Jill Gustafson, CNM helps her patients from across the Treasure Valley to treat menstrual irregularities from her welcoming practice on the Boise Bench. To learn more about hormone imbalance, call the office or request an appointment using the online booking tool.
Menstrual Irregularity Q & A
What is a "normal" menstrual cycle?
It is normal for your menstrual period to fluctuate from month to month, but there are parameters to help us define what is "normal" variation. In order to determine what is normal for you, you will first need to keep track of your bleeding days for a minimum of 3 months. Your hormones shift and change at many points throughout your life, so it is important to have a current record, as well as historical knowledge of what has been normal for you in previous years.
You can start by numbering the days of your cycle on a calendar or app, such as the Flo app. Your first bleeding day is considered Day 1 of your cycle. There are 3 parameters that you want to keep track of:
- How many days do you bleed
- How heavy or light is your flow
- How many days are there between periods
The average length of bleeding days varies considerably among women, but it is considered normal to bleed for up to 7 days.
As far as flow, heavy flow is normal on the first 1-3 days of your period. Then it should taper off to a slower flow for 1-3 days, followed by 1-2 days of spotting at the end of the period.
The length of the menstrual cycle is determined by recording the average number of days between Day 1 of one cycle and Day 1 of the next cycle. A normal length is typically between 21 and 35 days. It is normal for this interval to be slightly different from one cycle to the next, that is why we look for the average length to be within that parameter. It is normal for cycle length to shift as your hormones shift and change, and during temporary shifts such as moving, major life events, or illnesses.
What is "abnormal" menstrual bleeding?
Bleeding in any of the following situations is considered abnormal uterine bleeding:
- Bleeding or spotting between periods
- Bleeding or spotting after sex
- Heavy bleeding during your period
- Bleeding that soaks through one or more tampons or pads every hour
- Bleeding that lasts more than 7 days
- Menstrual cycles that are longer than 35 days or shorter than 21 days
- "Irregular" periods in which cycle length varies by more than 7 to 9 days
- Not having a period for 3 to 6 months
- Bleeding after you have already passed through menopause
Are there stages of life when abnormal bleeding is more common?
During adolescence and perimenopause, periods may not occur regularly. This is due to normal, expected fluctuations in our hormones and is not, by itself, cause for alarm. It is also normal to have no periods at all for a few months after you give birth, and for an extended period of time if you are breastfeeding.
Menarche is the time of your very first menstrual period. In the years around menarche, our hormones fluctuate a lot more than they do when we become more mature. This means that it may take some girls years for their periods to become regular. For example, it is normal during the first few years of menstruation for your flow to change from very light to very heavy, and for the number of bleeding days to be different from month to month. It is also normal for your period to not come at the same time every month during the first few years after menarche. However, if your period had previously been coming at regular times, and now is suddenly not, this can be a sign of illness or pregnancy and should be discussed with your provider. Menarche, in the U.S., typically occurs around age 12 but can start as early as age 9 or as late as age 17.
Perimenopause is the time leading up to your very last period. During this time, your ovaries are slowing down, and there are tremendous hormone fluctuations (similar to what we experience during adolescence). Most women start to experience signs and symptoms of perimenopause for 3-10 years before reaching menopause. One of those symptoms is irregular periods. During perimenopause, it is normal for some, or all of the parameters of your period to change. For example, the number of days between your periods can become shorter, or longer. It is also common to skip periods altogether, or for your flow to change (either lighter or heavier bleeding). This is part of a natural progression that ends with menopause when a woman has no more periods at all. The average age of menopause in the U.S. is 51.
What causes abnormal bleeding?
Some of the causes of abnormal bleeding include the following:
- Problems with ovulation - Lack of ovulation can cause irregular, sometimes heavy, menstrual bleeding. If you do not ovulate for several menstrual cycles, areas of the endometrium (the tissue that lines the uterus) can become too thick. This condition can occur during the first few years after you start having periods (menarche) and during perimenopause. It also can occur in women with certain medical conditions, such as polycystic ovary syndrome (PCOS) and hypothyroidism.
- Adenomyosis - In this condition, the endometrium grows into the wall of the uterus. Signs and symptoms may include heavy menstrual bleeding and menstrual pain that worsens with age.
- Bleeding disorders - When a woman's blood does not clot properly, there can be heavy bleeding. You may have a bleeding disorder if you have had heavy periods since you first started menstruating. Other signs include heavy bleeding after childbirth or during surgery, gum bleeding after dental work, easy bruising, and frequent nosebleeds.
- Medications - Hormonal birth control methods can cause changes in bleeding, including breakthrough bleeding (bleeding at a time other than your period). Some medications, such as blood thinners and aspirin, can cause heavy menstrual bleeding. The copper intrauterine device (IUD) can cause heavier menstrual bleeding, especially during the first year of use.
- Cancer - Abnormal uterine bleeding can be an early sign of endometrial cancer. Most cases of endometrial cancer occur in women in their mid-60s who are past menopause. It usually is diagnosed at an early stage when treatment is most effective. A condition that can lead to endometrial cancer is called endometrial intraepithelial neoplasia (EIN). It also causes abnormal uterine bleeding. Treatment of this condition can prevent endometrial cancer.
- Pregnancy - The first sign of pregnancy is usually - but not always - a missed period. In some cases, a pregnant woman can still have vaginal bleeding, but that bleeding is usually markedly different from normal (i.e., only one day of spotting, or intermittent spotting with no discernible pattern). Other causes of abnormal uterine bleeding during pregnancy can include ectopic pregnancy (a pregnancy that implants outside of the uterus) and miscarriage. Anyone who is pregnant and experiencing vaginal bleeding, with or without pain, should be evaluated immediately. It is also important for everyone who is sexually active to know the normal signs of early pregnancy, which can include a missed period, sore breasts, nausea, vomiting, extreme fatigue, constipation, bloating, and mood swings.
- Other causes - Endometriosis and other problems related to the endometrium can cause heavy menstrual bleeding. Pelvic inflammatory disease (PID), bacterial vaginosis, or HPV (a sexually transmitted disease) can also cause irregular bleeding. Sometimes, there is more than one cause.
