Image credit: Illustration by Caitlin G. McCollom – Teen Vogue
When we first start our periods, it’s difficult to know what to expect. Aside from what we see in movies, hear from our mothers, or learn from our friends, periods aren’t talked about often. As women, we also run the risk of having our experiences and medical concerns brushed aside. This means it can be hard to tell what is normal or abnormal when it comes to our menstrual cycle.
Today, we’re breaking down everything you need to know about abnormal periods so you can equip yourself with the information you need to seek help from your family doctor or specialist!
What is an Abnormal Period?
To understand abnormal menstruation (i.e., your period), you need to understand what’s normal. Your period is a monthly cycle that prepares your body for pregnancy. During your body’s monthly cycle, it releases hormones like estrogen and progesterone to mature an egg in your ovary, preparing it for fertilization. These hormones are also responsible for the build-up of the lining of your uterus, making it thick and full of nutrients intended to support a pregnancy. An average monthly cycle lasts around 28 days, although normal can be anywhere between 21 and 35 days, as each of our bodies are different. To count how long your menstrual cycle is, start at day one of your last period until day one of your next period.
There are 4 phases in a 28-day cycle:
|1. Menstruation||Bleeding||Days 1-7|
|2. Proliferative||Lining of Uterus Builds Up||Days 8-12|
|3. Ovulation||Release of a Mature Egg||Days 13-15|
|4. Secretory*||Progesterone hormone is produced for pregnancy||Days 14-28|
*If the egg isn’t fertilized during the Secretory Phase, the body sheds the lining of the uterus, including the egg, and bleeding starts, signaling the end of the fertilization “period.”
Most women will have a period that occurs every 21 days and lasts for about 4-7 days. When girls start menstruating, it’s not uncommon for them to experience longer cycles and shorter cycles that begin to shift into becoming more regular as they get older.
So What Causes An Abnormal Period?
If you’re one of the women who fall outside of this “norm,” you’re not alone. Between 9% and 14% of women who have started menstruating, and aren’t yet in menopause, will have irregular periods1. There are so many different causes for an irregular period, and the symptoms and severity can vary. As we look at some of the common examples of abnormal menstruation, you may notice that most of these conditions end with “-rrhea.” Rrhea means “to flow” and is referencing the flow of your period.
Amenorrhea – Having NO Monthly Period
Amenorrhea (A “no” + Men “month” = No Monthly Cycle) is a condition in which a woman who is of menstruating age is not having her period. Young women tend to start their periods around 14, but usually no later than 15 or 16 (or within three years after their breasts begin to develop). If their period hasn’t started by this time, it is considered primary amenorrhea, a symptom rather than a disease.
A girl who hasn’t started her monthly cycle could be experiencing this issue due to a variety of underlying conditions, sometimes as a result of a lack of hormones being secreted, maldeveloped reproductive organs, or other problems. Treatment options are available for amenorrhea, but it’s essential for young girls to meet with their healthcare provider if they haven’t started their period by an appropriate time2.
There is also something called secondary amenorrhea. Secondary amenorrhea is when your period has begun but then stops for three months or longer2. This may or may not be cause for concern, and it all depends on the root cause of the symptom, so again, it’s imperative to communicate with your gynecologist to ensure optimal pelvic health.
Here are some of the most common causes of secondary amenorrhea that can’t be prevented:
|Pregnancy||Body stops releasing eggs to fertilize|
|Breast Feeding3||Hormones that promote milk production stop ovulation|
|Menopause||Ovaries have stopped releasing eggs|
|Birth Control Pills: Going On||Most birth control pills contain a combination of the hormones estrogen and progestin that suppress the ovaries from releasing eggs|
|Birth Control: Going Off||Some women have irregular or missed periods for up to six months after discontinuing birth control pills|
There are also stress and lifestyle factors that can cause secondary amenorrhea. These influences require you to make the necessary lifestyle changes to help promote healthier menstruation.
|Health Area||Cause4||Description||Potential Treatment|
|Mind||StressDepression||When we are stressed out, our brains are not producing the hormones needed for healthy monthly cycles.||Exercise|
Mental Health Professional
|Body||ObesityExtreme Weight Loss or GainOver Exercise||When our body is in an energy deficit, it will conserve energy by shutting down reproductive organs.|
Excess working outputs our bodies into a state of stress (see above for effects of Stress)5.
Being overweight can impact your body’s estrogen production6.
|Diet||Poor Nutrition||Not having the right types of fats that provide Omega 3’s and Vitamin D can impact your periods and pelvic health.||See our article on a Healthy Diet for Pelvic Floor Health|
|Thyroid Ovaries||Too little or too much thyroid hormones can impact your period as well as tumors on your ovaries4.||See a physician.|
Women under 40 may also experience what is known as premature ovarian insufficiency, where the ovaries aren’t consistently releasing an egg each month. This isn’t to be confused with menopause, which may have similar symptoms such as hot flashes, painful sex, infertility, or irritability. More research needs to be done to understand this disorder better. Still, researchers currently believe it may be a result of autoimmune or thyroid diseases, but may also be a result of eating disorders, infections, ovary surgery, or toxins from radiation or chemotherapy.
Having Irregular Periods
While missing your period can be a sign of a variety of conditions, so can having irregular periods. Irregular periods refer to the different variations in cycles, symptoms, and severity. Let’s take a look at a few of the common examples of abnormal periods.
- Oligomenorrhea. (Oligo “Few” = Few Monthly Periods) This is when women have infrequent periods. If 28 days is the natural cycle, Oligomenorrhea occurs when you have cycles that occur for more than 35 days. Women with this condition may only have 4-9 periods a year, and the causes are similar to those of amenorrhea.
- Dysmenorrhea. (Dys “Painful” – Painful Monthly Periods). There are two types of dysmenorrhea, primary and secondary. Primary dysmenorrhea is pain associated with monthly menstrual cramping and not from any specific disease state. This pain is caused by chemicals produced in the uterus that affects your lower body and lasts anywhere from 12-72 hours, which is quite long to suffer needlessly. Women may also suffer from nausea, fatigue, and diarrhea. In general, cramps usually become less painful as a woman gets older and has been known to stop entirely after childbirth.
Secondary dysmenorrhea is a pain that is caused by some disease of the reproductive organs. Here are some of the most common disorders7:
|Endometriosis||The uterus’s lining grows outside of the uterus, often into nearby organs like your ovaries, fallopian tubes, and bladder.||Abdominal cramps or back pain during menstruation|
Painful bowel movements
|Severe menstrual cramps|
Difficulty becoming pregnant
|Adenomyosis||The lining of the uterus grows deep into the uterus’s muscle wall, but not past it.||Thick uterus 2-3 times its normal size |
|Heavy or prolonged menstrual bleeding|
Increasingly worse cramping
|Uterine Fibroids||Non-cancerous growths developed from the tissue of the uterus inside, outside or within the uterus wall. One nodule or clusters ranging from 1 mm to more than 20 cm (8 inches) in diameter may develop||Excessive or painful bleeding during menstruation|
Bleeding between periods.
|Low back pain|
Chronic vaginal discharge
Severe menstrual cramps
|Pelvic Inflammatory Disease||A Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. Bacteria may enter the vagina via sexual contact and then spread to the uterus and upper genital tract. Bacteria may also enter the reproductive tract via gynecologic procedures, through childbirth, miscarriage, or abortion.||Heavy vaginal discharge with an unpleasant odor|
|Pelvic and lower abdominal pain |
|Polycystic Ovary Syndrome||Common in obese women, higher-than-normal amounts of male hormones are produced, creating a hormonal imbalance. 70% of women will have hair growth on the face and body8.||Irregular periods|
|Male-pattern baldness. |
Menorrhagia (Meno “Period” + rrhagia “bursting” = Heavy bleeding). This condition marks a woman’s period that is abnormally heavy or has prolonged bleeding with enough intensity that she can’t maintain normal activities due to blood loss and cramping. Women suffering from menorrhagia will often bleed heavily for more than seven days and may have to change their pads, or double them up, every hour. It’s also possible that women will pass blood clots larger than a quarter. If you’re experiencing intense heavy flows, speak to your gynecologist, as this could be a sign of a more serious condition like hormone irregularities, and even uterine or cervical cancers.
Having a few irregular periods per year isn’t cause for alarm. The human body can be sensitive to any number of factors, as discussed in this article. If you aren’t on birth control or old enough to be entering perimenopause or menopause (see our article on menopause) and are experiencing consistently irregular periods, please let your gynecologist know. These symptoms aren’t fun to experience, and they are often easily treatable, allowing you to return to normal pelvic health and a better overall quality of life.