Understanding the Menstrual Cycle

The menstrual cycle is a continuous sequence of events that a woman experiences during her reproductive years, i.e., starting from puberty to menopause. During this cycle, an egg is developed in the ovary (under the influence of follicle-stimulating hormone), and the uterine lining is developed to receive this egg. If the egg is not fertilised, the developed uterine lining is shed during menstruation (period).

It is a continuous 28-day cycle, divided into two phases: the follicular and luteal phases. In another article, we have detailed the information about the basics of the menstrual cycle. Click here to read it.

During the reproductive years, women experience various issues related to their menstrual cycles, e.g., irregular periods, abnormal uterine bleeding, changes in the cycle length, etc. Understanding these issues is very important for optimum reproductive health. We are going to summarise some of these issues.

Why is there a sudden change in menstrual cycle length?

The standard menstrual cycle is 28 days long. However, it is rarely so regular. Minor changes and irregularities are normal. However, if you have a long, short, or missed period, it could be due to some underlying condition. First, you should know what an abnormal change in the menstrual cycle is.

What is an abnormal menstrual cycle?

Minor menstrual cycle length changes are normal and not clinically relevant. Slight differences in the cycle are a few days plus or minus from the standard 28 days. An abnormal cycle is a cycle that has variations exceeding 7-9 days from this 28-day standard,

Most women experience changes in the duration of menstrual periods, however, changes can also occur with other phases of the cycle. Let's understand what can cause a difference in the cycles.

The use of hormonal contraceptives

The events of the menstrual cycle are influenced by the hormones produced by the pituitary gland, i.e., follicle-stimulating hormone (FSH), which causes the growth of the egg and the luteinising hormone (LH), which causes the release of the mature egg. Hormonal contraceptives disturb these hormones.

Most hormonal contraceptives suppress ovulation, i.e., the release of the egg from the ovary. Ovulation is mandatory for normal periods. Suppression of ovulation means the contraceptive users are expected to have abnormal periods. However, some people do experience vaginal bleeding regularly, resembling periods. However, some women may not experience any bleeding at all.

Period irregularities due to hormonal contraceptives are normal. However, if you are uncomfortable with these changes, you should speak to the doctor and ask him to make the necessary adjustments.

Pregnancy

During pregnancy, a woman is not likely to experience periods. Slight spotting or missed periods are often the first sign of pregnancy. However, pregnancy also causes some other symptoms, e.g., tender and painful breasts, morning sickness, nausea, changes in senses etc.

A home pregnancy test can tell you if the cause of missed periods is pregnancy or something else. The pregnancy causes cessation of periods. However, the period begins soon after the end of pregnancy.

If you suspect pregnancy, our Pregnancy Blood Test can help you. It detects the presence of human chorionic gonadotropin (hCG) in the blood, which is the early biomarker of pregnancy. Click here to place your order.

Perimenopause

If you are in your 40s, your period irregularities could be due to perimenopause, the initial phase of menopause, which is experienced some years (average 4 years) before menopause. During this phase, the periods become irregular, then become more and less often and stop completely after menopause.

If you have the following signs, your irregular periods are likely to be due to perimenopause;

• Vaginal dryness

• Sleep disturbances

• Mood swings

• Night sweats

• Hot flashes

The symptoms of perimenopause are also common with some other issues, e.g., thyroid problems. The doctor may recommend blood tests to determine the exact cause of the symptoms. Keep in mind that menopause and perimenopause is not a disease that requires treatment.

These are normal physiological changes, and you need to address each symptom separately, as recommended by the physician.

Polycystic ovarian syndrome (PCOS)

It is one of the most common causes of irregular periods. The cysts develop on the ovaries, leading to the cessation of ovulation and, thus, irregular periods. This condition also results in high levels of androgen, the male hormone.

A woman with this condition is likely to miss periods or experience exceptionally heavy periods when the periods arrive. If you have the following symptoms, your menstrual irregularities are possibly due to PCOS;

• Insulin resistance

• Difficulty in conception and maintaining pregnancy

• Weight gain

• Increased risk of endometrial cancer

• Increased risk of cardiovascular diseases

• Hair loss

• Oily skin

• Acne

• Excessive hair growth on the body

Higher stress levels

High and chronic stress is perhaps the most underestimated cause of menstrual irregularities. The effects of stress on the periods were particularly studied during the COVID-19 pandemic when the population was exposed to chronic stress. It was noted that people who self-reported them to be influenced by the COVID-19 stress were more likely to have irregular heavy periods.

Another recent study published in Open Medicine in 2022 found that menstrual irregularities were also common after the vaccination for COVID-19, particularly after the second dose.

During stress, the body releases hormones, e.g., cortisol, adrenaline, etc. These hormones negatively affect the reproductive hormones (which regulate the menstrual cycle), causing irregular periods.

Other causes

Besides these well-known causes, some less common but important factors can also cause menstrual cycle irregularities. These include;

• Endometrial and cervical cancer: These cancers can cause bleeding resembling the periods on and off. It becomes difficult to track the periods.

• Drugs: Some drugs are also enlisted as a cause of menstrual changes. These include;

1. Anticancer chemotherapy

2. Antidepressants

3. Epilepsy drugs

4. Blood thinners, e.g., aspirin

5. Nonsteroidal anti-inflammatory drugs (NSAIDs), e.g., ibuprofen etc.

Heavy exercise: Female dancers and athletes often experience these issues because heavy exercise is known to disturb the hormones responsible for periods.

Weakness and being underweight: Excessive weakness and being underweight can depress the activity of the hypothalamus, the part of the brain that controls the secretion of reproductive hormones. Your period irregularities are likely due to weakness if you are also experiencing low mood, loss of concentration, tiredness, hair thinning, dry skin etc.

Endometriosis is a condition in which the tissue resembling the endometrium (the inner lining of the uterus) develops outside the uterus lining. It results in pain and infertility. The common symptoms are excessively long periods with heavy bleeding and bleeding between the periods. Bowel movements and sexual intercourse become painful.

Uterine fibroids: These are benign growths that develop along the inner wall of the uterus. They are variable in size and can cause heavy, painful and longer periods.

Thyroid issues: The thyroid hormones also influence the secretions of the reproductive hormones as they modulate the development and metabolism of the placenta, ovaries and uterus. Therefore, both hypothyroidism and hyperthyroidism can cause changes in the menstrual cycle. You can also note a visible change in your thyroid gland, which is present in your neck.

These changes are, however, also accompanied by the other signs of thyroid disturbances, e.g., excessive sweating, hair thinning, trembling or twitching, palpitations etc.

What should you do?

Period irregularities are very common, particularly for women with a history of reproductive issues. However, any abnormal and persistent change should be reported to the health professionals and treated as they advise.

Our Well Woman Blood Test can help you find the reason if you suspect any issues with your reproductive health. It detects the levels of various biomarkers related to sexual health in the blood, whose levels indicate sexual health. Click here to order your test kit.

Why is my menstrual cycle getting longer/shorter?

The menstrual cycle is a part of life. However, defining a 'normal' menstrual cycle is confusing. Everything is unique for everyone, and each woman has her own set of 'regularities' and 'irregularities'. The release of an egg and the formation of the corpus luteum (which produces progesterone) are common events.

The most commonly accepted average length of the menstrual cycle is 28 days, meaning most women will have a cycle length close to it. If you had consistent periods in the past, any change becomes easily detectable. The difference in the menstrual cycle should be at least 7-9 days for the change to be clinically relevant. Let me summarise some situations that can result in a shorter or longer cycle.

Which situations cause the cycle to become shorter?

The menstrual cycle's most expressive and variable phase is the menstrual phase (periods). Its length can be anywhere from 2 to 7 days. The shortening of the cycle is mostly attributed to a short menstrual phase. The reasons for a short menstrual phase are;

Too much exercising: Normal exercise has little to no influence on the cycle length. However, excessive exercise-related activities can reduce the menstrual phase, or you may not have any periods. Extreme exercises influence the hypothalamus to reduce the level of the ovulatory hormone.

So, consult your gynaecologist if you are going to the gym to build heavy Ab's.

You have chronic stress: Chronic stress interrupts the ovulation process, thus reducing the length of the menstrual phase.

Breastfeeding also impacts the hormones and prevents ovulation by disturbing the hormones. The hormone which causes milk let-down, i.e., prolactin, also prevents ovulation by suppressing the luteinising hormone (LH). Therefore, period disturbances are common if you are breastfeeding heavily.

You are taking some drugs: Some drugs that can shorten the menstrual cycle are contraceptives, IUDs, anti-epilepsy drugs, antidepressants, thyroid drugs etc. These drugs can cause the shortening of the periods or vice versa.

You are in the premenopausal phase: This phase starts years ahead of periods and can result in gradual shortening and the ultimate en