Delayed and Irregular Periods

For centuries, regular menstrual cycles have been considered an indication of good health in women. A missed period brings with it a wide array of questions ranging from a suspicion of pregnancy, malnutrition/deficiency diseases, stress or hormonal disturbances. As common or mundane as they may sound, some reasons might be mild and can be treated easily, whereas some may indicate a serious health issue that might need urgent attention.

According to research studies, approximately 5% to 35% women have irregular periods during their lifetime. The reasons for this irregularity may be different in different women and accordingly, the treatment approach also varies. Having said that, it is also important to remember that many women may have an occasional delayed or missed period in a year and it is mostly innocuous, you don’t really need to panic if an occasional period is delayed. However, if the irregularity persists or worsens, then of course you need to meet your doctor and get yourself evaluated to diagnose whether or not there is a potential problem that needs to be treated.

So in order to identify whether your periods are really abnormally irregular or just occasionally erratic, it is important to understand the normal menstrual cycle and sequence of events that lead to a normal period. Let’s delve a little deeper into normal female physiology to understand these issues.

What is a normal period?

A menstrual cycle is the term used to describe the monthly events and hormonal changes that take place in a woman’s body to prepare for pregnancy. These changes occur as a result of an interplay of hormones and chemical substances produced by the brain & the ovaries to prepare for pregnancy every month. If the egg released by the ovary gets fertilized & implanted in the uterus, these changes help the uterus to nourish & nurture the growing embryo, whereas, if there is no fertilization & no pregnancy, then all these changes regress and the lining of the uterus sheds in the form of menstrual blood to give rise to your monthly period.

Let’s take a deeper look into this mechanism to understand it better. So the brain has got a structure called Hypothalamus that secretes GnRH, which is a hormone that stimulates another gland –Pituitary gland in the brain. This small Pituitary gland releases two hormones which play an important role in the menstrual cycle:

1. Follicle Stimulating Hormone ( FSH)
2. Luteinizing Hormone ( LH)

Every month, the Pituitary gland releases the FSH that stimulates the ovary to promote the growth of an egg ( Follicle) in the ovary. As the egg grows, the ovary releases a hormone called Estrogen that promotes the growth of blood vessels & tissues in the lining of the uterus to prepare for nurturing a pregnancy.

As the levels of Estrogen rise in the blood and the egg in the ovary ripens, it sends a signal to the brain to decrease the production of FSH and increase the production of LH.

LH is a hormone that induces the ovary to release the egg which is then picked up by the fallopian tube to transfer to the uterus. Once the egg is released, the remnant shell of the egg in the ovary forms a structure called Corpus Luteum. This corpus luteum secretes the hormone Progesterone which plays an important role to support & nurture a pregnancy if the egg in the fallopian tube is fertilized.

If however, the egg is not fertilized, then within a span of 2 weeks, the levels of Estrogen & Progesterone start decreasing and the uterine lining which was growing to support a pregnancy also starts to bleed & shed off. This bleeding and shedding off of the uterine lining alongwith the unfertilized egg and other tissues is experienced as the monthly period in women.

Simultaneously, the preparation for the next menstrual cycle and growth of another egg in the ovary again starts in response to the hormones produced by the brain & Pituitary gland.

What is the duration of a normal menstrual cycle?

The length of a menstrual cycle differs from one woman to another. Typically, an average menstrual cycle maybe 21-35 days long, which means that the interval between the first day of one menstrual cycle and the first day of the next menstrual cycle is 21-35 days normally. Many women have their periods like clockwork- coming on the same date every month while others may have shorter or longer cycles. As long as the interval between two periods is within 21 to 35 days and remains constant from one cycle to the next, you don’t really need to be worried about your cycles.

As for the flow, it is normal to have blood flow for 2-7 days during each menstrual cycle. It is considered unusual to have blood flow which lasts less than 2 days or more than 7 days even if you have regular cycles.

What factors affects the length of menstrual cycle?

There are two phases in a menstrual cycle.

1. Preovulatory phase/proliferative phase/follicular phase- This is the phase in which the egg is growing in the ovary in response to FSH produced by the Pituitary gland. The length of this phase varies in different women due to several factors. In some women, the egg might either take too long to develop or the development may take less time. If the egg takes too long to develop, it leads to an increase in the duration of the preovulatory phase.
2. Postovulatory phase/luteal phase/secretory phase- This is the phase after the release of the egg from the ovary and the length of this phase is 14 days, which is fixed in most women.

Hence, the length of your menstrual cycle will depend on the length of the Follicular phase. Anything that disturbs the follicular phase and leads to a delayed or early ovulation, will disturb the cycle, leading to delayed or irregular periods.

What are the causes of delayed periods?

There are many causes of delayed periods. In some cases, there might be some physiological reason that might be causing irregular periods, whereas at other times, the irregularity may be a result of an underlying disease or pathology that needs to be treated.

1. Pregnancy: The most important cause of a delayed period that needs to be considered in a woman of reproductive age group is pregnancy. This is especially important if there has been an unprotected intercourse in the recent past.
2. Lactating women: In the breast-feeding stage, a hormone known as prolactin is released in the body which suppresses the ovulation. This in turn results in delayed periods.
3. Peri menopausal stage- Peri menopausal stage is when a woman is close to menopause. During this stage, your periods will happen less frequently because the female hormones start declining. Also, the number of eggs in the ovaries decreases with age and so ovulation occurs irregularly, resulting in irregular periods. These periods may be light or heavy depending on your body type.
4. Stress: Stress is one of the many factors that contribute to delayed periods. It leads to release of stress hormones and disrupts the cyclical release of hormones from the brain & Pituitary gland leading to irregular ovulation & delayed periods.
5. Teenage phase: When a girl hits puberty and starts getting her periods, the hormonal cycle may take a few months to two years to regularize and thus the periods may be irregular in the first couple of years. This is completely normal and you need not worry as long as you are getting spontaneous period every 2-3 months in the first few years of puberty. If however, the periods are delayed more than this or are very heavy, do consult your gynaecologist.
6. Lifestyle: There are plenty of lifestyle factors that can impact your periods. A sedentary lifestyle, faulty eating habits, disturbed sleep cycles etc can all lead to delayed or irregular periods. Sudden increase or decrease in weight can also affect the menstrual cycle.

Apart from physiological reasons, that are few reasons that might require medical attention and intervention. As we discussed, any condition that might interfere with the preovulatory stage can result in delayed or irregular periods.

1. Thyroid: The thyroid gland releases the thyroxine hormone which is responsible for a number of bodily functions like brain development, heart functions, etc. When there is a dysfunction in the thyroid gland it leads to hyperthyroidism (excess release of thyroxine) or hypothyroidism (insufficient release of thyroxine). This directly affects the functioning of the brain and results in hormonal imbalance leading to irregular periods.
2. Polycystic Ovarian Disorder (PCOD): One of the most common reasons of delayed periods these days is PCOD. It is a condition wherein the ovaries develop tiny cysts and produce excess of male hormones ( androgens) as compared to female hormones which interferes with ovulation & causes irregular or delayed periods.
3. Premature Ovarian Failure: Normally, a woman experiences menopause after 40-45 years of age. When the menopause happens before 38 years of age, that is as early as 34-35 years, it is known as a premature menopause. This means, the ovaries are approaching the phase where it shall stop producing the eggs sooner or later. During this stage, the woman faces the same difficulties a woman would face in the perimenopausal phase.
4. Medication: There are certain medicines that can impact your periods. Antidepressants, antipsychotics, thyroid medications, anticonvulsants, cancer medications, birth control, etc. can lead to irregular periods.

What can you do?

One of the most important things to resolve the problem of irregular periods is to make lifestyle changes. What are these lifestyle changes?

1. Eat healthy food: Include foods that are rich in nutrients. Include more of fresh fruits and vegetables in your diet. Focus on consuming healthy, home cooked, hygienic food.
2. Cook your food in cast iron vessels to avoid getting Iron deficiency which is an important cause of anaemia.
3. Avoid packaged foods: Packaged & processed foods contain a lot of preservatives & chemicals that may not be helpful for you. They also contain compounds like Xeno-estrogens that may interfere with the normal hormonal cycle and disrupt the hormonal balance leading to irregular periods.
4. Exercise, but don’t over exercise: Research has shown that excessive & rigorous exercise can interfere with the cyclical release of hormones from the Hypothalamus in brain and this, in turn, leads to irregular ovulation & delayed periods. So exercise regularly but do not overdo it. A moderate intensity, sweat inducing exercise for 45 minutes per day is usually enough to maintain a healthy body. You can do Yoga, swimming, jogging, brisk walk, pilates or any other exercise that suits you.
5. Bring your BMI to normal range: If you are overweight, focus on reducing your weight by eating right and getting good exercise, If you are underweight, eat well and also exercise, not to lose weight but to build your muscle mass & improve the stamina. Include foods rich in protein accompanied with moderate exercise. Do not over eat but do not starve yourself either. Moderation is the key.
6. Consult your Gynaecologist: If your periods continue to be irregular, or too heavy/ prolonged, do not hesitate to consult your gynaecologist. Your doctor might want to perform a physical examination, get a few blood investigations and an ultrasound done to determine the cause of your irregular periods, and advise an appropriate treatment.