Your menstrual cycle is not always like clockwork. While some women get their periods right on schedule every 28 days, other women’s cycles are not so predictable.

A normal menstrual cycle lasts 28 days, plus or minus seven days. Menstrual bleeding is considered irregular if it occurs more frequently than every 21 days or lasts longer than 8 days. Missed, early, or late periods are also considered signs of an irregular cycle.

Period irregularities are very common and chances are you will experience them at one time or another during your reproductive years. “Irregular” can refer to the schedule, frequency, or duration of your period. It can also be about the amount of bleeding you experience, and/or the amount of pain you feel during that time of the month.

To determine whether your menstruation schedule is irregular, count from the last day of your previous period and stop counting on the first day of your next. Repeat this for three months

Periods as either “normal” or “abnormal” based on three criteria:

• how regular your cycles are
• how long the bleeding lasts, and
• how much you are bleeding.

If your menstrual cycle is irregular from time to time, it is probably no big deal. But do you know how to tell if you have reason to be concerned?

1. Stress and lifestyle factors. Stress can cause something called anovulation, when your body does not release an egg every month like it is supposed to.  It can suppress the hormones that regulate ovulation, or the release of an egg from one of the ovaries. If ovulation does not happen, a period will not happen either. Gaining or losing a significant amount of weight, dieting, changes in exercise routines, travel, illness, or other disruptions in a woman’s daily routine can have an impact on her menstrual cycle.
2. Extreme Exercise.  Intense or excessive exercise has been shown to interfere with the hormones responsible for menstruation. Working out for hours a day may put your periods on hold. Your body perceives excess exercise as an extreme stressor. Cutting back on your training and increasing your calorie count can help restore your periods.
3. Medication and Birth control pills.  Many medications can all cause irregular bleeding and in some cases make your period go away altogether and it may change your bleeding pattern, too.*Birth control pills
   contain a combination of the hormones estrogen and progestin (some contain progestin alone). The pills prevent pregnancy by keeping the ovaries from releasing eggs. Whenever you start a new type of oral contraceptive or go off another, it can make your period irregular for up to a few months as your body adjusts to its new, pill-directed cycle. Also, many birth control pills have very low estrogen content, which can cause irregular bleeding. Going on or off birth control pills can affect menstruation. Some women have irregular or missed periods for up to six months after discontinuing birth control pills. This is an important consideration when you are planning on conception and becoming pregnant.*Other medications
   Anticoagulants (blood thinners) like heparin or warfarin can make your period heavier. Some antipsychotics, antidepressants, and the drug methadone can also cause irregular delayed periods. If a new medication seems to be messing with your cycle, talk about it with your prescribing doctor.
4. Existing medical condition such as;
   *Polycystic ovarian syndrome (PCOS).
   Unpredictable or irregular delayed periods are a hallmark sign of PCOS, a hormonal imbalance that interferes with the body’s ability to ovulate normally (anovulating). In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. These can often been seen on an ultrasound. The hormonal changes can prevent eggs from maturing, and so ovulation may not take place consistently. Sometimes a woman with polycystic ovary syndrome will have irregular periods or stop menstruating completely. In addition, the condition is associated with obesity, infertility and hirsutism (excessive hair growth and acne). This condition may be caused by a hormonal imbalance, although the exact cause is unknown. . If you begin to skip periods completely, it could be a sign of PCOS or. PCOS is also the most common cause of infertility in women, yet millions have it without knowing—so seeking treatment sooner rather than later is a smart part of family planning.
   
   About 1 in 10 women with irregular menstrual cycles has PCOS.
   
   *Endometriosis
   The endometrial tissue that lines the uterus breaks down every month and is discharged into the pelvis with the menstrual flow. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs in the lower digestive tract and in the area between your rectum and uterus. Endometriosis may cause abnormal bleeding, cramps or pain before and during periods, and painful intercourse.*Thyroid Disorder
   Such as hyperthyroidism (hy-pur-THY-roi-diz-uhm). Hyperthyroidism, or overactive thyroid, causes your thyroid to make more thyroid hormone than your body needs. Hyperthyroidism can also cause fewer and lighter menstrual periods than normal. Thyroid disorders can cause irregular periods if blood levels of the thyroid hormone go too low or too high. Other health conditions that may cause an irregular cycle include sexually transmitted diseases, diabetes, fibroids, eating disorders, and endometriosis.
5. Benign tumors and other growths
   Certain harmless growths can crop up in your genital tract and affect your bleeding.
   You might have polyps in the uterus or the cervix, for example. You could also have uterine fibroids — growths that are not cancerous but can cause pain and bleeding. Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumors that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumors are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.
6. Menopause (Perimenopause)
   Perimenopause is the transition phase before you enter menopause. It usually begins in your 40s, but can occur earlier.You may experience signs and symptoms lasting from 4 to 8 years, beginning with changes to your menstrual cycle. During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle, and menstruation occurs about 2 weeks later. During perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods.
7. Premature ovarian insufficiency. This condition occurs in women under age 40 whose ovaries do not function normally. The menstrual cycle stops, similar to menopause. This can occur in patients who are being treated for tuberculosis or cancer with chemotherapy and radiation, or if you have a family history of premature ovarian insufficiency or certain chromosomal abnormalities. If this condition occurs, see your physician.

A missed or irregular period may be the first clue that you have a condition that needs medical attention.

An irregular cycle can also make it more difficult to get pregnant, especially if you are not ovulating every month. Your doctor can run tests to see if you are ovulating. Women with irregular periods who are trying to have a baby are sometimes prescribed fertility drugs to increase ovulation.

While it is possible to get pregnant on your own if you have irregular periods, it is still a good idea to be checked out by a doctor just to make sure that nothing serious is going on.

For most women, their period then lasts from four to seven days. Your “normal” will likely be different from your friends’, and that is perfectly OK. “The thing I always tell patients is that it is really about your own perspective. If it feels like its abnormal and it is bothering you, then it is,” says Dr Mahalakshmi Ratnavale, Island Hospital’s Obstetricians & Gynaecologists.

History — There are often clues about the cause of amenorrhea in a woman’s personal and family medical history. A woman should mention if she had any health problems during infancy or childhood, when her first period started (if there was a first period), and how frequently periods have occurred since. If known, the woman should also mention if there is any family history of irregular menstrual periods.

Other important points include the presence of discharge from the breasts, hot flashes, adult acne, facial or chest hair, and headaches or impaired vision. The doctors will also ask about any medications, herbs, and vitamins used; recent stress; recent gynecologic procedures; changes in weight, diet, or exercise patterns; and illnesses.

Physical examination — During the physical examination, the doctor will examine the face, neck, breasts, and abdomen. A pelvic examination will also be performed.

Testing — Depending upon the individual, the doctor may order blood tests. Because pregnancy is the most common cause of secondary amenorrhea, a urine pregnancy test is usually recommended for women whose menstrual periods have stopped. Blood tests to measure hormone levels will also be ordered.

• Mark on a calendar the dates when each period starts and stops. This information can help your healthcare provider make a correct diagnosis. Take the calendar to your appointment. Tracking your menstrual cycle is important. Consider using a calendar or app on your smartphone or tablet computer to help track irregularities in your menstrual cycle.

• Eat healthy foods and keep your weight steady.
  • If you are overweight, a balanced diet and regular exercise will help you lose weight slowly.
  • If you are underweight, make sure you are getting enough nutrition.

Talk with your healthcare provider if you are not sure what your proper weight should be, or if others are worried about your weight. A nutritionist may also be able to give you helpful advice.

• If you follow a strenuous exercise program, consider cutting back until your periods come back. If you do not want to cut back on your exercise, see your healthcare provider to see if you need to cut back on exercise, eat more calories, or need treatment.

• If you have had sex, get a pregnancy test if your period is 5 or more days late. You might want to rule out pregnancy first. Take a home pregnancy test first.

• See if you can get some counseling if you are feeling stressed out.

A couple of irregular periods per year are usually nothing to worry about. Any more than that, and you should see a doctor to be sure an ovulation problem or health condition is not the cause.

Although some women do not mind missing couple of irregular menstrual period per year, it is usually nothing to worry about. . Any more than that and any changes should always be discussed with a doctor to be sure an ovulation problem because irregular period can signal underlying medical conditions and potentially have long-term health consequences.

A one-off irregular period may not be cause for alarm. If you call your gynecologist, he or she may advise you to wait a few more cycles to see if the irregularity persists. If it does, then it’s time to see your doctor.

Our  gynecologist will be able to determine the cause of your irregular periods and help you figure out a treatment course to get your menstrual cycle back on track.