FAQ on Irregular Menstruation

by Dr Y.L.M.

Recently, my periods have become quite irregular. I had one period that was more spotty than usual, and it lasted for just 3 days. Then 2 weeks later, I had my period again. This one lasted for 5 days and was associated with heavier bleeding. What is the cause of this?

In order to understand abnormal periods or menstruation, we have to understand what goes on in normal menstruation.

The menstrual cycle is a series of changes a female body goes through every month to prepare for a possible pregnancy. For most women, this takes up the duration of 28 days. Around once a month, your uterus or womb grows a new lining, called endometrium. This is to get ready for a possibly fertilised egg to nest in.

How is the menstrual cycle regulated? I heard it has something to do with my hormones?

Yes. The hormones concerned are oestrogen and progesterone. During each menstrual cycle, your brain sends hormonal signals back and forth to your ovaries.

Let's talk about the average menstrual cycle of 28 days. Day one is considered the first day of your period. Day one to 14 is considered the follicular phase of your cycle, and ends at your ovulation. Here, a hormone called FSH (follicular stimulating hormone) rises and stimulates the development of ovarian follicles. This in turn stimulates the release of oestrogen from the ovarian follicles.

As more oestrogen is produced, FSH declines.

One follicle usually develops into the dominant one destined for ovulation, and the rest regress. This follicle aggressively secretes oestrogen, so much so that there is a LH (luteinising hormone) surge.

LH causes ovulation, and the egg is expelled into the Fallopian tube.

Then we enter the luteal phase. Now the ovaries are converted by LH to secrete progesterone instead. Progesterone induces the womb's lining (endometrium) to become thicker and secrete more. Many women tend to gain a little weight during this period in the cycle.

menstrual cycle process
In the absence of fertilisation by day 23, the ovarian follicle which had discharged the egg degenerates, and oestrogen and progesterone levels decrease. So the endometrium undergoes thinning, or involution.

Finally, by day 28, the womb lining begins to shed. Then we go back to day one, the start of your menstrual period.

If I don't have a 28-day menstrual cycle in the first place, is that normal?

Of course. Although the average cycle is 28 days, it is perfectly normal to have a cycle as short as 21 days, or as long as 35 days. Some teenagers can have normal cycles that last up to 45 days because of low or changing progesterone levels.

menstrual cycle
Women close to menopause also have abnormal cycles, such as changing lengths in cycles and heavy menstrual bleeding. Women usually start to have fewer and fewer periods between ages 39 and 51.

When you are nearing menopause, your cycles will probably get longer, and then finally stop.

So what causes irregular menstrual cycles?

Speaking strictly about the timing (too short or too long), there are many causes, a lot of them benign.

Stress is a very common cause. When you are facing a particularly anxious period in your life, such as a huge office project, or an exam, or a wedding, your cycles can go off a little.

Naturally, when you are at the onset of your menstruation – at puberty – your cycles can be a bit irregular before falling into an established pattern.

Your diet can also affect your cycles, such as during a new crash course diet (starvation). People who have anorexia can experience the absence of menstruation.

If you exercise too much, this can also cause your cycles to go off, or even stop completely. That's why female marathon runners, swimmers or other athletes sometimes don't get their periods.

Other causes include certain types of drugs, a break in your normal routine (traveling), new sexual activity, and illness.

Naturally, a delayed menstrual period may also indicate that you are pregnant!

Should I go see a doctor?

If the irregularity has occurred for a long time, then yes, especially if it's associated with excessive bleeding, pain, or having no cycles for months on end. Go see a gynaecologist as you may have some underlying condition.

But if the irregularity only occurs as a once off, then your cycles are likely to get back on track. Eat normally, don't exercise too hard, and try to deal with stress!


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