Normally, the menstrual period usually lasts from four to seven days. Examples of menstrual irregularities include having periods that are shorter than 21 days or longer than 35 days, not having three or more consecutive periods, and having abnormally heavier or lighter flow.

What is Menstrual Irregularity?

Most women have menstrual cycles that last between four to seven days, and a woman typically menstruates every 28 days, with a normal range of 21 to 35 days for the menstrual cycle. The menstrual cycle is the time from the first day of one period to the start of the next.

Examples of menstrual irregularities include:

• Periods lasting less than 21 days or more than 35 days
• Missing three or more periods in a row
• Much heavier or lighter flow than usual
• Bleeding lasting more than seven days
• Menstrual bleeding accompanied by pain, cramps, nausea, or vomiting
• Bleeding or spotting occurring after menopause, sexual intercourse, or between periods

Menstrual irregularities also include:

• Amenorrhea: This is the absence of menstruation in women who are not pregnant, not breastfeeding, or haven’t reached menopause (typically occurring between the ages of 45 and 55). It is considered amenorrhea if a woman goes 90 days or more without a period. Young women who haven’t menstruated by age 15-16 or within three years of breast development are also considered to have amenorrhea.
• Oligomenorrhea: This term refers to infrequent menstrual periods.
• Dysmenorrhea: This refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.
• Abnormal uterine bleeding includes having more menstrual bleeding than usual, periods lasting more than seven days, or bleeding or spotting after menopause, sexual intercourse, or between periods.

What Causes Abnormal Menstrual Bleeding?

There are many underlying reasons for menstrual irregularities, ranging from stress to more serious medical conditions:

Stress and lifestyle factors: Significant changes in a woman’s daily routine, such as weight changes, diet alterations, exercise routines, travel, illness, or other disruptions, can affect the menstrual cycle.

Uterine polyps or fibroids: Uterine polyps are small benign growths on the lining of the uterus, while uterine fibroids are tumors that attach to the uterine wall. Fibroids, ranging in size from an apple seed to a grapefruit, can cause heavy bleeding and pain during periods. Large fibroids may also cause discomfort by pressing on the bladder or rectum.

Endometriosis: This condition involves the growth of endometrial tissue outside the uterus. The endometrial tissue, which usually sheds and is expelled during menstruation, can grow on the ovaries or fallopian tubes and sometimes in the intestines or other organs in the lower abdomen area. Endometriosis can lead to abnormal bleeding, pain, cramps, or painful intercourse during the menstrual cycle.

Pelvic Inflammatory Disease (PID): PID is a bacterial infection that affects the female reproductive system. Bacteria can enter the vagina through sexual contact and then spread to the uterus and upper genital area. Bacteria can also enter the reproductive system due to gynecological procedures or through childbirth, miscarriage, or abortion. Symptoms of PID include foul-smelling discharge, irregular periods, pain in the pelvic and lower abdominal regions, fever, nausea, vomiting, or diarrhea.

Polycystic Ovary Syndrome (PCOS): PCOS involves the ovaries producing high levels of androgen (male hormone). Small fluid-filled cysts may develop on the ovaries, which can be visible on an ultrasound. Elevated androgen levels can prevent the maturation of eggs, leading to irregular periods or a complete lack of menstruation. PCOS is also associated with obesity, infertility, and hirsutism (excessive hair growth and acne). Treatment for PCOS depends on whether a woman desires pregnancy. If pregnancy is not desired, weight loss and oral contraceptive pills can regulate menstrual cycles. If pregnancy is desired, medications to stimulate ovulation may be tried.

Premature Ovarian Insufficiency: This condition occurs in women under 40 when their ovaries stop functioning normally. It is similar to menopause, where the menstrual cycle stops. Premature ovarian insufficiency can occur in those undergoing cancer treatments such as chemotherapy and radiation, have a family history of early ovarian insufficiency, or have certain chromosomal abnormalities. If this condition occurs, it is essential to consult with a doctor.

Other causes of menstrual irregularities include:

• Uterine or cervical cancer
• Medications such as steroids or anticoagulants (blood thinners)
• Bleeding disorders, inadequate or overactive thyroid gland, or pituitary gland disorders affecting hormonal balance
• Pregnancy-related complications, such as miscarriage or ectopic pregnancy (where the fertilized egg implants outside the uterus, typically in the fallopian tube).