Irregular Periods

Are you concerned you have abnormal bleeding but are unclear about what is normal versus abnormal and what to do next?

You’re in the right place.

This page walks you through the various ways in which bleeding can be abnormal and details the steps you should take to help you get to the bottom of your symptoms. Because let’s face it, abnormal bleeding can be extremely disruptive and is an important message from your body that should not be ignored.

For clarity, I’d like to quickly define a few terms:

• Menstrual cycle: This is the entirety of your menstrual cycle, including your period, follicular phase, ovulation, and luteal phase. Your menstrual cycle is from Day 1 of your period to Day 1 of your next period.
• Menstrual bleeding: This is another term for your period. The terms ‘menstrual bleeding’ and ‘period’ are used interchangeably.
• Intermenstrual bleeding: This is bleeding that occurs between your periods.

1. Irregular menstrual bleeding

• This type of abnormal bleeding is summed up by one word: unpredictability. You never know when your next period will start. Sometimes you go 3 weeks between periods, other times you go 3 months… There’s just no telling when your next period will start. Irregular bleeding is defined as more than 7 days variation in menstrual cycle length. If you’re an adolescent in your first few years of menstruating, or you’re in your 40s and entering perimenopause, irregular menstrual bleeding is expected and not cause for concern – but that doesn’t make it any less disruptive and it can be supported.

2. Prolonged menstrual bleeding

• This type of abnormal bleeding looks like looooong periods, specifically, periods that are consistently lasting more than 8 days. Prolonged bleeding may or may not overlap with heavy menstrual bleeding (see #3).

3. Heavy menstrual bleeding

• To put a number on it, heavy menstrual bleeding is more than 80 ml of blood loss over the span of one period. Here are some tips for measuring your blood loss volume:
  • If you are using a menstrual cup: the standard size DivaCup holds 30 ml of blood (and has measurement lines)
  • If you are using a menstrual disc: the Nixit (which comes in just one size) holds 70 ml of blood
  • If you are using pads or tampons: a soaked regular absorbency pad or tampon holds ~5 ml of blood while a soaked super absorbency pad or tampon holds ~10 ml of blood
• When it comes to heavy menstrual bleeding, putting numbers aside, please remember that if your menstrual blood loss is interfering with your quality of life, a conversation with a healthcare provider is absolutely warranted.

4. Abnormal bleeding frequency

• Frequent: when menstrual cycles are less than 24 days long
• Infrequent: when menstrual cycles are more than 38 days long
• Absent: when menstrual bleeding is unexpectedly absent (there is no menstrual bleeding at all). Please check-in with your healthcare provider:
  • If you’re 15 years old and have not yet had a period
  • If you were having periods but have now gone 3 months without one

5. Bleeding between periods (intermenstrual bleeding)

• This can be challenging to differentiate from irregular (see #1) or frequent (see #4) menstrual bleeding. In some cases, there is a small amount of bleeding immediately following ovulation owing to the brief drop in estrogen levels at that time – this is considered cyclical midcycle intermenstrual bleeding. In other cases, the intermenstrual bleeding is acyclical such as bleeding during or after intercourse.

6. Postmenopausal bleeding

• Any episode of bleeding after menopause needs to be assessed.

As you can see, there are many ways that abnormal bleeding can manifest, and it is not uncommon for someone to experience more than one type of abnormal bleeding. So what can you do about it?

This one’s easy. You need a thorough assessment. Because the way we treat your abnormal bleeding depends on the cause of your abnormal bleeding, and there are many causes. 

What a thorough assessment looks like:

• A detailed history-taking by a healthcare provider
• Lab testing (through LifeLabs)
• Physical exams such as a pelvic exam may be needed
  • a pap test may be recommended
• Imaging such as a pelvic ultrasound may be needed

What you can do to support the assessment process:

Track your menstrual cycle. It’s very tough to remember exactly how your last menstrual cycle went, and the one before that, and the one before that… Some questions a healthcare provider may ask you include:

• What was the first day of your last menstrual period and several previous periods?
• How long are your menstrual cycles? 
• How many days do you bleed? 
• How many period products do you use each day? 
• Do you bleed in between your periods, and if so, what day(s) of the menstrual cycle? 
• And more…

It’s A LOT to remember. If you can even remember what you ate for breakfast yesterday you get a gold star! The point is, recalling past menstrual cycles isn’t easy, and research shows it isn’t accurate either. So jump on the cycle-tracking bandwagon and get to know your menstrual cycle really well. 🙂 Clue app is my go-to (https://helloclue.com/).

1. Abnormal bleeding can look like:

• Irregular bleeding: menstrual cycles are unpredictable as there is more than 7 days variation in menstrual cycle length
• Long bleeding: periods last more than 8 days
• Heavy bleeding: more than 80 ml of blood loss over the span of one period
• Frequent bleeding: menstrual cycles are less than 24 days long
• Infrequent bleeding: menstrual cycles are more than 38 days long
• Absent bleeding: menstrual bleeding is unexpectedly absent
• Intermenstrual bleeding: bleeding between periods that may be cyclical or acyclical
• Postmenopausal bleeding: any bleeding after menopause

2. Abnormal bleeding warrants a thorough assessment – connect with a healthcare provider well-versed in menstrual health who can walk you through this process.

3. You can support the assessment process by tracking your menstrual cycle.

Further reading: What is a normal period?