Hit or miss

Every woman is different and so are her periods. Any irregularities should be looked at in terms of what is normal for her, writes Dr Manjula Deepak

Every woman is different and so are her periods. Some get it but for some, it’s an unpredictable wait. On average, a woman gets her period every 21 to 35 days and it usually lasts for about 2 to 7 days. Is your period irregular and if so, does it need attention? Many women are worried about a late period and want to be sure that they are not pregnant. Did you know that a delayed or a missed period happens for many reasons other than pregnancy? The common causes can range from normal physiological conditions, stress or obesity, anxiety-related issues, lifestyle changes or hormonal imbalances.

Here are some signs to watch out for if you have irregular periods:

The time between each period starts to change.

You lose more or less blood during a period than usual.

The number of days that your period lasts varies a lot.

However, every woman must understand that she is different and a missed or irregular period should be looked at in terms of what is normal for her. The causes and treatment differ according to the age group of women and hence it is important to avoid comparisons.

What causes a delayed period?

Amenorrhoea is when menstruation is absent during the reproductive years, between puberty and menopause. It is not a disease, and it does not mean that a person is infertile, but it can be a sign of a health problem that needs some attention. It can occur in healthier women during breastfeeding or may signal other gynaecological conditions like hormonal imbalance, excessive exercising, eating disorders, stress, drug usage, PCOS, endometriosis, fibroids, an endocrine disorder like thyroid, pituitary gland, or premature ovarian failure.

Amenorrhoea usually happens when the ovaries stop making enough of the female hormone. Primary amenorrhoea refers to the absence of menstruation in someone who has not had a period by the age of 16 years. The most common causes of primary amenorrhoea relate to hormone levels, although anatomical problems can also cause amenorrhoea. Such conditions are rare and constitute less than 0.1 per cent of the individuals. Secondary amenorrhoea refers to the absence of three or more periods in a row by someone who has had periods in the past. Pregnancy is the most common cause of secondary amenorrhoea, although problems with hormones can also cause secondary amenorrhoea. A range of factors, including those below, can cause an irregular period.

You’re stressed out: If you’re under a lot of stress, your body can stay in fight-or-flight mode, which can make you temporarily stop ovulating. This lack of ovulation, in turn, can delay your period.

Changes in body weight (increase/ decrease in weight): Severe changes in body weight can impair the period’s timing. An extreme increase or decrease in body fat can lead to a hormonal imbalance that causes your period to come late or stop entirely.

You have PCOS: Polycystic ovary syndrome (PCOS) is caused by an imbalance of reproductive hormones. People with PCOS don’t ovulate regularly. As a result, your periods may be lighter than normal, arrive at inconsistent times, or disappear altogether. Besides a delayed period you may also notice excess or coarse facial and body hair, acne on the face and body, thinning of hair, weight gain or trouble losing weight, dark patches of skin, often on the neck creases, groin, and underneath breasts, skin tags in the armpits or neck.

You’re in perimenopause: Perimenopause is the time leading up to your menopausal transition. It typically starts in your mid to late 40s. Perimenopause lasts for several years before your period stops completely. For many, missed periods are the first sign of perimenopause. You may skip a period one month and be back on track for the following three or you may skip your period three months in a row and find that it arrives unexpectedly, often lighter or heavier than you’re used to.

Speak to a gynaecologist in the following circumstances:

You miss three or more periods a year.

You get your period more often than every 21 days.

You get your period less often than every 35 days.

You are bleeding more heavily than usual during your period.

You bleed for more than 7 days.

You have more pain than usual during a period.

You’re in early menopause: Early menopause, also known as premature ovarian failure, happens when your ovaries stop working before you turn 40. When your ovaries aren’t working the way they should, they don’t produce enough hormones. You will begin to experience the symptoms of menopause. A late or missed period may be an early sign.

Chronic diseases: Chronic diseases such as diabetes, tuberculosis, liver disorders can also affect your menstrual cycle. These are linked to hormonal changes,
so even though it’s rare, these could cause your period to be irregular.

Thyroid issues: An overactive or underactive thyroid gland could also be the cause of late or missed periods. The thyroid regulates your body’s metabolism, so hormone levels can be affected as well. Thyroid issues can usually be treated with medication. After treatment, your period will return to normal.

Contraceptives/ birth control medicines: Medicines such as birth control pills, Intra-Uterine devices may cause lighter, less frequent, more frequent, or skipped periods or no periods at all.

Uterine causes: Thickening of the endometrium, polyps, uterine fibroids, uterine cancer, endometriosis, adenomyosis can also be a cause.

Diagnosis of a missed/delayed period

A detailed history

Family history

Examination of the patient

Lab investigations: follicular stimulating hormone, luteinising hormone, thyroid-stimulating hormone, estrogen, testosterone prolactin, Beta HCG

Ultrasound

Many things can cause an irregular period — from routine lifestyle changes to underlying medical conditions. If your period is regularly late, make an appointment with a gynaecologist to determine the cause. Irregular periods aren’t always a sign of a problem but it is important to understand the underlying causes of delayed/missed periods. It is a myth to state that a delayed period indicates infertility and conception related issues. Timely medical intervention is advisable. A gynaecologist will be able to determine the cause of your irregular periods and help you develop the best treatment plan.

(The author is a senior consultant gynaecologist.)