There are several times in a woman’s life when menstrual irregularity is normal. When first start having your period and, then again, around menopause where some women will experience irregularity as their cycle slows. Severe, or long term stress may also cause an irregular menstrual cycle for some women2. Pregnancy will cause periods to cease. When a girl begins to menstruate, the cycle may take around 12 months to become regular, in response to the onset of the ovulatory cycle. Whilst ovulation usually occurs in the first 40 months after menarche, 1 out of 5 girls may not start ovulating for four to five years after their first menses3.
Peri-menopausal women may experience irregular cycles for some six to 12 months. There is no definitive time frame. However, ‘the older the women, the more likely no menstruation for six months means they are approaching menopause’. This increases by 70% if over 53 years4. It is important to consider all other factors as an underlying pathology may also cause an irregular menstrual cycle.
Without intervention, irregular periods and/or when menstruation does not occur at all can lead to symptoms of oestrogen deficiency and problems with fertility. Irregular periods are divided into two categories; ovulatory or anovulatory. It is important to differentiate between the two in order to determine whether or not the cycle has an established follicular phase, which is what promotes monthly ovulation.
A normal menstrual cycle ranges between 21 and 35 days in length and normal duration of bleeding is considered 3 to 5 days5. At the beginning and end of a woman’s fertile life, it is normal for menstruation to be irregular for several months. If irregular bleeding is occurring outside of these times, then further investigations are required.
Factors which can help to establish regular periods
Well balanced diet, nutritional supplements, herbal supplements, stress management, healthy exercise regime.
Factors which can cause irregular periods
Stress, trauma, poor diet. The oral contraceptive pill can be used to regulate periods so coming off the pill can deregulate the cycle.
Factors which may increase susceptibility to irregular periods
A personal or family history of amenorrhoea, DUB, eating disorders, thyroid disorder, PCOD, endometriosis. Eating disorders, over-exercise, excessive stress. Steroid use.
Women who have previously achieved a normal cycle and are aged between 18 and 45 and experiencing irregular bleeding, should have further investigations.