Treating irregular periods (abnormal menstruation)

Irregular periods, or abnormal menstruation, are a common concern for many women and people who menstruate. While the menstrual cycle can vary slightly from person to person, a pattern that is unpredictable, too frequent, too infrequent, or particularly heavy may signal an underlying issue. Understanding the causes and treatment options can assist patients in getting their cycle under control, and giving them their quality of life back. 

What is considered an irregular period?

A typical menstrual cycle lasts between 21 and 35 days, with menstruation usually lasting 2 to 7 days. Irregular periods may include:

• Skipped periods or long gaps between cycles
• Cycles that come more frequently than every 21 days or less often than every 35 days
• Very heavy or prolonged bleeding (menorrhagia)
• Very light periods or spotting between periods
• Painful menstruation (dysmenorrhoea)

Occasional irregularities can be normal, but persistent changes should be discussed with a healthcare professional.

What causes abnormal menstruation?

There are several reasons why someone may experience irregular periods. Common causes include:

• Hormonal imbalances: Especially during puberty, perimenopause, or due to conditions like polycystic ovary syndrome (PCOS)
• Thyroid disorders: Both overactive and underactive thyroids can disrupt the cycle
• Weight changes: Significant weight gain or loss, as well as eating disorders, can affect hormonal function
• Stress and lifestyle factors: Emotional stress, intense exercise or disrupted sleep patterns may interfere with ovulation
• Medical conditions: Uterine fibroids, endometriosis, and pelvic inflammatory disease can all contribute
• Medications and contraception: Certain contraceptives or treatments may alter the menstrual pattern

When should you seek medical advice?

It’s important to consult a doctor if you:

• Frequently miss periods
• Experience very heavy bleeding or bleeding between periods
• Have extremely painful menstruation
• Notice changes in your menstrual cycle that persist for more than a few months
• Are trying to conceive and your periods are irregular

How are irregular periods diagnosed?

A healthcare provider will take a detailed medical history and may perform:

• Pelvic examination
• Blood tests to check hormone levels, thyroid function, and general health
• Ultrasound scan to assess the uterus and ovaries
• Further investigations like hysteroscopy or MRI if abnormalities are suspected

What are the treatment options?

Treatment depends on the cause, severity and individual goals such as symptom control or fertility. Options may include:

• Lifestyle adjustments:
• Maintaining a healthy weight
• Reducing stress
• Regular moderate exercise

• Medical treatments:
• Hormonal contraceptives (e.g. the pill, patch or hormonal IUD) to regulate cycles
• Progesterone therapy for specific hormonal imbalances
• Treatment for thyroid or metabolic conditions
• Anti-inflammatory medications for pain and bleeding

• Specialist treatments:
• Surgery for fibroids or endometriosis
• Fertility support if needed

Can periods become regular again?

In many cases, periods can return to a regular pattern once the underlying issue is addressed. Ongoing monitoring, personalised care, and support from a gynaecologist or GP can help restore menstrual health and improve quality of life.