What causes menstrual cycles to change? | BY HEIDI

What causes menstrual cycles to change? | BY HEIDI


     

    Occasionally having irregular periods is fairly common. But if someone often has very long or short menstrual cycles, cycles that change from month to month, or missed periods, this can stem from an underlying health issue.


    Doctors consider a person to have irregular periods if their cycles are longer than 38 days, or if the length of each cycle varies by more than 7–9 days.


    Below are some potential causes of irregular periods, their symptoms, and their treatments.


    Pregnancy

    JUSTIN TALLIS/AFP via Getty Images

    Pregnancy stops a person from having periods. A missed period or spotting instead of a period can be the earliest sign. Other signs of early pregnancy may include:


    morning sickness

    nausea

    sensitivity to smells

    breast tingling or tenderness

    fatigue

    Diagnosis

    If a person’s period is late, they might take an over-the-counter pregnancy test or request testing from a doctor. If the result of a store-bought test is positive, consult a healthcare professional about the next steps.


    Speak with a doctor as soon as possible if bleeding occurs after a positive pregnancy test, as this can be a sign of pregnancy loss or ectopic pregnancy. Ectopic pregnancies are life threatening without treatment.


    Some signs of an ectopic pregnancy include:


    pain in the pelvis or abdomen

    nausea

    vomiting

    dizziness

    fainting

    Hormonal birth control

    Hormonal birth control works by suppressing ovulation. This means that a person does not have a true period. However, people who use hormonal birth control pills, patches, implants, and intrauterine devices, called IUDs, can still experience vaginal bleeding.


    This bleeding may occur roughly once a month, like a regular period. Some people have spotting, irregular bleeding, lighter bleeding, or heavier bleeding after they start this form of birth control. For others, the bleeding stops entirely.


    Irregular bleeding due to contraception is usually not harmful, but if a person finds it undesirable or wants to try something else, they can speak with a doctor.



    Breastfeeding

    Prolactin is a hormone that plays a role in breastmilk production. It can also suppress ovulation, especially in people who exclusively and frequently breastfeed during the first months of a baby’s life. This means that a person may not get periods during this time.


    Doctors call this lactational amenorrhea. It is not harmful. Periods usually return shortly after a person starts breastfeeding less frequently or when they stop breastfeeding.


    Perimenopause

    Perimenopause is the first stage of menopause, and it begins 4–8 years before menopause starts, usually when a person is in their 40s.


    During perimenopause, the menstrual cycle may get longer or shorter at various points. Eventually, periods happen less often, and they stop altogether when menopause begins.


    Other possible signs of perimenopause include:


    hot flashes

    night sweats

    mood changes

    difficulty sleeping

    vaginal dryness

    Identifying perimenopause

    Doctors can identify perimenopause by performing blood tests. They may also perform tests to rule out other factors that can have the same effects, such as thyroid disease.


    Menopause and perimenopause are natural stages of life, not health problems that require treatment. Some of the changes that they bring can be uncomfortable or distressing, however, and doctors can recommend ways to minimize the impact.


    The right approach depends on the changes. For example, if a person experiences vaginal dryness, lubricants and vaginal moisturizers may help, while estrogen therapy may help with hot flashes.


    Stress

    High stress levels are associated with irregular periods. Scientists confirmed this in 2021 by conducting a retrospective study on cycle regularity during the COVID-19 pandemic.


    Out of 210 participants, 54% reported changes in their menstrual cycles in the early months of the pandemic. Those with higher self-reported stress were more likely to have longer, heavier periods.


    When a person is stressed, the body releases stress hormones, such as adrenaline and cortisol. These can interact with the sex hormones that regulate menstruation.


    Diagnosis and treatment

    In the short-term, stress can help people respond to threatening situations. However, chronic stress is harmful to mental and physical health.


    A person who frequently feels stressed, for any reason, may find it helpful to speak with a mental health professional, who can talk feelings through and teach ways of reducing stress. There are many stress reduction techniques that people can try.


    Learn more about why stress happens and how to manage it.



    Polycystic ovary syndrome

    Irregular periods are the most commonTrusted Source sign of polycystic ovary syndrome (PCOS), which occurs when cysts grow in the ovaries. People with this condition often have high levels of androgens, which are male sex hormones. This can stop ovulation, resulting in irregular periods.


    People with PCOS may miss periods and have heavy bleeding when periods do arrive. Other symptoms include:


    excess facial or body hair

    acne and oily skin

    weight gain

    hair loss

    difficulty getting pregnant

    insulin resistance

    Diagnosis and treatment

    There is no single test for PCOS, so a doctor bases the diagnosis on symptoms, blood test results, and an ultrasound scan to look for cysts on the ovaries.


    The treatment depends on whether the person is trying to get pregnant. If they are, medication to induce ovulation may help.


    Otherwise, hormonal birth control may help regulate the person’s cycle. Some people also find that their symptoms improve after they lose any excess weight, start avoiding high sugar foods, or both.


    Thyroid conditions

    The thyroid is a butterfly-shaped gland in the neck that produces thyroid hormones. These have an influence on the menstrual cycle.


    Having an underactive thyroid — a condition called hypothyroidism — means that the thyroid gland does not produce enough hormones. This can cause longer, heavier periods. Other symptoms include tiredness, sensitivity to cold, and weight gain.


    An overactive thyroid, or hyperthyroidism, can cause shorter, lighter periods. A person with this condition may also experience unexplained weight loss, anxiety, and heart palpitations.


    Diagnosis and treatment

    To diagnose thyroid disease, a doctor requests a blood test that checks levels of thyroid hormones. They also ask about symptoms and take a medical history.


    If a person has hypothyroidism, the doctor prescribes medication that replaces the missing thyroid hormones.


    If someone has hyperthyroidism, the doctor may recommend medication to reduce thyroid function, radiotherapy targeting the thyroid, or the surgical removal of part or all of the thyroid.




    Uterine fibroids

    Fibroids are growths that can develop in the wall of the uterus. Most fibroidsTrusted Source are noncancerous. They can range from the size of an apple seed to the size of a grapefruit.


    A person with fibroids may have periods that are painful and heavy enough to cause anemia. They may also experience:


    pelvic pain or pressure

    lower back pain

    leg pain

    pain during sex

    However, some people have no symptoms aside from irregular periods.


    Diagnosis and treatment

    Most fibroids that do not cause symptoms do not require treatment.


    Otherwise, a person may be able to manage the pain with over-the-counter medications. If someone has heavy periods, they may need an iron supplement to prevent anemia.


    A doctor may recommend surgically removing larger fibroids that cause pain or other symptoms.


    Endometriosis

    Endometriosis affects 1 in 10Trusted Source females of reproductive age. It causes the tissue that usually lines the uterus to grow outside the uterus. This can cause significant pain, especially around menstruation.


    Other symptoms include:


    heavy bleeding

    long periods

    bleeding between periods

    painful bowel movements

    pain during or after sexual intercourse

    Diagnosis and treatment

    Exploratory surgery is the only way to diagnose endometriosis. There is currently no cure, but medication and hormone therapy can manage the symptoms.


    People trying to become pregnant may need surgery to remove the tissue that is growing outside the uterus.


    Underweight

    Excessive or rapid weight loss can causeTrusted Source periods to become less regular or stop. This happens when parts of the brain stop releasing hormones that impact the menstrual cycle. The medical term for it is hypothalamic amenorrhea, and it leads to an estrogen deficiency.


    A person with underweight may develop:


    dry skin or hair

    thinning hair

    tiredness

    difficulty concentrating

    difficulty getting warm

    a low mood

    Diagnosis and treatment

    Using the body mass index (BMI), a person has underweight if their BMI is lower than 18.5Trusted Source. A doctor may calculate a person’s BMI to see if this could be the cause of irregular periods.


    How doctors approach underweight depends on the cause. A person may have unintentionally lost weight, in which case, nutritional counseling may help. However, if the cause could be an eating disorder, the doctor may refer the person to a therapist for an assessment.


    If a person finds it difficult to stop thinking about food or weight loss, or if they fixate on eating only “clean” or healthy foods, they need to speak with a medical professional. Seeking help can be hard, but it is important.


    Eating disorders can severely affect the quality of life of people living with these conditions and those close to them. Early intervention and treatment greatly improve the likelihood of recovery.


    Anyone who suspects that they or a loved one has an eating disorder can contact the National Eating Disorder Association for advice and support via:


    phone or text at 800-931-2237

    online chat, by going to this link

    These services are only open during specific hours. Someone in crisis can text “NEDA” to 741741 at any time to get support from a trained volunteer at Crisis Text Line.


    Alternatively, the Substance Abuse and Mental Health Services Administration (SAMHSA) run a Disaster Distress Helpline that people can contact on 800-985-5990 for 24-7 support.


    Many other resources are available, including:


    National Association of Anorexia Nervosa and Associated Disorders

    The Alliance for Eating Disorder Awareness

    F.E.A.S.T., who provide support and educational resources to friends and family who want to help someone living with an eating disorder

    Excessive exercise

    Excessive exercise can also interfere with the hormones responsible for menstruation. This can occur in female athletes, dancers, and others who train intensively. If intense exercise is combined with a restrictive diet, a person might develop the “female athlete triad,” which includes:


    disordered eating

    menstrual changes

    low bone mineral density, or osteoporosis

    This can result from pressure to be thin for people who participate in certain sports, such as ballet or gymnastics. In some cases, there may be a competitive advantage of having a lower body weight. Some people find it hard to stop exercising, and the medical term for this is compulsive exercise.


    Diagnosis and treatment

    A doctor may determine that exercise is causing irregular periods after asking about the person’s routine and diet. For some people, making changes to the exercise routine can help.


    If disordered eating or compulsive exercise is the cause, the person may benefit from working with a mental health professional.


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    Medications

    Certain medications can affect the menstrual cycle, including:


    blood thinning medications, such as aspirin

    nonsteroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen (Advil, Motrin)

    thyroid medications

    antidepressants

    epilepsy drugs

    chemotherapy drugs

    Diagnosis and treatment

    Medication-related changes to menstruation are not always harmful. However, if a person believes that their irregular periods are related to a medication, they may want to speak with a doctor about alternatives. A person should not adjust their dosage of any medication without consulting a doctor.


    Cervical and endometrial cancer

    Cervical and endometrial cancers can cause unusual bleeding from the uterus that may resemble a period. A person may also notice bleeding between periods or after sex.


    These types of cancer cause few symptomsTrusted Source in the early stages, so it is vital to speak with a doctor about any unexplained vaginal bleeding.


    Diagnosis and treatment

    To diagnose cervical or endometrial cancer, a doctor may take a tissue sample to send for analysis. They may also perform medical imaging tests, such as an ultrasound. Treatment for cancer may include surgery, chemotherapy, or radiation therapy.


    When to seek help

    People should speak with a doctor if they:


    stop having periods for several months and are not pregnant

    suddenly develop irregular periods, when these are usually regular

    have a cycle that is shorter than 24 days or longer than 38 days

    have a cycle that varies dramatically in length

    experience bleeding between periods or after sex

    experience bleeding after menopause

    experience other symptoms, such as unusual vaginal discharge or fever

    How to track periods

    Keeping track of when periods occur can help people recognize any irregularity and spot patterns. For example, if someone starts birth control or experiences a stressful event, they may notice that this affects their period.


    People can track periods in a diary, on a calendar, or with a period tracking app. Begin by marking the first day of a period, and continue marking the days when bleeding occurs. Within a few months, a person can tell if their periods are regular.


    Some people also note down any symptoms, how light or heavy the bleeding was, and any factors that might have affected it. It can be useful to show this record to a doctor when speaking with them about irregular periods.


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