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Irregular Menstrual Cycles

Hormone Therapy for Women in Massachusetts

Are you concerned that your menstrual cycle has recently become irregular? This could be due to a number of reasons. It could be a sign of a problem — or it might be completely benign and nothing to worry about. You could be pregnant — or you could be entering perimenopause.

How can you tell the difference? Keep reading to understand how to identify the causes behind your irregular periods, what happens to your menstrual cycle during perimenopause (and what you can do about the symptoms you may be experiencing), and when to call a doctor.

Causes of Irregular Menstrual Cycles

The two primary causes of missing periods are pregnancy and perimenopause — and either of these can occur in your 40s. If you’re pregnant, you should be able to confirm your condition pretty quickly with a pregnancy test. The gradual slowdown of your menstrual cycle as you approach menopause is less clear cut, and you may end up wondering what’s going on with your body.

Those aren’t the only causes of an irregular menstrual cycle, however. You may also experience irregular periods due to other conditions, including:

  • Polycystic ovary syndrome (PCOS): This medical condition is a result of a hormone imbalance that interrupts menstruation.
  • Hyperprolactinemia: Prolactin is the hormone that regulates milk production. If you have too much of it in your bloodstream, your periods can become irregular.
  • Medications: Antipsychotic medications and antiseizure meds are among the drugs that can interrupt your period.
  • Stress: The hormones that your body produces when you’re undergoing prolonged stress can delay your period or cause you to skip it.
  • Premature ovarian failure: Some women experience the cessation of egg production by the ovaries in their 20s or 30s. Typically women with this rare condition see their menstrual cycle stop entirely, though some may have occasional periods.
  • Diabetes: When diabetes isn’t controlled, blood sugar levels can affect hormones in a way that disrupts the normal menstrual cycle.
  • Eating disorders: Women with anorexia or bulimia may not produce enough hormones to regulate a normal menstrual cycle.

The most common reason for irregular periods during the 40s, however, is perimenopause, which can cause an irregular menstrual cycle for many years.

Irregular Menstrual Cycles and Perimenopause

During perimenopause, your body’s production of estrogen and progesterone fluctuate unpredictably, though always trending downward. Because of these erratic fluctuations, you may miss your period or experience lighter (or, for some women, heavier) flow than you’ve been used to. You may have shorter periods than usual, and they may be less predictable in their arrival. No real tests are available to predict how your perimenopause will proceed, though keeping a diary of your menstrual cycle may help you get the big picture on what’s happening inside your body.

Typically, once perimenopause begins, women’s menstrual cycles become unpredictable and may even occur more frequently. Bleeding may become lighter or heavier. After a couple of years of perimenopause, though, periods become less frequent until they taper off entirely.

When you’ve gone three months with no period, you’re experiencing amenorrhea, which means “lack of menstruation.” Periods that occur more than 35 days apart are known as oligomenorrhea, and heavy bleeding that lasts for more than 7 days is called menorrhagia. You may experience any or all of these during perimenopause, as your periods become more irregular.

Irregular periods can take several forms, including the following:


Some women experience spotting during perimenopause, with small amounts of blood showing up on their underwear in between periods. This is typically a result of hormonal changes. However, if you spot regularly, you may have a hormonal imbalance that requires some kind of medical care. Keep track of your periods, including spotting, to provide your doctor the information needed to understand what’s happening.

Heavy Bleeding

As hormonal levels become unbalanced, with estrogen outpacing progesterone, the lining of the uterus builds up excessively. This results in a menstrual flow that’s heavier than usual. During perimenopause, any skipped periods can also result in buildup of the uterine lining, also resulting in extra heavy bleeding.

You’re experiencing heavy bleeding if you need to change your tampon or pad every hour for several hours, if you require both a tampon and pad to catch the bleeding, or if your period lasts longer than a week. Heavy menstrual flow can cause you to become fatigued, and some women are at risk for anemia with heavy bleeding. If you’re also experiencing significant cramps or pain, you should check in with your doctor.

Dark Blood

You’re probably used to the pattern of bleeding that results in bright red blood near the beginning of your period and darker blood, even brown blood, toward the end. During perimenopause, you may even experience dark brown spotting when you’re in between your period.

The dark blood is older blood. It occurs when it has taken longer than usual for blood and tissue to leave your body. However, if it’s accompanied by a foul odor, you may be experiencing an infection. In this case, you should give your doctor a call.

Irregular Cycles

As your estrogen levels fluctuate during perimenopause, your uterine lining may become thinner. This can result in ultra short periods of just a couple of days, or a shortening of your entire cycle, so that you get your next period only a couple of weeks after your last one ended. This unpredictability can be frustrating.

Later in perimenopause, your menstrual cycle may seem to stretch out, showing up only after 38 days or more have passed. Typically, these longer period cycles involve less bleeding, as your body produces less and less estrogen to feed the uterine lining. You may find that your periods are less and less predictable, not falling into a pattern at all. While this irregularity can be unsettling, your body is just moving closer to the day when you’ll stop ovulating entirely. In the meantime, keeping panty liners on hand and paying attention to any unusual pain or discomfort should get you through this stage.

Missed Periods

During perimenopause, you may miss a menstrual period or two. You may even lose track of the last time you had a period, if you’re not keeping track. Even when you miss several periods in a row, though, if your menstrual cycle is still active, you are still ovulating.

If you miss a period or two, take a pregnancy test to make sure you’re not pregnant. If you’re also experiencing nausea, frequent urination, sensitivity to aromas, or tender breasts, chances are you are indeed pregnant — but make sure to take that test. If you’re not pregnant and you’re in your 40s, those missed periods are most likely just signs of perimenopause.

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Boston Hormone Therapy for Women

Questions about Hormone Therapy?

We have answers

Perimenopause is the stage at which your body starts to prepare for menopause. During this time, your estrogen levels drop and your ovaries cease to ovulate every month. By the time you reach menopause, your body has finished its child-bearing years, and you’re no longer able to get pregnant naturally.

Women reach menopause at an average age of 51. The years preceding menopause are the perimenopause stage, which typically lasts about 4 years, but can last anywhere from 1 to 10 years. During this time, your periods become irregular and sporadic. After 1 full year without having a period, you’re considered to be in menopause.

While most women in their 40s have difficulty getting pregnant, it’s still possible as long as you’re menstruating. If you’re taking birth control pills, they may affect any tests you might take regarding your perimenopause symptoms. Most women should continue birth control until they’re fully through perimenopause and in menopause, typically in your 50s.

Treatment for Irregular Periods

While perimenopause is natural and doesn’t require treatment of any kind, you may want to seek medical help to deal with the various symptoms of perimenopause and menopause. As your production of estrogen wanes, you may experience other menopausal symptoms, including hot flashes, mood swings, bone loss, depression, weight gain, night sweats, and more. You may want to seek treatment for these symptoms.

At the top of the list for treating the symptoms of perimenopause is hormone replacement therapy. This treatment goes directly to the heart of the cause of menopause by raising your estrogen levels. Hormone replacement therapy quells the unpleasant symptoms that often accompany perimenopause. While your periods will still stop, you can avoid many of the uncomfortable effects of this transitional period through hormone replacement therapy.

Other treatments for the symptoms of perimenopause include exercise to keep bones strong, meditation to manage mood swings and irritability, and antidepressants to help with depression and anxiety.

When to See a Doctor About Irregular Periods

Irregular periods don’t necessarily require medical treatment, but in some situations you should see a doctor. If you find yourself bleeding for more than 7 days, if you bleed between your periods, if your periods start occurring less than 3 weeks apart, your period is intensely painful, or if your flow is excessively heavy, you should seek medical treatment. These unusual symptoms may indicate a medical condition that goes beyond simple perimenopause. In addition, women who experience vaginal bleeding after not having a period for over 12 months, should also reach out for medical help.

Help is also available for women experiencing the uncomfortable symptoms of menopause. At Hormonally Balanced, we stand with you and understand what you’re going through. If you’re curious about what hormone replacement therapy might be able to do for you, we can answer all your questions. Contact us today about your irregular periods or about any other concerns you have regarding perimenopause.

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