Ask A Midwife: Irregular menstruation

This conversion with Laura Kennedy, a Board-Certified Nurse Practitioner, breaks down irregular menstruation: what causes it, how it affects fertility, and how to regulate your cycle.

Ashley: What is a normal period? An irregular period?
Laura: A normal period usually occurs around the same time each month. However, this can vary from every 21 to 35 days and still be considered “normal.” An irregular period occurs less than every 21 days or greater than every 35 days.

A: Is it normal to have periods twice a month?
L: Some months have 4 weeks and other months have 5 weeks. If your cycle is on average 28 days, then yes, you can have 2 cycles in a month — one towards the beginning and one towards the end of the month. As previously mentioned, any period that is less than 21 days is considered abnormal.

A: What are possible causes of irregular periods?
L: There are many causes of irregular periods that could include: thyroid disorders, weight loss or weight gain, stress, Polycystic Ovary Syndrome, a cyst/lesion on the brain, whether or not you live an active lifestyle, certain types of contraception and medications, hormone imbalances, abnormalities of the uterus, pelvic inflammatory disease — and those are just to name a few!

A: What does discharge mean? Is it normal?
L: Most vaginal discharge is normal and can vary from woman to woman. This discharge is the body’s natural way to expel fluid and microscopic cells. It can change in consistency and appearance based on the menstrual cycle, intercourse, pregnancy, or infections.

A: What are the different types of discharge? What’s spotting?
L: Discharge can appear as any color and consistency honestly! Spotting is experiencing pink, red, or brown bleeding that is not during the menstrual cycle.

A: What can cause a missed period besides pregnancy?
L: I would have to say the same causes of irregular periods, as mentioned above.

A: Will an irregular period eventually become regular?
Laura: It all depends on what is causing the irregular periods. Once this is identified, then treatment options can be discussed in order to regulate cycles.

A: Can birth control make a period irregular?
L: Yes and no. It comes down to the type of birth control. There are certain types used to assist in regulating cycles, but there are others that could potentially cause some irregularity.

A: Is there any way to regulate your period?
Laura: There are a variety of options to help regulate menses such as a healthy diet, exercise, stress management, and/or birth control are just a few of the options.

A: If my periods are irregular, how will I know when it’s coming?
L: You may not, but some women may experience other symptoms such as cramping, breast tenderness, or moodiness as a “head’s up.”

A: Does Polycystic Ovarian Syndrome (PCOS) cause irregular periods?
L: Most patients with PCOS have irregular periods. However, there are some women that have regular cycles.

A: Do irregular periods influence the ability to get pregnant?
L: You can still become pregnant with irregular periods, but it may take a little more time and patience due to timing of ovulation. There are times that women with irregular periods don’t ovulate, in which seeking pregnancy can become even more difficult.

A: Are irregular periods a reason to be concerned?
L: One irregular period every now and then isn’t something to be overly concerned about. However, if the cycles are consistently inconsistent, I would recommend seeing your health care provider for further evaluation.

A: Is having sex on your period safe?
L: It’s considered safe, but may be a little messy! If you’re not in a committed relationship, I always recommend using a condom.

A: Can you get pregnant while on your period?
L: Although it’s very rare, it’s still possible!

A: What are the menstrual cycle’s four phases? During which phase is it least risky to have sex and not become pregnant?
L: The four phases of the menstrual cycle are the menstrual phase, follicular phase, ovulation phase, and the luteal phase. The ovulation phase is the riskiest phase to become pregnant. There’s not an absolute safe phase in order to avoid pregnancy, especially because cycle lengths often vary, but the least risky is during menstruation.

A: Can tampons cause Toxic Shock Syndrome (TSS)?
L: Yes, although it’s rare. There are at least two ways that tampons can potentially cause TSS. Tampons — especially the super absorbent kinds — that remain in the vagina for long periods of time can allow for bacteria to grow. Tampons can also adhere to the walls of the vaginal canal, which is more common during light flow days, and potentially cause small tears or abrasions when removed. Bacteria can then enter the bloodstream through those tears.

A: What causes hormone imbalances? What is it like to live with hormone imbalances? Is there a difference between hormone imbalances and irregular periods?
L: There are so many potential causes ranging from thyroid disorders, being over or underweight, eating disorders, stress, athletic activity, tumors, cysts, medications, pregnancy, age, insulin resistance — the list goes on and on!

Every person will experience hormone imbalances differently, as it depends on the cause of the imbalance. Some women may not have any symptoms at all. Symptoms may include bloating, fatigue, hot flashes, night sweats, mood swings, difficulty concentrating, hair loss/growth, acne, weight gain, trouble sleeping and infertility. Possible hormone imbalances can also potentially cause irregular cycles.

A: If your periods are really heavy, should you see your OB/GYN?
L: YES! No one should have to live their life like that. There are several causes of heavy cycles, as well as many treatment options.

A: Which foods help with period cramps?
L: An overall healthy diet and staying well hydrated is the best! Fruits, vegetables, fish and nuts with omega-3s, ginger, and whole grains have been shown to decrease inflammation in the body, which can potentially decrease painful cramps.

A: Are there any specific vitamins that help maintain menstrual health and regulate abnormal periods?
L: There are supplements and/or vitamins that may help with cycle regulation and some of the unwanted effects of menses. However, most haven’t been definitively tested or proven. My biggest recommendation is always a healthy diet, exercise, and hydration.

Often, many women suffer from Premenstrual Syndrome, otherwise known as PMS, which can cause mood swings, anxiety, depression, bloating, cramping, crying, food cravings, etc. Some vitamins and supplements that can be used to help alleviate these symptoms include those with calcium, vitamin D, magnesium, omega-3s, chasteberry, evening primrose, ginkgo biloba, vitamin B6 and B12, and probiotics.

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