Abnormal Periods

Abnormal periods at a glance:

An abnormal period is a menstrual cycle that differs significantly from the woman’s typical cycle, or from the normal range of menstrual cycles. This can include skipped periods, irregular cycles, and extremely heavy bleeding, called menorrhagia. Abnormal vaginal bleeding refers to an unusual amount of blood during and/or between periods.

For most women, an average menstrual cycle occurs every 28 days, but cycles can occur every 21 to 35 days. Most women’s periods last between two to seven days. A normal amount of blood is between four to 12 teaspoons total over each cycle.

Many women experience abnormal menses or vaginal bleeding at some time in their lives.

What is an abnormal period?

Some signs of abnormal periods or menses include:

  • Unexpected menstrual periods
  • Lighter or heavier (menorrhagia) flows than usual
  • Spotting between periods
  • Non-existent periods
  • Menstrual cycle occurring at unexpected times in life, such as before age 10, during pregnancy, or after menopause

Causes of abnormal periods or abnormal vaginal bleeding:

Abnormal periods (menses)

Many things, such as stress, illnesses, excessive exercise, and low body weight can cause missed periods.

Other causes of abnormal menses or menstrual cycles include:

Abnormal vaginal bleeding

Abnormal vaginal bleeding has many possible causes on its own and doesn’t necessarily indicate a serious condition. The following conditions may be factors:

  • Ovulation, which can cause mid-cycle bleeding
  • Pregnancy
  • Structural lesions
    • Polyps
    • Fibroids
    • Endometriosis
    • Cancer
    • Unopposed estrogen (lack of ovulation)
      • Polycystic ovary syndrome (PCOS)
      • Estrogen-only treatments
      • Progesterone-dominant therapies
        • Oral birth control pills
        • Birth control patches
        • Depo Provera
        • Implanon
        • Progesterone containing IUDs
        • Perimenopause or menopause (due to sporadic ovulation or lack of ovulation)
        • Pelvic organ infections or sexually transmitted infections, including pelvic inflammatory disease (PID)
        • Inherited bleeding disorders
        • Other hormone imbalances such as hypothyroidism, hyperthyroidism, elevated prolactin, and pituitary gland dysfunction

Symptoms of abnormal periods or vaginal bleeding:

Irregular periods with frequent and prolonged bleeding or spotting are the most common symptoms of abnormal menses or abnormal vaginal bleeding. Fatigue and lightheadedness can occur if prolonged bleeding is present and causing anemia.

Other symptoms for abnormal menses/bleeding may include heavy bleeding for more than seven days, excessive blood loss that limits daily activities or passing blood clots larger than a quarter.

If it has been three months since your last period, this also may be a sign of abnormal menses.

Evaluation of abnormal periods or vaginal bleeding:

A physical exam is necessary to determine all factors that could be causing complications. Blood tests are often ordered to investigate hormone levels.

An ultrasound can help diagnose anatomical causes of abnormal periods. In some cases, additional imaging such as MRI or sonohysterography may be recommended to further evaluate suspected abnormalities seen on regular ultrasound.

Uterine cavity lesions are best seen with sonohysterography, which is a test involving fluid infusion into the uterus under ultrasound visualization. MRI is very helpful to better characterize fibroids and adenomyosis, particularly if surgical therapy is being considered.

Treatment for abnormal periods or vaginal bleeding:

Treatment for abnormal menses or bleeding depends on the cause or diagnosis. Hormonal causes are treated by correcting the hormonal imbalance.

PCOS, which is the most common cause of irregular ovulation and subsequent irregular menses, is treated by helping the patient with weight loss (if needed) and giving the patient progesterone alone or in a birth control pill or IUD.

Low weight induced irregular ovulation is treated by helping the patient slowly gain weight and using hormones to regulate the cycles until a healthy weight is attained. Surgery is usually needed to treat anatomical abnormalities.