of the pregnancy-support hormone, progesterone. These problems can increase the risk of miscarriage.

To determine if a woman does ovulate regularly, investigations are necessary, in the form of blood tests to check the hormone levels, and an ultrasound scan to check on the uterus and ovaries.