Ask an expert: How are abnormal or irregular periods defined?

Written by: Mr Amer Raza
Edited by: Sophie Kennedy

Although many women experience some small variations in the length or timing of their periods, significant changes to a typical cycle should be investigated to rule out several underlying conditions which may require specialist treatment. In this informative guide, highly respected consultant obstetrician and gynaecologist Mr Amer Raza shares his expert insight on how abnormality in a woman’s menstrual cycle is defined and the most common causes of irregular periods. The leading specialist also details the most impactful lifestyle modifications which can help to reduce a woman’s risk of developing menstrual abnormalities.



How are abnormal or irregular periods defined?


For the majority of women, periods last from four to seven days and occur every twenty-eight days, although menstrual cycles ranging from twenty-one up to thirty-five days in length are still considered to be normal.


Abnormality in a woman’s menstrual cycle may include:

  • periods which occur more frequently than every twenty-one days
  • periods which occur less frequently than every thirty-five days
  • a much heavier or much lighter menstrual flow than usual
  • periods which last longer than seven days
  • symptoms of pain, cramps, nausea or vomiting which occur with periods
  • spotting or bleeding between periods, following the menopause or after sexual intercourse


There are a number of conditions which fall under the umbrella of abnormal menstruation, including amenorrhea, where a woman’s periods have stopped entirely. Amenorrhea is defined as a lack of menstruation over a period of ninety days or more, which is considered to be abnormal unless the woman is pregnant, breastfeeding or is going through the menopause, which typically occurs between the ages of forty-five and fifty-five. Younger women who have not started their periods by the age of fifteen to sixteen, or within three years of their breasts beginning to develop, may also be diagnosed with amenorrhea.


Other types of abnormal menstruation include:

  • oligomenorrhea: infrequent periods
  • dysmenorrhea: painful periods with severe menstrual cramping, which exceeds the normal levels of discomfort felt by most women during their menstrual cycle
  • abnormal uterine bleeding: a heavier than usual menstrual flow, bleeding or spotting in between periods, following sexual intercourse or after the menopause


What causes abnormal menstruation?


There are a wide range of possible causes of abnormal menstruation, including stress and other lifestyle factors, some types of medication and certain underlying medical conditions. Causes of irregular menstruation related to your lifestyle can include:

  • stress
  • your lifestyle
  • some contraceptives and birth control methods
  • some types of medication, including steroids or anti-coagulant (blood thinning) tablets


In addition, some types of medical conditions, which may be underlying, can affect menstruation, such as:


Although rare, abnormal menstruation can also be a sign of uterine or cervical cancer. If you are concerned about symptoms of abnormal menstruation, you should see a specialist to establish the cause of any irregularity and rule out more serious underlying causes.


It’s important to keep an accurate record of any changes you observe in your menstrual cycle. This should include the start date and length of your periods, any bleeding or spotting between periods and symptoms which accompany your periods, including cramping and pain. You should also track how heavy your periods are and if you pass large blood clots.


The best treatment option for each patient depends on the underlying cause of menstrual irregularity. After carrying out the necessary investigations, the best course of treatment can be selected. Some underlying conditions, such as uterine fibroids or endometriosis, may require surgical treatment, while in other cases, simple pain control may be the best approach to treatment.


Is it possible to prevent abnormal menstruation?


Although it is not always possible to prevent irregularities in your menstrual cycle, the following lifestyle advice can help you to lower your risk of abnormal menstruation.



Adopt a healthy lifestyle


Follow a healthy lifestyle and eat a balanced diet. If you are looking to lose weight, aim to do so gradually, rather than following extreme diets which excessively limit your calorie intake.



Find ways to relieve stress


Incorporate stress relief and relaxation activities into your daily life, such as mindfulness or breathing exercises. Take enough rest and practise healthy sleep habits



Take part in moderate exercise


Exercise moderately, as excessive or endurance sporting activities can cause abnormal menstruation



Contraceptives and sanitary products


Speak to your doctor about any doubts you have about your contraceptive method of choice. It’s important to use birth control pills or other devices as directed. You should change sanitary pads or tampons every four to six hours to help avoid toxic shock syndrome and infections.




If you are concerned about abnormal menstrual symptoms or changes in your periods, you can schedule a consultation with Mr Raza by visiting his Top Doctors profile.

By Mr Amer Raza
Obstetrics & gynaecology

Mr Amer Raza is a leading obstetrician and gynaecologist based in London who specialises in endometriosis, robotic surgery and pelvic pain alongside fibroids, menstrual disorders and hysteroscopy surgery. He has a specific interest in excisional surgery for endometriosis and is a passionate expert in laparoscopic surgery.  He privately practises at Chelsea and Westminster Hospital - Private Patients' Department, Cromwell Hospital, and Basinghall Clinic, alongside The Women's Wellness Centre. His NHS base is Chelsea and Westminster Hospital NHS Foundation Trust. 

Mr Raza is highly qualified, with various awards from leading educational institutions. These include an MBBS from Nishtar Medical College at Bahauddin Zakariya University, Pakistan, a BSc and a MRCOG. He also has an BSCCP, DFFP in Family Planning and Sexual Health and a PG Cert in Advanced Laparoscopy.
Mr Raza, who is very experienced in minimal access surgery and is an accredited endometriosis specialist, leads a multidisciplinary team of colorectal surgeons, urologist and radiologists for complex endometriosis cases as part of his practise. 

He also provides obstetric services in pregnancy, and believes that individualised care and empowerment of women's wishes can bring about safety and satisfaction through pregnancy and labour. 

Further to his impressive career and educational achievements, Mr Raza leads on many laparoscopic training programmes for specialists in the UK and around the world. He is also is the co-founder and director of Chelsea Centre of Minimal Access Gynaecologist (CCMIG), which is one of the largest online portals for training in laparoscopic surgery.

Mr Amer's research work has been published in various peer-reviewed journals and he is a member of professional organisations including the Royal College of Obstetricians and Gynaecologists, the British Society for Gynaecological Endoscopy and the British Society of Colposcopy and Cervical Pathology

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