A woman flips her lustrous hair, breezing through city streets in an ivory dress with a giant, pearly-white grin to match—according to feminine care commercials, life can be this good when you’re on your period. But the reality is, we get thrown for a loop even when it happens like clockwork, let alone those times it arrives ahead of schedule—or doesn’t show up at all.
When menstruation occurs regularly, it’s a good sign that the endocrine and reproductive systems are A-OK. Menstrual cycles typically range from 21 to 35 days, with the average being 28 from the first day of a period to the last day before the next. But for some women, a period may come earlier or later than expected, or last longer than average—as many as one in three women who visit the gynecologist complain about this, according to Dr. Raegan McDonald-Mosley, chief medical officer at Planned Parenthood. An irregular period could be signal that something is off; in many cases that something is relatively benign and manageable—but it could also indicate a more serious problem.
It’s important for every woman to become familiar with her rhythm. The first step is to monitor the length of your cycle (the amount of time between period start days) for at least three months. If the number is outside of the normal range (21 to 35 days) or varies significantly from month to month, your period could be considered irregular. If so, here are some of the issues that could be at play.
A number of factors could influence hormonal balance, including extreme exercise or dieting, or being underweight or overweight. Very commonly, stress plays a huge role, too. If irregular bleeding comes with a bombshell of acne, insomnia, mental fogginess, unusual hunger, and fatigue, your hormones may need a little rejiggering. Here are some of the ways you can help them out:
- Consider going a little easier on workouts and relaxing any strict diet plan for a while.
- Supplement with folic acid, riboflavin (B2), vitamin B6, vitamin B12, vitamin C, vitamin E, zinc, and DHEA.
- Get plenty of fiber from whole grains, fruits, and vegetables.
- Consume healthy fats like coconut oil, avocado, olives, fatty fish, cod liver oil, flaxseeds, and nuts.
- Avoid refined sugars and pasteurized juices that can spike insulin and cortisol, which affects the thyroid (more on that later). Minimize soy products as well, because they’re high in estrogen.
Early or late periods may also mean that two specific types of hormones, estrogen and progesterone, are off kilter. After ovulation, a woman’s most fertile time, when the ovary releases a mature egg, the body produces progesterone. And a lack of it could be a sign you’re not ovulating—a serious fertility issue.
Certain drugs, including types of birth control and antidepressants, may cause breakthrough bleeding, aka bleeding or spotting between periods. If it continues several months after starting the medication, ask your physician about alternatives.
Polycystic ovary syndrome
Abnormally high levels of androgens (male sex hormones), such as testosterone, may cause tiny cysts to crop up on the ovaries. This condition, known as polycystic ovary syndrome, may interfere with ovulation, which affects the regularity of your period. Very heavy bleeding, unusual body hair, and acne are possible side effects of this condition. “Polycystic ovary syndrome is more common than people think,” says Dr. McDonald-Mosley. “ If you are experiencing the symptoms, it’s best to go see a doctor and get tested. While it is manageable, it can be very serious if it goes undiagnosed or untreated.” A doctor may recommend diet or exercise changes, or prescribe medication in order to help rebalance hormones.
The thyroid gland helps regulate metabolism and hormone release in the body. Having an overactive or underactive thyroid can disrupt hormonal balance and cause a ripple in your menstrual cycle. Look out for these potential signs of an overactive thyroid, also known as hyperthyroidism:
- Rapid heart rate
And the possible indications of hypothyroidism, or an underactive thyroid:
- Sensitivity to cold temperatures
Your doctor can diagnose these conditions with a blood test and treat them fairly easily.
While menstrual bleeding comes from the uterus, the cervix may experience irregular bleeding. It’s tough to determine the source on your own, but if spotting or bleeding happens outside of your regularly scheduled period, that gives you a clue. Sexually transmitted infections, polyps, or even cervical cancer could be the culprit, so definitely see your gynecologist for a pap smear at least every three years—or if you suspect any cervical bleeding.
“The good news is that cervical cancer takes years to develop, and we have excellent tests available that can detect early changes in the cervix which can generally be treated before they become cancer,” says Dr. McDonald-Mosley.
Irregular spotting between periods could be a sign of endometriosis, a painful condition when the uterine lining grows on the ovaries, intestines, bladder, or other surrounding areas. If you experience pain during sex, exercise, or bowel movements, or spotting for several days before menstruation, check with your doctor. Hormone treatments or even surgery may be in order.
With any of these issues it’s never a bad idea to check in with your doctor. We’re used to hearing that everyone’s menstrual cycle is different. And while that’s true, don’t feel as though you need to accept irregular periods as a minor inconvenience and hope they normalize on their own. Get to know your body and face these potential issues head on.
Illustration by Karley Koenig