Ask an expert: How are abnormal or irregular periods defined?

Although many women experience some small variations in the length or timing of their periods, significant changes to a typical cycle should be investigated to rule out several underlying conditions which may require specialist treatment. In this informative guide, highly respected consultant obstetrician and gynaecologist Mr Amer Raza shares his expert insight on how abnormality in a woman’s menstrual cycle is defined and the most common causes of irregular periods. The leading specialist also details the most impactful lifestyle modifications which can help to reduce a woman’s risk of developing menstrual abnormalities.

How are abnormal or irregular periods defined?

For the majority of women, periods last from four to seven days and occur every twenty-eight days, although menstrual cycles ranging from twenty-one up to thirty-five days in length are still considered to be normal.

Abnormality in a woman’s menstrual cycle may include:

• periods which occur more frequently than every twenty-one days
• periods which occur less frequently than every thirty-five days
• a much heavier or much lighter menstrual flow than usual
• periods which last longer than seven days
• symptoms of pain, cramps, nausea or vomiting which occur with periods
• spotting or bleeding between periods, following the menopause or after sexual intercourse

There are a number of conditions which fall under the umbrella of abnormal menstruation, including amenorrhea, where a woman’s periods have stopped entirely. Amenorrhea is defined as a lack of menstruation over a period of ninety days or more, which is considered to be abnormal unless the woman is pregnant, breastfeeding or is going through the menopause, which typically occurs between the ages of forty-five and fifty-five. Younger women who have not started their periods by the age of fifteen to sixteen, or within three years of their breasts beginning to develop, may also be diagnosed with amenorrhea.

Other types of abnormal menstruation include:

• oligomenorrhea: infrequent periods
• dysmenorrhea: painful periods with severe menstrual cramping, which exceeds the normal levels of discomfort felt by most women during their menstrual cycle
• abnormal uterine bleeding: a heavier than usual menstrual flow, bleeding or spotting in between periods, following sexual intercourse or after the menopause

What causes abnormal menstruation?

There are a wide range of possible causes of abnormal menstruation, including stress and other lifestyle factors, some types of medication and certain underlying medical conditions. Causes of irregular menstruation related to your lifestyle can include:

• stress
• your lifestyle
• some contraceptives and birth control methods
• some types of medication, including steroids or anti-coagulant (blood thinning) tablets

In addition, some types of medical conditions, which may be underlying, can affect menstruation, such as:

• uterine polyps and fibroids
• endometriosis
• thyroid and pituitary gland disorders
• conditions which cause hormonal imbalances
• pelvic inflammatory disease
• polycystic ovary syndrome (PCOS)
• premature ovarian insufficiency

Although rare, abnormal menstruation can also be a sign of uterine or cervical cancer. If you are concerned about symptoms of abnormal menstruation, you should see a specialist to establish the cause of any irregularity and rule out more serious underlying causes.

It’s important to keep an accurate record of any changes you observe in your menstrual cycle. This should include the start date and length of your periods, any bleeding or spotting between periods and symptoms which accompany your periods, including cramping and pain. You should also track how heavy your periods are and if you pass large blood clots.

The best treatment option for each patient depends on the underlying cause of menstrual irregularity. After carrying out the necessary investigations, the best course of treatment can be selected. Some underlying conditions, such as uterine fibroids or endometriosis, may require surgical treatment, while in other cases, simple pain control may be the best approach to treatment.

Is it possible to prevent abnormal menstruation?

Although it is not always possible to prevent irregularities in your menstrual cycle, the following lifestyle advice can help you to lower your risk of abnormal menstruation.

Adopt a healthy lifestyle

Follow a healthy lifestyle and eat a balanced diet. If you are looking to lose weight, aim to do so gradually, rather than following extreme diets which excessively limit your calorie intake.

Find ways to relieve stress

Incorporate stress relief and relaxation activities into your daily life, such as mindfulness or breathing exercises. Take enough rest and practise healthy sleep habits

Take part in moderate exercise

Exercise moderately, as excessive or endurance sporting activities can cause abnormal menstruation

Contraceptives and sanitary products

Speak to your doctor about any doubts you have about your contraceptive method of choice. It’s important to use birth control pills or other devices as directed. You should change sanitary pads or tampons every four to six hours to help avoid toxic shock syndrome and infections.

If you are concerned about abnormal menstrual symptoms or changes in your periods, you can schedule a consultation with Mr Raza by visiting his Top Doctors profile.