Here’s an old wives’ tale for you. For centuries, a woman’s menstrual cycle had been tied to the lunar cycles, supposedly because the moon is associated with feminine energy. But more likely because lunar cycles last 29.5 days, about the same length as a “typical” menstrual cycle.

What Is a “Normal” Menstrual Cycle? 

It is not uncommon for women to have irregular menstrual cycles near the beginning of their periods (menarche) or nearing the end (perimenopause). For most reproductive-age women, a typical menstrual cycle occurs regularly every 21-35 days with bleeding that lasts 2-7 days. However, approximately 15-20% of women have irregular periods. 

What Does It Mean To Have Irregular Periods? 

There is more than one way that we can have irregular periods. Some of the terms you may have heard to describe these atypical cycles are:

  • Amenorrhea
  • Metrorrhagia
  • Menorrhagia
  • Dysmenorrhea
  • Polycystic Ovarian Syndrome (PCOS)

Amenorrhea is the lack of menstruation. If a young woman has not begun menstruating by the age of 15-16, that is considered ‘primary’ amenorrhea. There are often genetic conditions that could cause this which would require an evaluation by a pediatric endocrinologist or a gynecologist. 

If a woman had menstruation previously, however irregular but none further in 6 months or more, that is called ‘secondary’ amenorrhea. There are many causes for secondary amenorrhea, including significant weight loss, intense exercise, eating disorders, hyperthyroidism, PCOS etc. 

Metrorrhagia is bleeding that is more frequent than once a month. This would include heavy spotting in between menstrual cycles. It may be caused by stress, hormonal fluctuations such as during perimenopause, improper use of birth control pills, uterine fibroids and bleeding disorders. 

Menorrhagia is a menstrual cycle that appears monthly but lasts longer than 7 days with heavy bleeding. This is sometimes seen in postpartum women when they resume their cycles. Or also due to copper IUDs, fibroids, adenomyosis, bleeding disorder, PCOS or hormonal imbalances, including hypothyroidism. 

Dysmenorrhea is severe pain and cramping associated with menstrual cycles. It may coexist with nausea, heavy bleeding and sometimes IBS or diarrhea. It may be associated with uterine fibroids, pelvic inflammatory disease or endometriosis.

Polycystic Ovarian Syndrome (PCOS) is a complex hormonal disorder in which there is an imbalance in sex hormones, specifically, higher than normal testosterone levels in a woman. This can manifest as oily skin/acne, excess facial or body hair and male pattern hair loss. In addition, one of the hallmark symptoms of PCOS is skipped or irregular periods. 

Is It Important To Have Regular Periods? 

Fertility is the one of the primary reasons to desire regular menstruation. Yes, monthly ovulation is a large part of what our menstrual cycle represents. But menstruation serves many other purposes, including sloughing off the endometrium (the lining of the uterus). Chronic thickening of the endometrial lining is a risk factor for uterine cancer. And the normal flux of hormones play an important role as well. Estrogen is needed for bone health and a lack of it, such as in amenorrhea can increase the risk of osteoporosis or fragile bones. An imbalance in testosterone causing disruption of menses can also cause cosmetic concerns such as acne, increased facial hair (hirsutism) or hair loss.

In my upcoming posts, I will discuss some of the natural approaches to treating menstrual irregularities. 

Yours in good health, 

Ashita Gupta, MD