Irregular Periods/Secondary Amenorrhoea

What are irregular periods?

An average menstrual cycle lasts approximately 28 days, although most women have menstrual cycles that vary and can range from slightly longer to slightly shorter than the stipulated average.

Menstrual cycles are temperamental at times. While some women may notice the gap between the end of their last periods and the start of their next period constantly changing, others may have missing or infrequent menses. 

There are two types of irregular periods, these are:

Amenorrhoea

Amenorrhoea, also known as the absence of menses and can be further categorised into:

• Primary amenorrhoea: periods that have not commenced by the age of 16.
• Secondary amenorrhoea: periods that are absent for 3-6 months in a woman who previously had periods.

Oligomenorrhoea
Oligomenorrhoea, also known as infrequent irregular menses and is defined by fewer than 6-8 periods per year.

What are the symptoms of irregular periods?

Women with irregular periods may experience the following symptoms:

• Menstrual bleeding that lasts longer than usual (more than 7 days)
• Heavier than usual menstrual bleeding (changing pads/tampons every 1-2 hours)
• Menstrual bleeding or spotting in between cycles
• Spotting or bleeding after sexual intercourse
• Spotting or bleeding after menopause

If you are experiencing any of the above symptoms, you are advised to consult your doctor to evaluate your symptoms further.

What causes irregular periods?

Irregular periods can be normal in some women. However, for others, there may be underlying medical conditions that require intervention/attention to re-establish a normal period cycle.

Below are some common medical causes of irregular or ceasing of periods: 

• Pregnancy
• Polycystic Ovarian Syndrome (PCOS)
• Low body mass (frequently associated with eating disorders such as anorexia nervosa, bulimia nervosa)
• Emotional stress
• Strenuous exercise
• Premature Ovarian Failure (menopause before the age of 40)
• Brain lesions such as pituitary or hypothalamus lesion
• Structural abnormalities of the womb, ovaries, cervix
• Hormonal conditions such as thyroid disease
• Genetic inheritance disorders

Be honest and open when sharing your medical history with your doctor. This will help him/her come to the most accurate diagnosis with regards to your irregular periods.

When should I see a doctor for irregular periods? Should I be worried if I have irregular periods?

You are advised to seek medical attention if your period:

• becomes irregular, and you are below 45 years old
• is too frequent (less than 21 days)
• is too long (more than 35 days)
• lasts longer than 7 days
• has always been irregular, and you are not able to conceive 

How are irregular periods diagnosed?

Irregular periods and the underlying cause(s) can be diagnosed with clinical history and physical examination which involves a full body examination including abdominal and pelvic examinations. 

Depending on your condition, you may be required to undergo the following:

• Pregnancy test (urine and blood test)
• Hormone tests (blood tests)
• Imaging such as ultrasound or magnetic resonance imaging (MRI) of the gynaecological region
• Pap smear

For sexually active patients, a pregnancy test will be offered. Depending on individual cases, further investigations such as blood tests, hormonal tests, ultrasound of the pelvis, MRI of the brain, and genetic testing may also be advised or conducted. 

What are the treatment options for irregular periods?

The goal of treatment is to treat the underlying condition and restore fertility in women who are in the reproductive phase of their life. How can we make irregular periods regular? This depends on the cause of the irregular periods. 

Let’s take a look at some general treatment options for irregular periods:

• Oral contraceptive pills: hormonal oral contraceptive pills in the form of oestrogen, and/or progesterone are commonly used to regulate and restore menses. This treatment also reduces the risks of osteoporosis in females in their later life.

• Healthy diet and exercise: women who experience exercise-induced amenorrhoea are advised to increase their calorie intake and reduce the intensity or frequency of exercise. They are also advised to consume 1200 mg to 1500 mg of calcium and 400 IU of vitamin D daily. Healthy lifestyles with good de-stressing techniques are encouraged.

• Take care of your mental health and emotional wellbeing: women with eating disorders often require further support from psychiatrists and dietician specialists to tackle the underlying cause.

• Others: thyroid medication may be required for management of any underlying thyroid disease. In premature ovarian failure cases, hormonal replacement therapy (HT) may be offered to prevent symptoms and long-term complications associated with menopause such as vaginal dryness, hot flushes, and osteoporosis. Surgical options may be offered to patients with structural problems of the reproductive tract. 

Do speak to your doctor for further understanding on individual treatment and management of your irregular periods.

What is a healthy diet and lifestyle for irregular periods?

You are advised to consider moderate exercise; some women can restore a regular menstrual cycle with healthy moderate exercise. Exercises such as yoga, have also been clinically proven to alleviate premenstrual syndrome (PMS) symptoms as there is an increase in the production of endorphin and serotonin, commonly known as the ‘happy’ hormones.

In terms of diet, a healthy balanced diet, high in fibre, omega-3 fatty acids, calcium, and vitamin D is also important. Fatty meals high in saturated fats, salt, carbohydrates, and caffeine should be reduced or avoided.

You are encouraged to discuss your daily lifestyle when sharing your concerns regarding irregular periods with your doctor. 

Can I get pregnant if I have irregular periods?

Some women with irregular periods may have difficulty in getting pregnant as they may not ovulate regularly. Hence, it is good practice to speak to your doctor if your menstrual cycle is abnormal.

Depending on individual medical circumstances, your doctor may advise hormonal medication or fertility treatment to facilitate the process of conceiving naturally.

Are irregular periods normal?

Some women may notice their period irregularity since young/puberty— this can be normal. Occasionally, period cycles may also become irregular due to stress, lifestyle changes, medical conditions, illnesses, vaccinations, etc.

You are encouraged to discuss your symptoms with your doctor so that he/she can come up with a concerted plan to screen for any underlying medical issues that may be the cause of your irregular periods and manage accordingly.