By Gerard M. DiLeo, M.D., C.L.C.P.
As inconvenient as a period can be, the fact that it is periodic is comforting. When you have that monthly event, on time, you can be assured that everything is working right—and not just in your uterus, but your ovaries and even those parts of your brain that coordinate this cycle.
Everyone wants reassurance; everyone wants regularity. Because there are many steps, organs, and even body regions involved in the menstrual cycle, this means many things can go wrong. Thankfully, most irregular periods are harmless and fixable.
Just what Is your period?
Your uterus (womb) prepares for pregnancy each cycle, and when this doesn’t happen, the innermost lining of your uterus sloughs away itself from the middle muscular layer. This leaves bleeding sites, which combined with the bleeding and the tissue debris is what you call your period. The muscle layer contracts—you feel this as cramps—which clamps down on those bleeding sites so the bleeding won’t become dangerous.
Irregular periods are when your cycle varies in length by more than 7-9 days or are outside the range of 24-38 days.
Hormone Imbalance—the usual culprit.
This, without a doubt, is the most common cause of irregular periods. When the cycle is interrupted by a temporary hormone imbalance, the innermost layer of the uterus will either hang in there, with a missed period; or shed irregularly, seen by you as lingering bleeding. Along with this outward sign, you can assume the rest of your cycle is out of synch, too, so when this irregularity ends, your next period may be early, late, light, or heavy, but eventually will “straighten out” to your usual. Ovarian cysts can cause such an interruption in your cycle, and with it, pain on one side of your pelvis and pain with sex or even walking. Other conditions associated with hormonal imbalance are PCOS, estrogen dominance, changing birth control, chronic stress, sleep disorders / jet lag, night / shift work, the first 2-3 years after menarche (your first period), during breast feeding, or perimenopause.
Other problems with the inner layer of your uterus.
The design of your uterus is perfect, but there could be sabotage:
Infection. Infection causes an inflammatory state that can affect clotting and hormonal response.
Symptoms: pain and irregular, lengthy bleeding, painful sex.
Abnormal growths. Not all tumors are cancer. For example, a wart is technically a tumor. As such, tumors are either benign (harmless) or malignant (certainly not harmless). A polyp is a benign growth from the inner lining that interferes with the orderly falling away of menstrual tissue. (Note that with advance age, the chances of a polyp being malignant increase.)
Symptoms: Irregular bleeding, but throughout the entire month or with the mechanical jostling around that occurs with sexual intercourse.
Irregular periods: the rest of the story…when there are problems with the middle muscular layer of your uterus.
Your uterus is designed to eject anything that is inside of it, be it menstrual blood, clots, or even a baby when the time comes. The muscular layer is the source of the contractions that push all of these out into the outside world. It also serves to clamp and cinch down against bleeding sites that are exposed when the inner lining is discarded with the period. Therefore, things that interfere with its ability to do this effectively will cause your periods to become heavy, lengthy, and irregular.
Fibroids (leiomyoma): an overgrowth of fibromuscular tissue in the uterus’ muscular layer. Unlike the muscle where a fibroid is embedded, it doesn’t contract. So this is wasted space that is functionless compared to what the muscle tissue does. Less contracting means less clamping down on the bleeding, which further means heavier and longer periods.
Symptoms: more bleeding means more clots in the uterus, which stimulates even stronger contractions, so the usual cramping you experience with a normal period can become so painful as to become disabling, seriously affecting your quality of life.
Adenomyosis: when the innermost lining of the uterus invades the uterus’ muscular layer, it causes pain and poorly controlled bleeding. This tissue is bloody, and blood is very irritating when it’s in the wrong place. In the muscle it causes inflammation, which inhibits effective contracting which cause more bleeding which causes stronger contracting. The stronger contractions are more painful with adenomyosis than with fibroids, because you’re trying to contract with muscle that is inflamed.
Symptoms: irregular bleeding, pelvic tenderness, and pain with sex.
Malignancy: while fibroids (above) are benign, there can be cancer in the uterus of which the very first hint presents as irregular bleeding. It could be from either the innermost lining, the muscle layer, or even the outside layer. These cancer cells invade space and cut off normal tissue tissue, which can then no longer function properly. Eventually this process leads to other areas of the body, spreading the cancer.
Symptoms: painless bleeding, either with a period or any time in your cycle. This is an age-related problem, and it is unusual in women before menopause. However, when irregular periods occur, ruling this out can give you the luxury of worrying about only the fixable problems.
The above disorders, who’s disease origin comes from within the uterus or a hormonal imbalance, will account for over 90% of irregular periods, but other things can cause irregular bleeding, which can be misinterpreted as irregular periods:
Clotting disorders: in someone without a disorder, microscopic clotting is happening within the blood and tissue debris you see as your period. If you have a problem with blood clotting, one of the results is that bleeding with periods continues since there is nothing stopping it.
Symptoms: naturally, extra bleeding as lengthier or heavier periods, and cramping severity proportionate to the amount of extra blood that collects in your uterus to be expelled. Often clotting problems are due to other problems, such as genetic disease, spleen problems, immune disease, or even HIV.
Cervicitis: this has nothing to do with the inside of your uterus, but is when there’s inflammation of your cervix, which is in the back of your vagina. Usually yeast or bacterial vaginosis is the cause.
Symptoms: irregular bleeding at any time in the cycle, but especially after sexual intercourse.
Thyroid problems: both hypo- and hyperthyroidism can cause hormone imbalances and, with them, irregular periods.
Symptoms: less frequent or more frequent periods. If either happens, you should have your thyroid checked with a simple blood test before submitting to more involved diagnostic steps.
Irregular periods or bleeding are a nuisance, but only certain situations are cause for alarm. Your uterus is a dynamic organ that is always very busy, so routine follow-up with your professional health provider is the best way to keep things into perspective. Herbal medicine can positively impact the regularity of menstrual cycles, especially when the root cause is a hormonal imbalance. If you would like a personalized herbal blend of your own, click below!