For many women, that "time of the month" can be uncomfortable and painful. If you've ever wondered whether your period was normal, then you're not alone. According to the National Institute of Health, 14 to 25 percent of women have irregular menstrual cycles.
According to Dr. Heather Jones, a board-certified OB/GYN, a normal menstrual cycle is defined as a period every 21-35 days that can last up to 7 days. "As OB/GYNs, we define a normal flow as less than 80 mL(think of 5-6 tablespoons)," she says. "Abnormal uterine bleeding(AUB) is bleeding outside of normal volume, frequency, volume and number of days."
What are some potential causes of irregular periods?
To help provide some clarity, we tapped the experts to learn more about the five different types of abnormal menstruation and when you should see a doctor for further evaluation and treatment.
1. Menorrhagia
Do you bleed a lot while on your period? Well, although that's the point, it is possible you may be bleeding too much.
"Menorrhagia is defined as heavy menstrual bleeding, greater than 80mL, with a regular cycle or irregular cycle," says Dr. Jones. "Commonly, a heavy period can also be a concern for a uterine fibroid or polyp."
According to an article from Harvard Health, about 10 percent of menstruating people deal with excessive bleeding during their period.
Menorrhagia can be caused by a variety of factors such as hormone problems and uterine issues (fibroids and IUDs.) If you notice yourself changing pads more frequently than every two to four hours, bleeding for longer than seven days, or passing quarter-sized blood clots, then that could mean you have menorrhagia and you'll want to schedule an appointment with your OB/GYN.
The most common treatment options for menorrhagia include birth control pills, progesterone, and prostaglandin inhibitors. Other more invasive options may include endometrial ablation, resection, or a hysterectomy.
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2. Oligomenorrhea
Is your period irregular? Does it come at inconsistent intervals? Perhaps every other month? If you're asking yourself these questions, then you may be dealing with oligomenorrhea.
Dr. Eric Flisser, board certified reproductive endocrinologist and OB/GYN at RMA of New York, says oligomenorrhea refers to having infrequent periods with cycles typically longer than 35 days apart. This usually leaves an individual with four to nine periods per year on average.
In many cases, oligomenorrhea is a sign of underlying health issues that need to be addressed. According to a book from the National Library of Medicine, some health issues that may contribute to irregular periods include polycystic ovary syndrome (PCOS), Type 1 diabetes mellitus, eating disorders, and hyperthyroidism.
Common treatment options for oligomenorrhea include lifestyle changes (diet and exercise), hormonal therapy, and possible surgical interventions to treat underlying conditions. You'll want to consult with your doctor to figure out the underlying cause of your inconsistent periods and come up with a treatment option suitable to your needs.
3. Amenorrhea
Some individuals may completely skip out on having a period in its entirety which can be a cause for concern.
"Amenorrhea is the absence of menstruation altogether and can be primary (when someone never starts menstruating [by the age of 15]) or secondary (when periods stop for three months or more in someone who used to have regular cycles)," says Dr. Flisser.
According to the American College of Obstetricians and Gynecologists, about 1 in 25 women who are not pregnant, breastfeeding, or going through menopause experience amenorrhea at some point in their lives.
The causes for amenorrhea vary depending on whether it's primary or secondary. For primary amenorrhea, common causes include genetic conditions, issues with brain development, and the delayed onset of puberty. Secondary amenorrhea is usually brought on by drastic weight loss, stress, PCOS, and eating disorders.
Treatment options for amenorrhea include hormone therapy, lifestyle changes, and weight loss/weight gain. As mentioned before, you'll want to schedule an appointment with your provider to discuss what treatment modality would be best for your situation.
4. Polymenorrhea
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Per Dr. Jones, polymenorrhea refers to bleeding that occurs more often than every 21 days — aka more frequent periods. Common causes of polymenorrhea include stress, sexually-transmitted diseases (STDs), endometriosis, and menopause.
For some individuals, more frequent periods are completely normal. However, if this something you've more recently noticed, then you'll want to contact a doctor to discuss your symptoms.
5. Dysmenorrhea
Raise your hand if you experience painful periods. If that sounds familiar whether that's period cramps, back pain, or extreme fatigue, then you may have dysmenorrhea.
"Dysmenorrhea is painful menstruation, causing severe cramps and discomfort that can interfere with daily life," says Dr. Flisser.
This pain is generally caused by uterine contractions and generally gets less severe as you age. According to the Office on Women's Health, the risk of dysmenorrhea is greatly increased if you have high stress levels, smoke, and had your first period before the age of 11.
Secondary dysmenorrhea involves pain that comes from another health issue outside of your period — fibroids, ovarian cysts, and endometriosis are common culprits.
The treatment depends on the cause of your pain and can vary from hormonal pills to IUD's and even surgery in more severe cases.
At the end of the day, you know your body better than anyone else. If you feel that you're bleeding more or less than usual, then you're probably right. It's better to be safe than sorry and schedule an appointment with your provider so you can discuss your symptoms and find a treatment course that works for you.
Casey Clark is a freelance writer from New York City who specializes in beauty, food, and lifestyle content in the commerce sector. Her work has been featured in Women’s Health, Allure, Cosmopolitan, SELF and more. When she’s not writing, you can find her swatching the latest lipsticks or out to brunch with her girlfriends.
