Irregular periods | NHS inform

Most people who menstruate have their period around every 28 days, but it’s different for everyone.

Periods can range from day 24 to day 38 of your cycle.

Signs of irregular periods can include:

• the number of days in between each of your periods is different and keeps changing
• the amount of menstrual blood changes from one period to the next
• your periods come closer together – less than 25 days from the start of one to the start of the next one
• your periods come further apart – longer than 35 days between the start of one and the next one

Some people might have a less regular cycle, and experience a different cycle each month (this is often the case when girls first start their period). However, it can also be caused by things like stress, certain health conditions or pregnancy. Irregular periods can also be a sign of menopause. Most of the time there’s no need to worry but sometimes it is important to speak to your doctor.

If you think you might be pregnant, it’s important to take a pregnancy test as soon as possible.

Further information on your options if you’re pregnant

Non-urgent advice:

Speak to your doctor if:

You’re not pregnant and:

• you have started your period but haven’t had one for a while (around 3 to 6 months)
• you bleed between your period, after sex or after the menopause
• you experience irregularities with your periods for example the number of days in between your period keeps changing
• your periods are closer together or further apart than usual

If you’re seeing your doctor, there are some useful pieces of information to think about beforehand:

• the first day of your last period (when it started)
• how many days your period usually lasts
• what was the shortest time between your periods (from the first day of one period to the first day of the next)
• what was the longest time between your periods (from the first day of one period to the first day of the next)
• how often you need to change your period products on a heavy day
• if you are over 25, when you had your last smear test

It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor who can decide if any tests or treatments might be needed.

Irregular periods can be caused by lots of different things, usually involving hormonal changes, including menopause or hormonal contraception.

Your menstrual cycle is regulated by 2 hormones, oestrogen and progesterone. Both of these hormones can be affected by natural changes in your body. For example puberty, pregnancy, childbirth, breastfeeding and menopause.

Your period will start during puberty. It can take up to 2 years for oestrogen and progesterone levels, and your periods, to settle.

Your period will stop during pregnancy but you might still experience some bleeding or spotting early on. If you’re worried about bleeding during pregnancy, speak to your midwife, doctor or local early pregnancy centre.

Most women won’t have periods when they’re exclusively breastfeeding. But you can still get pregnant so you should think about your contraceptive options if you don’t want another pregnancy.

Irregular periods can be common before menopause. The amount of menstrual blood can vary from one period to the next.

Other things that can cause irregular periods are:

• stress
• weight gain
• eating disorders
• extreme exercise
• hormonal contraception

Irregular periods can also be caused by underlying health conditions, including:

• endometriosis – a long-term (chronic) condition where tissue similar to the lining of the womb is found elsewhere in the body
• pelvic inflammatory disease – an infection of the womb, ovaries and/or fallopian tubes
• fibroids – non-cancerous growths that can develop in the muscular wall of the womb
• adenomyosis – when the tissue that normally grows within the womb (the lining) grows into the muscular wall of the womb instead
• polycystic ovary syndrome – a hormonal condition which affects how your ovaries work
• thyroid problems

In rare cases, irregular periods may be a sign of cancer of the womb or the neck of the womb (cervix). These cancers can cause bleeding in between periods or during sex. If you’re worried, speak to your doctor.

What is Considered an Irregular Period?

Dama Awadallah

Before getting into irregularities, let’s start by defining what a regular period is. A 28-day cycle with a period that lasts 4-7 days is just a rough average. In truth, everyone’s “normal” is a bit different, and the best way to figure it out is by tracking different factors related to your period.

A period is considered irregular if the timing or flow is not within normal ranges or if you experience any unusual changes or pain.

How to Spot an Irregular Period

Timing

• Cycle length – A cycle that takes place every 21 to 35 days with a period that lasts between 2 to 8 days is within the normal range. A cycle is the number of days between the first day of your period each month. So if your period started on January 1st and the next period started on January 27th your cycle would be 26 days [1].
• Cycle regularity – While some variation in the length of your cycle is normal if your period is 21 days one month and 35 days the next, that would be a cause for concern even though it’s within a “normal” range [3].

Flow

• Flow – Menstrual flow is the amount of blood loss during your period. Tracking your flow is useful so that you can notice if your flow becomes lighter or heavier than usual.

  Menorrhagia is the term for excessive or prolonged bleeding. If you find yourself changing a pad or tampon more than once every two hours or if your period lasts longer than 7 days, contact your doctor as too much blood loss can lead to anaemia or may be a sign of ectopic pregnancy or miscarriage [3].

Additionally, while small blood clots are normal, larger clots may signify an underlying problem. Generally, a dime-sized clot is normal, while clots bigger than a quarter should be checked out [2].

• Abnormal bleeding – Are you noticing any blood between periods? While some spotting during ovulation is normal for some menstruators, bleeding between periods is generally considered irregular and should be discussed with your doctor [3].

Other Symptoms

• Pain – Unfortunately for many, cramps are part of the package deal that comes with periods. While some pain is normal, excessive pain with nausea or vomiting isn’t. If your pain is interfering with daily living or if you notice changes, that might be a sign to get checked out and find a way to ease the pain [2].
• Changes – For some, mood or behavioural changes or symptoms such as headaches, bowel symptoms, and breast tenderness are completely normal. It’s worth tracking these symptoms so that you know what’s normal for you and can be sure when a new symptom pops up [2].

What causes Irregularities?

So what causes these irregularities? Well, it depends. There are times in life when irregular periods are completely normal.

• Menarche is the term used for the first period that many people with uterus get when they’re between 8 to 15 years old. During the first 3 years, the cycles can be erratic, but they will normalize in time and become more regular [2].
• Perimenopause is the period of time before menopause when a person’s period begins to naturally come to an end. During this time it’s normal for periods to start occurring less frequently. Menopause occurs when someone doesn’t have their period for 12 months in a row. This usually occurs between the ages of 45 to 55 for most menstruators [2].
• An occasional irregular period now and then is totally normal. In times of stress, such as an illness or during travel, it’s possible to have a missed period or have some spotting. Good sleep hygiene and maintaining a healthy weight might get you back on track. If your period doesn’t normalize within 90 days consult a doctor to find out what’s happening [5].

On the other hand, irregularities might be caused by external factors such as medication, pregnancy, or certain medical conditions. 

What to do about it?

Tracking your cycle and symptoms associated with your period is the best way to know when changes occur and what is irregular for you. There are multiple period trackers available as apps as well as the inne minilab to keep track of your ovulation. The minilab works by measuring the hormone progesterone in your saliva and can help to notice irregularities and confirm ovulation. 

For those that are trying to get pregnant, irregular periods can be extra frustrating. Tracking ovulation can be one way to help with timing and remove uncertainty from the process. 

Even if your period works like clockwork, arriving the moment you expect it to and lasting exactly 2-6 days, it’s normal for bodies to change over time. Whether it’s stress or your body is entering the menopausal period, knowing your “normal” and paying attention to changes by tracking them is invaluable for when those changes do inevitably come.

References 

1. Reed BG, Carr BR. The Normal Menstrual Cycle and the Control of Ovulation. [Updated 2018 Aug 5]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279054/
2. https://www.womenshealth.gov/menstrual-cycle/your-menstrual-cycle
3. https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding
4. https://www.pharllc.com/wp-content/uploads/2014/03/Fraser-Semin-Reprod-Med-2011.pdf
5. https://my.clevelandclinic.org/health/diseases/14633-abnormal-menstruation-periods
6. https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-cycle/art-20047186
7. Chao S. The effect of lactation on ovulation and fertility. Clin Perinatol. 1987 Mar;14(1):39-50. PMID: 3549114. https://pubmed.ncbi.nlm.nih.gov/3549114/

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Treatment of menstrual disorders and irregular periods

Text created with the participation of gynecologist Natalia Dmitrievna Sadova

Menstrual disorders are not standard changes in a woman’s usual MC. Currently, MC disorders are recognized by doctors around the world as factors that affect the performance and life of women, in connection with the pain and suffering they experience. Therefore, the treatment of menstrual irregularities is of great importance and necessary for the return of comfort to women in their lives. Obstetrician-gynecologists of the clinic “Dynasty” will help each of their patients in the diagnosis and professional treatment of menstrual disorders.

TREATMENT OF MENSTRUAL CYCLE DISTURBANCES AVAILABLE IN THE BRANCHES:

Treatment of menstrual disorders in the Primorsky district

Address: St. Petersburg , Primorsky district, st. Repishcheva, 13

Treatment of menstrual disorders in the Petrogradsky district

Address: St. Petersburg , Petrogradsky district, st. Lenina, 5

Treatment of menstrual disorders in Vsevolozhsk

Address: Vsevolozhsk , Oktyabrsky pr-t, 96

Description of menstrual disorders

Physiological monthly uterine bleeding, during which the unfertilized ovum, together with menstrual blood, endometrial particles and mucous membranes of the cervix, leaves the female body, is called menstruation. Normally, their volume is about 150 ml. The term menstrual cycle combines not only menstruation, but the entire period from the maturation of the egg until the moment of its ovulation and the growth of the endometrium for the subsequent introduction of a fertilized egg into it. In the normal course of the ovarian-menstrual cycle, monthly menstruation occurs with systematic periodicity and duration. Any change from the norm in the MC is considered a disorder, which implies the need for timely treatment of menstrual disorders.

Menstrual disorders manifest themselves in different ways. They vary depending on symptoms and signs, including pain during menstruation, heavy discharge or irregular menstrual bleeding for up to three months, or a reduction in MC for less than 21 days. An irregular menstrual cycle is associated with a problem in the work of the hypothalamic-pituitary-ovarian axis, therefore, early detection and treatment can minimize the complications of a woman’s reproductive abilities.

Menstrual disorders are classified into the following types:

1. Premenstrual disorders:

• Premenstrual syndrome. It occurs one to two weeks before menstruation and refers to physical and emotional symptoms. Symptoms can vary from mild to very significant and unpleasant manifestations (depression, irritability, headache, increased appetite, etc. ).
• Premenstrual dysphoric disorder occurs within a week before menstruation and presents as a severe mood disorder that affects cognitive and physical functions.

2. Violations of the duration of the MC (with a norm of 21-45 days):

• Amenorrhea – non-onset of MC during reproductive age (during pregnancy and lactation) or beyond reproductive age (in childhood and after menopause).
• Irregular menstruation – exceeding the duration of MC 8 days.
• Polymenorrhea – menstrual periods 21 days apart or less.
• Oligomenorrhea – infrequent periods, mild in manifestations, with intervals of more than 35 days.

3. Violations of the MC (at a rate of up to 7 days):

• Abnormal uterine bleeding – changes in the course of bleeding (regularity of the flow, its volume and duration). Bleeding may occur between periods after intercourse and after menopause, during pregnancy is excluded.
• Metrorrhagia is irregular monthly bleeding that does not occur at the expected MC interval. The reasons may be: abnormal blood clotting, failure of hormonal regulation or in the endometrial mucosa of the uterus.
• Hypomenorrhea – abnormally rare menstruation.
• Menorrhagia is an abnormally heavy and prolonged menstrual period.

4. Ovulation disorders:

• Oligoovulation is unstable or infrequent ovulation of less than 8 cycles per year.
• Anovulation is not the onset of ovulation in its usual time period. It manifests itself in the form of irregular periods, inconstancy of intervals of duration or bleeding. May cause missed periods or excessive bleeding.

5. Other menstrual disorders:

• Spasms.
• Dysmenorrhea.
• Painful menstruation (pain may be constant or intermittent, sharp or aching and aching).

Symptoms of disorders

One of the most common MC violations:

• spotting between regular periods;
• decrease in days (rarely prolongation) between subsequent cycles;
• more profusion of menstrual bleeding compared to the norm.

The appearance of any changes may be a symptom of ovarian dysfunction. More attentive to the violation of the MC should be women after 45 years. Ovarian dysfunction may be accompanied by disease of the thyroid and pancreas, kidneys or adrenal glands.

MC Delay

An unplanned absence of menstruation within five days of a woman’s usual schedule is considered a MC delay. The reason for this may be pregnancy, which can be confirmed or refuted using a rapid test, as well as contact a medical center for consultation and further diagnosis.

What causes a change in MC

Doctors consider hormonal changes to be one of the causes of MC changes. Factors that affect the functioning of the hormonal system can be conditionally divided into:

1. Pathological:

• ovarian disease or surgery;
• disorders of the hypothalamic-pituitary system;
• pathological changes in the endometrium;
• existing chronic diseases in the uterus;
• genital infections;
• oncological diseases;
• consequences of abortion;
• diseases of the liver, kidneys;
• coagulopathy.

2. Medications (drugs affecting MC):

• hormonal contraceptives;
• anticoagulants;
• anticonvulsants;
• glucocorticosteroids;
• dilantin and digitalis preparations;
• antidepressants;
• use of an intrauterine device;
• tranquilizers.

3. External (physiological):

• frequent stress;
• malnutrition;
• abrupt climate change;
• lack of sleep.

Violation of the MC is also directly affected by age. So in a teenager, violations of the MC are often observed. The causes of irregular periods in a girl are due to the fact that the MC becomes stable only for several years from the day the first menstruation begins. Therefore, irregular periods should not cause panic in adolescence, it is during this period that the volume of secretions, the duration of MC and menstruation differ. In the case when the MC of the girls has already been established, and the violations have begun to occur again, you need to contact a gynecologist and, if necessary, treat the violation of the menstrual cycle.

Under the supervision of doctors in women after 20 years, MC should be normally stable and systematic. The causes of its violation can be gynecological and systemic diseases, hormonal contraceptives.

After 40 years, the restructuring of the woman’s body to the subsequent menopause begins, the processes of hormonal restructuring are activated. The basis for the violation of the cycle of menstruation during this period can be a decrease in estrogen produced by the ovaries. This can be a reason for meager periods or, on the contrary, abundant ones, as well as a reduction and irregularity of the cycle. Another cause of the violation is the formation of a follicular cyst. The cyst grows in size, but later heavy menstruation follows. This period can last up to 8 weeks, and a woman may mistake this for pregnancy. Also, the MC increases after an abortion, while recovery can take up to two to three months, but if there are concomitant complications, then for a longer period. Frequent reasons for the failure of the menstrual cycle in this age group are cysts, fibroids, endocrine disorders, etc.

At age 50, MC may still be stable despite approaching menopause and this is normal. The intervals between cycles become longer, the body produces a large amount of sex hormones. At this time, you should be more careful about disease prevention, visit a mammologist and gynecologist.

In case of violations of the MC, the occurrence of pregnancy is possible, but it directly depends on the degree of the woman’s disorders. In the early stages of pregnancy, menstrual irregularity often leads to spontaneous interruption.

Diagnostics of MC violations

In the event that any abnormalities occur in the MC, the woman should contact the obstetrician-gynecologist of the clinic for further advice and treatment. The doctor begins the diagnosis with an in-depth anamnesis. It is clarified whether the woman had a pregnancy and how it proceeded, what methods of contraception were used by the patient, the list of diseases she had and the presence of surgical interventions, and the BMI is calculated. The doctor’s next step will be a gynecological examination.

Further diagnostics may include:

• blood test for hormones;
• complete blood count;
• urinalysis;
• gynecological ultrasound;
• vaginal flora swab;
• colposcopy;
• Pap smear (Pap test).

The gynecologist of the clinic, having received the results of the diagnosis, will prescribe the appropriate treatment for the patient’s menstrual disorders. In this case, the doctor may additionally prescribe a consultation of other specialists (therapist, endocrinologist, surgeon).

Treatment of menstrual disorders

The primary task of the doctor is to eliminate the cause of the disease, therefore, the treatment of irregular periods is based on the results obtained during the diagnosis. Having learned the cause of MC disorders, the clinic doctor can use the following methods:

1. Hormone therapy (thyroid replacement therapy, hormone therapy with progesterone and estrogens, oral contraceptives, gonadotropins).

2. Anesthesia and spasm relief (antibiotics, anti-inflammatory drugs, uroseptics, vitamin complexes).

3. Surgical methods. Surgical intervention is performed if neoplasms of the genital organs are found. Removal of the endometrium, accumulated blood clots in case of excessive uterine bleeding is carried out if hormone therapy is not effective.

In the case of physiological causes of MC disorders, the doctor prescribes recommendations to the woman on normalizing the daily regimen, ensuring proper rest, developing a healthy diet, and a system of moderate physical activity is prescribed.

If a woman has problems with MC, she should immediately make an appointment with the doctor of the clinic and receive timely and high-quality treatment.

Reception conducted by gynecologists:

Choose a branchClinic “Dynasty” in St. Petersburg, Krasnogvardeisky districtClinic “Dynasty” in St. Petersburg, Petrogradsky districtClinic “Dynasty” in St. Petersburg, Primorsky districtClinic “Dynasty” in VsevolozhskVisiting service

Pediatric specialists

Consults online

Abazyan Lilit Gagikovna

Obstetrician-gynecologist, gynecologist-endocrinologist, first category

Atajanyan Anna Sarikovna

Obstetrician-gynecologist, gynecologist-endocrinologist, ultrasound specialist

Gavrilyuk Nina Bokhadyrovna

Obstetrician-gynecologist

Ginzhul Galina Mikhailovna

Obstetrician-gynecologist, pediatric gynecologist, oncologist, mammologist, second category

Ivanova Ekaterina Alekseevna

Obstetrician-gynecologist

Krisanenko Julia Georgievna

Obstetrician-gynecologist

Najaryan Marine Tigranovna

Obstetrician-gynecologist

Sadovaya Natalya Dmitrievna

Obstetrician-gynecologist, candidate of medical sciences

Samarina Olga Vladimirovna

Obstetrician-gynecologist, gynecologist-endocrinologist

Tuzhik Anastasia Petrovna

Obstetrician-gynecologist, gynecologist-endocrinologist

Cost of treatment of menstrual irregularities:

Service name	Price in rubles
	St. Petersburg	Vsevolozhsk
Primary appointment with obstetrician-gynecologist 1st stage	2100	1850
Repeated appointment with an obstetrician-gynecologist 1st stage	1900	1650
Primary appointment with an obstetrician-gynecologist, level 2	2500	–
Obstetrician-gynecologist re-appointment 2nd stage	2300	–
MANIPULATION
Insertion of obstetric pessary	1500	1500
Intrauterine device (IUD) insertion	2500	2500
Insertion of the Mirena intrauterine device	4000	4000
Insertion of implantable contraceptive “IMPLANON” (without contraceptive cost)	2500	2100
Video colposcopy	2000	1700
Swab collection (gynecological)	400	400
Instrumental removal of the intrauterine device (IUD)	2500	2100
Intravaginal suppositories (excluding the cost of medicines), 1 procedure	500	500
Vaginal treatment	700	700
Medical abortion	13000	13000
Topical treatment of the vulva	700	700
Obstetric pessary removal	1000	1000
Intrauterine device (IUD) removal	1500	1500
Removal of the Mirena intrauterine device	3000	3000
Implantable contraceptive removal “IMPLANON”	2500	2300
Removal of a foreign body from the vagina	1800	1800
Endometrial streak biopsy (pipel diagnostic)	1500	1200
Plasmolifting of the intimate area (PRP-therapy), 1 area	3900	–
Plasmolifting of the intimate area (PRP-therapy), 2 zones	5200	–
Plasmolifting of the intimate area (PRP-therapy), 3 zones	6500	–
ULTRASONIC AND FUNCTIONAL DIAGNOSIS
Pelvic ultrasound (single transducer)	1800	1300
Pelvic ultrasound (two probes)	1900	1500
Folliculometry (1 study)	1400	1400
Folliculometry (4 studies)	3900	3900
PREGNANCY ULTRASOUND
Pregnancy ultrasound	1900	1500
Pregnancy ultrasound (I, II and III trimesters)	2000	2000
1st trimester ultrasound screening	3000	–
1st trimester ultrasound screening (multiple pregnancy)	3600	–
Ultrasound screening II, III trimester	3250	–
Ultrasound screening II, III trimester (multiple pregnancy)	3900	–
Uteroplacental blood flow Doppler (fetal Doppler)	1200	–
CTG (fetal cardiotocography)	1800	–
CTG (multiple pregnancy)	2300	–
LASER SURGERY
Cervical biopsy + histology	5000	4000
Single cervical cyst	1500	1500
Solitary papillomas and condylomas of the vaginal walls	3000	3000
Generalized condylomatosis, papillomatosis	from 6000	from 6000
Removal of single warts, papillomas of the vulva, cervix (for 1 unit)	600	600
Ectopia (erosion) of the cervix (less than 2 cm)	6000	4000
Ectopia (erosion) of the cervix (more than 2 cm)	9000	9000
Cervical endometriosis (single focus)	1000	1000
RADIOSURGERY
Radioknife cervical biopsy	2500	2000
Treatment of vulvar leukoplakia and kraurosis with the radiosurgical knife	5300	5100
Treatment of cervical pathology with a radiosurgical knife up to 1 cm	5000	3700
Treatment of cervical pathology with a radiosurgical knife up to 2 cm	6500	6000
Removal of cervical polyps with a radiosurgical knife	4000	2500
Fulguration of cysts, endometrial lesions with radiosurgical knife	3500	2200
Electrocoagulation of warts on the skin in the perineal area with a radioknife (for 1 unit)	800	800
Electrocoagulation of warts, papillomas of the vulva with radioknife	1400	1400
Electrocoagulation of condylomas, vaginal papillomas with radioknife	from 3200	from 3200
OPERATIONS
Intimate contouring	–	26000
Surgical defloration	8000	8000

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Irregular cycle | Bionorica

Let’s talk about which menstrual cycle is considered regular and which is not. And what should be the deviations from the regularity, so that you can start to worry.

• Signs of a normal cycle
• Why are these changes cyclical?
• Why should the cycle be regular?
• How to set up a cycle?

The menstrual cycle is a complex of cyclic changes in the body of a non-pregnant healthy woman of reproductive age. The beginning of the cycle is the 1st day of menstrual bleeding.

Signs of a normal cycle

Why are these changes cyclical?

Since a woman was created by nature to give birth to offspring, every month conditions are created inside her for conception and bearing a fetus. If conception does not happen, the endometrium prepared for accepting a fertilized egg becomes unclaimed and is rejected. Actually, this is what we see as menstrual bleeding.

The regularity of the cycle is one of the most important signs of a woman’s reproductive health, and general health too. All phases of the menstrual cycle are controlled by the endocrine system. Deviation from the norm (a change in the regularity, profusion or duration of menstruation) is often the first manifestation of diseases of the ovaries, uterus, and sometimes other diseases not related to the reproductive system.

And vice versa – a regular, stable menstrual cycle is one of the main signs of a woman’s health.

Types of menstrual cycle disorders

Depending on which sign of the cycle has changed, the following disorders are distinguished:

These changes alone do not allow a diagnosis to be made. They only indicate that something is not working as it should. Each case requires detailed study and examination.

Why should the cycle be regular?

The regular cycle has a serious impact on many aspects of a woman’s life.

If, while reading this article, you realized that your cycle does not correspond to the described norm, or something has changed recently, this is a reason to see a doctor. Since the cycle is associated with a whole chain of hormonal interactions, it is important to restore balance as soon as possible and protect the body from the negative effects of pathological changes.

Disturbed hormonal balance affects not only the ability to become pregnant and give birth to a healthy child, but also the general well-being of a woman, the condition of her skin, hair, nails, and mood. A long-term hormonal imbalance can lead to the development of various diseases, including cancer.

How to set up a cycle?

To choose a treatment, it is necessary to undergo an examination and identify the cause of the disorders. Sometimes it takes more than one month, as it is required to take tests at different phases of the menstrual cycle. This allows the doctor to get a complete picture – the production of which hormones was disturbed, what was the root cause, and how it can be corrected.

Treatment does not necessarily involve the use of hormonal drugs. Today, there are non-hormonal remedies that allow you to restore the female cycle. These include Cyclodinone ^® , a herbal non-hormonal drug that purposefully has a normalizing effect on the production of a number of hormones. Due to the mild action, the drug is well tolerated and can be taken for a long time. The average course of treatment is 3-6 months. It is important to note that the drug is produced using a unique patented technology based on the concept of phytoneering (phytoneering ^® ). This technology makes it possible to produce a high-quality and effective drug from medicinal plants.

If the problem cannot be solved without hormones, there is a rich arsenal of drugs consisting of one or more hormones in various proportions.