Irregular Periods

Medically reviewed

Medically reviewed by Brenda G., MD | Written by Menopause Now Editorial Team | Updated: Sep 30, 2020

Did you know?

Menopause occurs only after a woman has not had her period for one year.

Irregular periods are often one of the first signs that a woman is approaching menopause. Though the exact symptoms of irregular periods vary depending on a woman's unique cycle, most women will experience irregular periods for three to ten years before periods stop completely. In fact, only 10% of women reach menopause without any irregular periods.

As menopause approaches, women's hormones become imbalanced, and because the menstrual cycle is entirely dependent upon hormones, irregular periods often occur. Keep reading to learn more about irregular periods and their symptoms, common causes, and treatment options.

About Irregular Periods

When discussing irregular periods, it is helpful to first understand what a "normal" period is. While every woman is different, normal periods are typically described as occurring every 28 - 31 days, with bleeding lasting approximately five days. The average amount of blood loss during a normal period is two to eight tablespoons.

While this is a general definition of normal periods, some women may experience menstruation differently. Thus, irregular periods might be characterized by other symptoms. What is irregular for one woman may be normal for another.

Irregular periods, then, are any alterations in a woman's typical menstrual cycle that persist for several months. Such alterations usually include abnormal bleeding and unusual cycle lengths.

Types of Irregular Periods

Irregular periods are essentially characterized by what is unusual for each individual. There are, however, specific symptoms that can help to determine if irregular periods are occurring.

Research

Recent research shows that shortened intervals between periods are one of the most common symptoms of irregular periods in early menopause.

Irregularities in length

Infrequent or too frequent periods
Missed periods

Irregularities in flow

Changes in blood flow
Blood clots larger than an inch (2.5 cm) in diameter

Irregularities in pain

Painful cramping

Fertility and irregular periods

Many women wonder about their fertility when they begin to experience irregular periods. It is important to remember that pregnancy can occur anytime before menopause, even if a woman's periods are irregular. It is quite possible during perimenopause to go months without a period, only to have it return. During this time, it is still possible to become pregnant.

Anovulation

Anovulation is when a woman's ovaries do not release an egg during a menstrual cycle, which often occurs with irregular periods during menopause. In other words, it is common for perimenopausal woman to bleed but not ovulate.

Special cases

There are some special cases that can be associated with irregular periods, including use of cyclical hormones, incomplete hysterectomy, and postmenopausal bleeding.

Click here to learn more about irregular periods or continue reading below to understand the causes of irregular periods, especially in the time preceding menopause.

Menstrual Period Calendar: Keeping Track

As women near the end of their reproductive years, menstrual irregularities are some of the first indicators of the beginning of the menopausal transition. Period calendars are an important tool for those looking to track any abnormalities. Click here to learn more about period calendars as well as how to best use them.

Tests for Irregular Periods: Blood, Hormones, and More

Another fairly common cause of irregular periods is polycystic ovary syndrome (PCOS). In order to find out if this is the case a doctor will take your blood pressure, order blood tests, and possibly also carry out an ultrasound scan.These can reveal the levels of hormones, and the presence of cysts if they exist.

Causes of Irregular Periods

Did you know?

On average, a women has 500 menstrual cycles throughout her lifetime, between the time of her first period at about age 12 to her last period just prior to menopause.

Several factors can cause irregular periods, but for women approaching menopause, the most likely cause is fluctuating hormone levels. These hormonal changes are typically experienced between the ages of 45 and 55. A woman's menstrual cycle inextricably linked to her hormones because hormones, particularly estrogen and progesterone, drive the process. When hormone production begins to taper off, periods often become irregular.

To better understand the hormonal cause of irregular periods, it's helpful to learn what functions the hormones play during menstruation.

Role of hormones during the menstrual cycle

While menstruation is orchestrated by many hormones, progesterone and estrogen are the primary ones connected to irregular periods.

Estrogen

Estrogen is responsible for thickening the uterine lining before ovulation. As levels of estrogen become erratic during menopause, this lining is often shed irregularly and can lead to heavy bleeding.

Progesterone

Progesterone plays a part in regulating the release of an egg, known as ovulation. It is also responsible for controlling the intensity and duration of menstrual bleeding. When progesterone declines during menopause, it can lead to irregular periods. During anovulation, which is common with irregular periods in menopause, progesterone is not produced, or at least not at sufficient levels.

As production of these two essential hormones begins to decrease prior to menopause, periods are usually affected. Before decreasing to a consistently low level, estrogen and progesterone levels will often fluctuate drastically and cause irregular periods.

Other Causes of Irregular Periods

Although hormonal imbalance is the primary cause of irregular periods during menopause, there are some health conditions and lifestyle triggers that can cause irregular periods.

Health conditions

Eating disorders
Polycystic ovarian syndrome
Uterine abnormalities (fibroids, cysts, polyps, and endometriosis)
Thyroid dysfunction
Irritable bowel syndrome
Tuberculosis
Recent birth, miscarriage, or dilation and curettage ("D and C")
Liver disease
Diabetes
Cancer
Anemia

Lifestyle triggers

Significant weight gain or loss
Over-exercise
Poor nutrition
Smoking
Drug use
Caffeine
Excessive alcohol consumption
Increased stress
Medication
Breastfeeding

When to See a Doctor

Many experts advise that all women speak with their healthcare providers when they begin to experience the symptoms of menopause, including irregular periods. Annual pelvic exam appointments are a good opportunity to mention irregular periods, particularly if they are bothersome or concerning. You may want to call you doctor if you have:

Infrequent or too frequent periods
Missed periods
Painful cramping
Abnormal duration of bleeding
Changes in blood flow
Blood clots

Click here to read more about the causes of irregular periods or continue reading to understand the treatment options available for irregular periods.

Possible Reasons for Unusually Heavy Periods

While oftentimes contraception is prescribed to alleviate heavy and irregular periods, some types have been known to cause them. For example, the coil - also known as the intrauterine contraceptive device (IUCD). There are a number of other contraceptives to choose from, if the coil is problematic for you.

Irregular or unpredictable periods, heavy bleeding, painful periods, and spotting between periods are all symptomatic of menstrual irregularity. The menstrual cycle is closely linked with the body's physical and emotional well-being, and irregular periods are usually an outward indicator of changes or issues in the body.

5 Reasons for Irregular Periods in Middle-aged Women

When a woman goes through her forties and fifties, she is likely to notice her periods becoming irregular, with unpredictable and potentially heavy bleeding. Irregular periods are a well-known to be a common indicator of menopause, but there are other reasons a woman may experience them during middle-age, including stress, diet, and more.

Irregular Periods Treatments

To treat this symptom of menopause, a three-tiered approach can be utilized. It is recommended to start with the least invasive option, and then work up to more drastic measures if necessary.

Lifestyle changes

Some easy lifestyle tips can help you cope with irregular periods. Leading a sedentary lifestyle or consuming too much caffeine or alcohol can exacerbate symptoms. Increased stress due to work pressure or family obligations can also increase the severity of irregular periods. By practicing stress-relieving techniques such as yoga or meditation, the incidence of irregular periods can be reduced.

Getting sufficient, restful sleep is important as well. Increasing the intake of complex carbohydrates, fruits, vegetables, and water can help balance your system, making for a smoother cycle.

Out of pocket

Women spend approximately five billion dollars a year on hormone replacement therapy (HRT).

Alternative medicine

If lifestyle changes aren't working and a woman is still experiencing irregular periods, there are further treatment options available. Alternative medicines that address the hormonal imbalance at the source are the most effective method of treatment, particularly when implemented in conjunction with lifestyle changes.

Prescription medication and surgery

For more serious incidences of irregular periods, more invasive measures can be taken, but these should always be under the supervision of a doctor. Hormone therapy and surgery also carry more risks and side effects.

Most experts recommend that women who wish to treat irregular periods first begin with lifestyle changes, then move on to alternative medicines - ideally combining the two - and, finally, look to prescriptions or surgery if nothing else seems to work.

Click on the following link to learn more about specific treatments for irregular periods.

Best Ways to Track Your Periods: Menstruation Trackers

Many companies that produce sanitary products also offer online period-tracking services; tampax being one of the more popular options. It can simply be used without needing to set up an account, by merely inputting information regarding your last period: the date, duration, and length of your menstrual cycle.

The Most Commonly Prescribed Medicine for Irregular Periods

Irregular periods are the most common indicator that a woman has entered perimenopause. For women who struggle with irregular periods, it is possible for your doctor to prescribe medicinal treatment to improve this. Discover more about the most commonly prescribed medication for irregular periods during perimenopause here.

Irregular Periods Treatments

Sources

Hutchinson, S. (2007). The Stages of a Woman's Life: Menstruation, Pregnancy, Nursing, Perimenopause, Menopause.
Love, S. (2003). Menopause and Hormone Book. New York: Three Rivers Press.
National Health Service UK. (2015). Irregular periods. Retrieved April 4, 2016, from http://www.nhs.uk/Conditions/Periods-irregular/Pages/Introduction.aspx

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Symptoms that occur before a period are commonly referred to as premenstrual syndrome (PMS) symptoms. No matter a woman's age, this term is universal. Click here to learn more about menstrual signs and symptoms as well as their differences with perimenopause symptoms.

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Spotting

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