Causes of menstrual irregularities beyond PCOS
Dr. Ankita Gharge (she/her)

Dr. Ankita Gharge (she/her)

Nov 29Menstrual health

Causes of menstrual irregularities beyond PCOS

This blog has been compiled by Komal Adhlaka, a content writer for Proactive For Her.

Typically, menstrual periods last four to seven days. Irregularities in the menstrual cycle include periods that occur less than 21 days or more than 35 days apart, missing three or more periods in a row and menstrual flow that is much heavier or lighter than usual. There can be many causes of such irregularities beyond PCOS.

A normal menstrual cycle lasts for the duration of 2-8 days, and recurs somewhere between 21-35 days apart with the amount of blood loss being between 20-80 ml.

Any variation from this is considered an abnormal menstrual cycle. Menstrual irregularities don’t essentially include the length of the cycle being long or short, it also includes the conditions where the duration and quantity of menstrual flow are affected. Menstrual irregularities are by far an umbrella term that includes various conditions.

What are the most common irregularities?

Heavy menstrual bleeding associated with the passage of clots, spotting before and after periods, and scanty flow during periods is some of the most common menstrual irregularities.

Types of irregularities

  • Heavy menstrual bleeding is also called menorrhagia where there is increased flow of bleeding during periods that might be associated with the passage of clots, or the flow might extend for more than 8 days.
  • Scanty flow during periods in which the menstruators experience reduced flow during periods which usually lasts for 1-2 days and soak less than 2 pads in a day.
  • Spotting in which there is the passage of drops of blood before or after the periods or in between periods.
  • Intermenstrual bleeding in which there is bleeding or spotting between two regular periods.
  • Polymenorrhoea where the menstruator experiences very frequent periods, the duration between two periods lasts for less than 21 days.
  • Delayed periods where the duration between periods lasts for more than 35 days.

menstrual irregularities

What are the possible causes and symptoms of menstrual irregularities?

According to the type of menstrual irregularity, the symptoms can range from very heavy menstrual flow of blood where the menstruator has to change the sanitary pad every hour, to no bleeding at all, where the menstruator doesn't even soak a single pad in a day. The period flow can continue for days together or spot of blood where there is the observance of spots of blood every time while using the washroom.

There are many causes of abnormal periods, which include:

  • Stress and lifestyle factors. Gaining or losing a significant amount of weight, fad diets, inconsistent exercise routines, excessive travelling, etc. can have an impact on her menstrual cycle.
  • Birth control pills. Most birth control pills contain a combination of the hormones estrogen and progestin (some contain progestin alone). They prevent the ovaries from releasing eggs and thus reducing the chances of pregnancy. Going on or off birth control pills can affect menstruation. Some women experience irregularities in their periods for up to six months after discontinuing birth control pills. Besides, women who take birth control pills that contain progestin only may have bleeding between periods.
  • Endometriosis. The endometrial tissue that lines the uterus breaks down every month, causing the menstrual flow discharge. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus or on the intestines or other organs in the lower digestive tract and the area between your rectum and uterus. Endometriosis may cause menstrual irregularities, abnormal bleeding, cramps or pain before and during periods.
  • Uterine polyps or fibroids. Uterine polyps are small, noncancerous growths in the lining of the uterus. There may be one or several fibroids, which vary in size. These tumours are usually benign, but they may cause heavy bleeding and pain during periods. Large fibroids might put pressure on the bladder or rectum, causing discomfort.
  • Pelvic inflammatory disease. Pelvic inflammatory disease (PID) is a bacterial infection that occurs when the bacteria may enter the vagina via sexual contact, gynecologic procedures or through childbirth, miscarriage, or abortion and then spread to the uterus and upper genital tract. Symptoms of PID include a heavy vaginal discharge with an unpleasant odour, irregular periods, pain in the pelvic and lower abdominal areas, fever, nausea, vomiting, or diarrhoea.
  • Polycystic ovary syndrome. In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens (male hormones). Small fluid-filled sacs (cysts) may form in the ovaries, which can be diagnosed with an ultrasound. The hormonal changes can prevent eggs from maturing, and so ovulation may not take place consistently. Sometimes a woman with polycystic ovary syndrome will have irregular periods or stop menstruating completely. Other symptoms may include obesity, infertility and hirsutism (excessive hair growth and acne). This condition may be caused by a hormonal imbalance, although the exact cause is unknown. Treatment of PCOS depends on whether a woman desires pregnancy. If she does not want pregnancy, then weight loss, oral contraceptive pills, etc. can regulate a woman’s cycles. If pregnancy is desired, ovulation-stimulating medications can be tried.
  • Premature ovarian insufficiency. This condition occurs in women under age 40 whose ovaries do not function normally. The menstrual cycle ceases. This can occur in patients who are being treated for cancer with chemotherapy and radiation, or someone who has a family history of premature ovarian insufficiency or certain chromosomal abnormalities.

Other causes:

  • Uterine cancer or cervical cancer
  • Medications, such as steroids or anticoagulant drugs (blood thinners)
  • Pregnancy-related complications, including miscarriage or an ectopic pregnancy (the fertilized egg is implanted outside the uterus; for example, within the fallopian tube)
  • Medical conditions which affect hormonal balance, such as bleeding disorders, and under-or overactive thyroid gland, pituitary disorders

What complications can women develop with menstrual irregularities and what treatments are possible?

Different menstrual irregularities can lead to various complications such as anaemia or low haemoglobin, fainting, giddiness, weakness, breathlessness, palpitations, and reduced concentration.


The treatment of abnormal menstruation depends on the underlying cause. The treatment in case of heavy menstrual bleeding is primarily targeted toward stopping the flow. Once the bleeding is under control either hormonal therapy or treatment of underlying pathology can be carried out.

In case of scanty blood flow, underlying causes such as anaemia and hormonal disorders should be ruled out and the irregular periods treatment is based on the cause of the condition.

  • Regulation of the menstrual cycle: Hormones such as estrogen or progestin might be prescribed to help control heavy bleeding.
  • Pain control: Mild to moderate pain or cramps could be treated with an over-the-counter pain reliever, such as ibuprofen or acetaminophen. Besides, a warm bath or shower or using a heating pad might help to relieve cramps.
  • Endometriosis: Although there is no cure for endometriosis, hormone treatments such as birth control pills may help prevent overgrowth of uterine tissue and reduce the amount of blood loss during periods. Over-the-counter or prescription pain relievers may help to lessen the discomfort. In extreme cases, a gonadotropin-releasing hormone agonist or progestin may be used to temporarily stop menstrual periods; or surgery may be necessary to remove excess endometrial tissue growth in the pelvis or abdomen.
  • Uterine fibroids: Uterine fibroids can be treated medically and/or surgically. Fibroids that induce mild pain, can be treated with over-the-counter pain relievers. In case of heavy menstrual flow, an iron supplement might help treat anaemia. Low-dose birth control pills or progestin injections may help regulate heavy menstrual flow. If fibroids are non-reactive to medication, surgical alternatives to remove them or lessen their size and symptoms may be tried. The type of procedure will depend on the size, type and location of the fibroids. A myomectomy is the simple removal of a fibroid. Whereas hysterectomy is the removal of a fibroid along with the uterus. Other alternatives include uterine artery embolization, which cuts off the blood supply to the active fibroid tissue.

Are there any home remedies to treat menstrual irregularities?

Unfortunately, no home remedies can treat any menstrual irregularity. Eating papaya or pineapple is not going to make you get your periods early. Home remedies can be used to improve the nutrition deficiencies in the body. Indulging in a healthy diet and healthy lifestyle will keep a check on the hormonal balance and can help to maintain menstrual regularity.

What can I do to prevent menstrual irregularities?

  • Practice a healthy lifestyle, indulge in unprocessed foods, cut down on sugar and unhealthy fats.
  • Maintain meal timings and engage in physical activity at least 30 minutes a day for at least 5 days a week.
  • Manage the stress levels and maintain good sleep hygiene to have a good effect on the hormonal balance.

Final Words

Call your doctor in case of irregular periods and the pattern changes. Your doctor may suggest medical tests to rule out pregnancy or the following symptoms:

  • You miss three or more cycles of periods a year.
  • You get your period more often than every 21 days.
  • You get your period less often than every 35 days.
  • Your bleeding flow is heavier than usual during your period or lasts more than 7 days or, is accompanied by unusual pains and cramps.


Disclaimer - This information is educational and should not be construed as medical advice. Please consult your doctor before making any dietary changes or adding supplements

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