What should you know about really irregular periods?

A cycle may be irregular when bleeding comes at unpredictable intervals, is absent for a while, or changes markedly in flow or duration. Anovulation means an egg is not released in a cycle and can lead to infrequent or unpredictable bleeding. Polycystic Ovary Syndrome can involve irregular ovulation, while perimenopause may bring changing cycles as ovarian hormone patterns shift. Premature Ovarian Insufficiency is another possible cause when ovarian function reduces earlier than expected. Pregnancy, thyroid problems, high prolactin, significant stress, changes in eating or exercise, and some medicines can also affect timing.

Irregular periods do not identify one cause by themselves. The pattern, age, pregnancy possibility, pelvic symptoms, and other health changes help guide assessment.

Track the first and last day of bleeding, spotting, flow changes, pain, medicines, contraception, sleep, stress, and symptoms such as acne, increased facial hair, hot flushes, or nipple discharge. Take a pregnancy test when pregnancy is possible. Arrange a medical review if the pattern persists, returns after being regular, or concerns you. Assessment may include questions, an examination, blood tests, or ultrasound. Treatment depends on the cause; options may include the Combined Pill for cycle control or Metformin for PCOS when appropriate.

Seek urgent help for very heavy bleeding, faintness, severe or one-sided pelvic pain, fever, or bleeding during a possible pregnancy. Arrange prompt assessment for bleeding after sex, bleeding after menopause, or a prolonged absence of periods with headaches, vision changes, or other new symptoms. Keep a record of the bleeding pattern so the clinician can judge whether further tests are needed.

Ask what your pattern suggests, whether pregnancy or hormone testing is needed, and whether your medicines or contraception could be contributing. Ask how irregular ovulation may affect fertility, what treatment is intended to change, and which bleeding or pain symptoms should prompt an earlier review.