What should you know about extremely irregular periods?

You may have long gaps, closely spaced bleeds, skipped periods, or changing flow. Irregular bleeding can happen when ovulation is absent, during perimenopause, with polycystic ovary syndrome, after starting or stopping contraception, or with major changes in weight, exercise, stress, or general health. Premature ovarian insufficiency is another possibility when ovarian function changes earlier than expected. A late period can also be related to pregnancy, so consider a pregnancy test when relevant. The pattern itself does not identify one cause.

Keep a record of bleeding dates, flow, spotting, pain, medicines, contraception, and symptoms such as acne, excess hair, hot flushes, or vaginal dryness. Arrange a review if the pattern continues, changes suddenly, affects fertility plans, or follows previously predictable cycles. Depending on your history, a clinician may discuss pregnancy testing, blood tests, thyroid or hormone assessment, and an ultrasound. Treatment may target the cause; options can include the combined pill or metformin for PCOS when appropriate.

Get urgent help for very heavy bleeding with faintness, severe pain, or weakness. Seek prompt care for bleeding during pregnancy, severe one-sided pelvic pain, fever, or bleeding after menopause. A missed period with new pain or heavy bleeding also needs timely advice.

Could I be ovulating irregularly? Which tests would distinguish perimenopause, PCOS, anovulation, or premature ovarian insufficiency? How might treatment affect contraception or pregnancy plans?