“Taking back control of our menstrual cycles is one of the most powerful steps we can take in looking after our reproductive health,” Dr Brooke Vandermolen, obstetrics and gynaecology doctor and co-founder of The Birth Collective, tells Vogue. “This means getting to know your body—something many women don’t do until they need their body to do a particular function, such as getting pregnant.”
For women who experience irregular periods, technology—such as period tracker apps like Clue or Flo—can help to provide answers. “Technology can be very useful in this sense, because tracking the days of your cycle via an app can be a very accessible record of your bodily functions. I recommend the app Clue. To get the most out of it you can input as much information as possible, including how your mood, discharge and skin changes,” explains Dr Vandermolen. “The app can calculate important data, such as your cycle length; predict your fertile window; and also help to identify if you have any symptoms that need medical attention. By tracking this information, you get to know what is normal for your body, and can seek help at the appropriate time.”
If you experience irregular periods, know that you’re not alone. In September, a study suggested for the first time that women with long or irregular menstrual cycles are at greater risk of dying before the age of 70. For one, this shows there is still a lot we don’t know about menstrual cycles. While progress is being made, there is still a massive data gap when it comes to women’s health.
Below, Dr Vandermolen breaks down everything women should know about irregular periods—including what not to worry about, and when to seek medical advice.
What qualifies as an irregular period?
“Irregular periods are when the length of your menstrual cycle (the gap between the start of one period and the start of the next), keeps changing,” says Dr Vandermolen. “The average menstrual cycle lasts 28 days, although it’s normal for it to vary by a few days each month.”
What are the defining characteristics of an irregular cycle?
On the face of, periods can at the best of times feel pretty unpredictable. So, how do we know our menstrual cycle is actually irregular? “Women with irregular periods will notice that they can’t reliably predict when they will be menstruating, and as a result it is difficult to identify ovulation or pinpoint the fertile window,” explains Dr Vandermolen. “Irregular periods are common during puberty, while breastfeeding and also around the perimenopause [the time when your body makes the natural transition to menopause].” Hence why tracking your period is important. If using an app doesn’t suit you, then keep a diary. “It’s key to getting to know what is normal for you, which includes documenting other symptoms you notice throughout your cycle, such as pelvic pain, cervical discharge, PMS [premenstrual syndrome] symptoms and more,” she continues. Here are some features to look out for: your cycle lies outside of the 21 to 35 days range; periods last longer than seven days; there’s a big difference (at least 20 days), between your shortest and longest menstrual cycle.
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What causes irregular periods?
Working out what is causing your irregular periods can feel like a minefield, and there are many possible causes to be aware of. During puberty, it’s normal to have irregular periods for the first few years after your first ever menstrual cycle. Later, during perimenopause your periods may become irregular—either more frequent or more spaced out as you approach menopause. Of course, early pregnancy could be a factor (as always, if you’re late then take a pregnancy test). Dr Vandermolen advises taking note of the following factors too:
Forms of hormonal contraception: Contraception that contains progesterone, such as the combined pill or the Mirena IUD coil, causes the lining of the womb to stay thin, and may cause your periods to stop, or become very light and infrequent
Extreme weight loss or weight gain, excessive exercise or stress: These can affect your brain’s production of the hormones involved in the menstrual cycle
Polycystic ovary syndrome (PCOS) and endometriosis: These conditions can cause cysts to form on your ovaries which result in hormonal disturbances
Is it possible to ease irregular periods?
“The menstrual cycle is intimately linked to lifestyle, and changes in diet, exercise, and stress can have a big impact on your periods,” explains Dr Vandermolen. “To optimise your periods, it is a good idea to stop smoking and reduce alcohol intake. Regular exercise that is not overly excessive has a wide range of benefits. Additionally, make sure you are getting plenty of sleep (easier said than done!). Your periods will often be sensitive to stress, extreme calorie restriction and certain drugs and medications,” she says. However, if you’ve addressed all of these possible factors and you’re still experiencing irregularity, then speaking to your GP should be your next step. “If you’re not trying to conceive, then hormonal birth control is often used to help regulate your bleeding. If that’s not for you, or you want to get pregnant in the near future, then don’t delay: make an appointment to chat things through with your doctor, who may arrange some extra tests to identify if there are any underlying causes that can be treated.”
Why do some women experience irregular periods after coming off birth control?
After coming off birth control, many women experience changes to their menstrual cycles. “Many forms of birth control involve receiving extra doses of the hormones that are involved in the menstrual cycle, oestrogen and progesterone,” explains Dr Vandermolen. “Once you withdraw these hormones when you stop the pill, or remove the coil, it can take some time for your body’s natural hormone production to kick in again and for the levels to regulate out.” However, your regular cycle should return (within a few weeks or months). “In the meantime, you may experience other symptoms of the changing hormone levels, such as acne or a change in breast size. This can be due to the removal of the oestrogen hormone you were receiving as part of the birth control, or just your body naturally adjusting—especially if you’ve been taking the birth control for a long time,” she continues. “Importantly, taking hormonal birth control for a long time has no significant effect on fertility, and the majority of women who try to get pregnant after stopping birth control will be successful within the first year.”
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Is there any evidence to suggest that struggling to get pregnant is linked to irregular periods in women?
It’s quite common for women who experience changes or irregularities to their menstrual cycles to also feel concerned about their fertility—it is all linked, after all—but you shouldn’t be overly worried. “Many women have irregular periods and still conceive. Getting pregnant may take a little longer though, as you may not ovulate as frequently as women with regular periods. Underlying conditions may affect your own fertility, with the most common being PCOS,” says Dr Vandermolen. “A Finnish study showed that whilst women with PCOS may take longer to become pregnant, their lifetime fertility is not impaired. Factors that affect fertility include age, BMI, hirsutism index (hair growth) and the duration of trying to conceive,” she continues. For this reason, you should try to conceive as normal. “However, if after six months of irregular menstrual cycles, or one year of regular cycles, you have not successfully conceived, you should see your doctor for assessment,” she says.
When should a woman seek medical advice about her irregular periods?
While you may feel like you don’t want to “bother” your doctor (especially during the current Covid-19 pandemic), you definitely should if you’re concerned. There might not be anything wrong, but it’s a good idea to get checked out to see what the cause might be. Dr Vandermole recommends speaking to your GP if:
Periods suddenly become irregular and you’re under 45
Your cycle lies outside of the 21 to 35 days range
Periods last longer than seven days
There’s a big difference (at least 20 days) between your shortest and longest menstrual cycle
You have irregular periods and you’ve been struggling to get pregnant for more than six months