Insights on Irregular Periods

Mr Hemant Vakharia, consultant gynaecologist and advanced laparoscopic surgeon at London Gynaecology, worked on the Mother&Baby article providing some insights on irregular periods.

What are the causes of irregular periods?

When it comes to menstrual cycles, every woman’s experience can be a bit different. It’s normal for the time between the start of one period and the next (we call this the cycle length) to vary from 21 to 42 days. Lots of things can influence your cycle, including your age, weight, birth control methods, whether you’ve been pregnant, if you’re breastfeeding, and if you’re approaching menopause. These factors can all affect your hormone levels, which might lead to changes in your period.

It’s pretty common for periods to be irregular, especially during your teenage years. This is because ovulation (when an egg is released from the ovary) isn’t happening on a regular schedule yet. It usually takes until your early 20s for things to settle down and for your periods to find a regular rhythm.

A late period is often no big deal and can happen for many reasons, like stress, traveling, slight hormone shifts, or sometimes for no clear reason at all. If your period is more than a week late, it’s considered ‘late,’ and here are some reasons why this might happen:

• Pregnancy: If there’s a chance you could be pregnant, it’s a good idea to take a pregnancy test, even if you’re using contraception.
• Polycystic Ovary Syndrome (PCOS): This is a common condition where the ovaries contain many small cysts. It can lead to irregular ovulation, which might make your period late. A doctor might suggest a scan and some blood tests to diagnose this.
• Hormonal Imbalance: Issues with thyroid or pituitary gland hormones can delay your period. A doctor can check for these imbalances with tests.
• Eating Disorders: Conditions like anorexia can lower body fat significantly, which can affect how your ovaries work and lead to late or missed periods.
• Intense Exercise: Athletes, especially those in rigorous training, might miss periods due to low body fat levels.
• Approaching Menopause: As you get closer to menopause, your periods might become more irregular due to changes in ovulation.
• No Clear Reason: Sometimes, there’s no obvious reason for a late period. If you’re not pregnant, it’s usually okay to wait a bit longer before seeing a doctor. Keeping track of your periods and any other symptoms you notice can be helpful.
• Medications: Various medications can influence your menstrual cycle

Can irregular periods happen after birth?

Typically, your period will come back around 6 to 8 weeks after you’ve had a baby. However, if you’re breastfeeding, the timing for your period to return can differ. For mothers who are breastfeeding exclusively, periods might not resume until they stop breastfeeding. But for some, periods may start again sooner. Because of this inconsistency, relying solely on exclusive breastfeeding as a method of birth control isn’t advisable.

What about irregular periods during perimenopause?

Claire Phipps, GP and menopause specialist at London Gynaecology: “The perimenopause is characterised by fluctuating levels of the reproductive hormones, particularly oestrogen and progesterone. These wild fluctuations disrupt the natural regulation of the menstrual cycle and can lead to irregular periods.”

“Overall irregular periods during the perimenopause are due to the decline in hormone production.”

Can irregular periods happen after miscarriage?

Irregular periods after a miscarriage can be caused by several factors as your body adjusts and recovers. Here’s a breakdown of some of the reasons:

• Hormonal changes: Pregnancy initiates significant hormonal changes to support fetal development. After a miscarriage, it takes time for hormone levels, such as human chorionic gonadotropin (hCG), oestrogen, and progesterone, to return to their pre-pregnancy levels. These hormonal fluctuations can disrupt your menstrual cycle, leading to irregular periods.
• Uterine Healing: The process of miscarriage involves the shedding of the uterine lining and, in some cases, the expulsion of pregnancy tissue. Your uterus needs time to heal and rebuild its lining, which can affect the timing and nature of your first few periods after a miscarriage.
• Retained pregnancy tissue: In some cases, not all the pregnancy tissue is expelled during a miscarriage. Retained tissue can lead to irregular bleeding and may disrupt the normal menstrual cycle until it’s resolved. Medical intervention may be necessary to remove the remaining tissue.
• Emotional Stress: Experiencing a miscarriage can be emotionally traumatic. Stress can have a profound impact on your body, including the disruption of the hormones which regulates the menstrual cycle. This stress can contribute to irregular periods.
• Infection or Complications: If there were complications associated with the miscarriage, such as an infection, this could also affect menstrual regularity. Infections can cause inflammation and hormonal imbalances, further disrupting the menstrual cycle.

It’s important to give your body time to recover after a miscarriage and to seek medical advice if you’re concerned about your menstrual cycle or if you experience symptoms like heavy bleeding, severe pain, fever, or foul-smelling discharge, as these could indicate an infection or other complications. Most women’s cycles return to their regular patterns within a few months after a miscarriage, but this can vary widely from person to person.

What happens with periods after stopping birth control?

When you stop taking the pill, most women will quickly go back to their usual menstrual cycle without any lasting impact on their ability to have children. However, a small number of women might experience a delay in ovulation and miss periods. This can happen because the pill works by suppressing the pituitary gland, and sometimes, it might take a bit for this suppression to lift even after stopping the pill.

If you notice missing periods after coming off the pill, it’s wise to consult with a doctor or gynaecologist. They can check for other reasons that might be causing this, like pregnancy or issues with other hormones. Even if you’ve been on the pill for many years, fertility typically returns quite soon for most women after they stop taking it.

Can irregular periods happen during breastfeeding?

Periods can be irregular during breastfeeding due to the body’s natural hormonal changes that support breastfeeding and influence menstrual cycles. Here’s why:

• Prolactin: Breastfeeding increases the production of prolactin, a hormone responsible for milk production. Prolactin also has the effect of suppressing ovulation, which can lead to irregular or absent periods. The more frequently and exclusively a mother breastfeeds (including night feeds), the higher the levels of prolactin, and the more likely it is that her periods will be delayed or irregular.
• Ovulation Suppression: Because prolactin suppresses ovulation, the menstrual cycle, which is regulated by ovulation, can become irregular. Some breastfeeding mothers may not ovulate for weeks or even months after delivery, while others may begin ovulating before their first postpartum period which is why some couples get caught out and fall pregnant.
• Energy Demand: Breastfeeding demands extra energy from the mother’s body, which can sometimes affect the body’s readiness to resume regular menstrual cycles. The body may prioritize milk production over reproductive functions, leading to irregular periods.
• Individual Variation: Every woman’s body responds differently to the hormonal changes associated with breastfeeding. Some women may experience the return of regular periods soon after childbirth, even while breastfeeding, while others may not have a period until they significantly reduce breastfeeding or wean their child entirely.

What to do / how to treat irregular periods?

• If you begin to experience irregular periods it is a good idea to keep a diary and note down when the period occurs. This can be conveniently done using one of the many apps available.
• If periods become persistently irregular or if there are any ‘red flag’ symptoms such as prolonged bleeding, heavier flow, bleeding between periods or after sex, see your GP or gynaecologist urgently.
• If a period is slightly delayed or slightly early, that is no cause for concern unless it becomes a persistent pattern. Keep an eye on things and usually the cycle will return back to normal. A pregnancy test is recommended.

Do irregular periods have an impact on fertility?

The exact impact irregular periods have on your ability to conceive will depend on the cause which your doctor will investigate. In general, if you are not ovulating you will not be able to conceive and your doctor will talk to you about this.

From a general perspective, a very high or very low BMI can affect the menstrual cycle. Women who are very slim (BMI less than 18) can also have problems with absent periods. This can be seen in women with an eating disorder or athletes with low body fat. A High BMI can be related to ovulation problems particularly in women with PCOS (Polycystic Ovary Syndrome). In this context, being overweight can mean more insulin resistance and can impact on ovulation.

Maintaining a healthy weight before pregnancy is strongly recommended, as being overweight when pregnant is not only uncomfortable but also associated with significant risk of developing gestational diabetes, pre-eclampsia (blood pressure disorder of pregnancy), increased risk of caesarean section as well as thromboembolism (blood clot).

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