Reasons why your period might be irregular

Periods can suck, but they can also be comforting, in a way. For many women, that monthly spate of cramping and bleeding is a sign that everything inside the body is operating exactly as it should be.

That's why even one irregular cycle — what gynecologists call "abnormal uterine bleeding" — can be so worrisome. 

Pregnancy is the most common cause of irregularity, according to a gynecologist. But she told  that it's not the only thing that can throw your cycle out of whack. 

Here's a breakdown of nine possible reasons for abnormal bleeding — and what you should do if you notice that something's off. 

First, you have to know what counts as irregular.

"Typically, abnormal bleeding falls into broad categories," the Dr. said. "You can have regular [periods] that are either heavy or longer, you can have bleeding between your periods, and you can just have irregular bleeding that's due to ovulation problems, [or] no bleeding at all."

 Doctors define periods as either "normal" or "abnormal" based on three criteria: how regular your cycles are, how long the bleeding lasts, and how much you're bleeding.

A normal cycle can be anywhere from 24 to 38 days, as long as it's consistent, she said. Normal bleeding lasts five to seven days — if it's eight to 10 days or more, that's considered prolonged bleeding. A normal cycle also requires you to change your pad or tampon three or four times a day. If you're changing every hour for the whole day, then your bleeding is abnormally heavy.

1. You're really stressed out.

There are factors that affect our brain [which] affect our ovaries which in turn affect our menstrual cycle," the Dr. said.  Stress is one of them."

Broadly speaking, stress can suppress the hormones that regulate ovulation, or the release of an egg from one of the ovaries. If ovulation doesn't happen, a period won't happen either. 

2. You started exercising really hard

"Someone who starts increasing their exercise may miss their periods," she said. Just as with stress, it can impede ovulation. If there's no egg in the uterus, the uterus won't build up its usually monthly lining, and there will be nothing for it to shed.

Experts say you should aim for 150 minutes of moderate physical activity a week to stay healthy — and remember that more exercise isn't always better. 

3. Your weight has changed dramatically.

Dr. explained that having a BMI that's either too high or too low ("really either extreme," she said) can prevent ovulation, leading to irregular periods. Women who have anorexia, for example, may lose their periods.

4. You're taking certain medications.

Dr. ticked off a whole bunch of medications that may affect the menstrual cycle.

First, there's hormonal birth control, including the pill, the shot, the implant , and some types of IUDs. These can all cause irregular bleeding and in some cases make your period go away altogether. (For some women, that's a huge plus.)

A breast cancer drug called Tamoxifen, blood thinners, chemotherapy, antibiotics, and anti-psychotic drugs may change your bleeding pattern, too.

5. You smoke.

"We also have seen that smoking can cause irregular bleeding," she said. That's no surprise, considering smoking harms "nearly every organ of the body" according to the doctors.

 6. You have an existing medical condition, like polycystic ovarian syndrome (PCOS).

Your irregular bleeding might have something to do with an underlying condition, like thyroid disease, kidney disease, chronic liver disease, endometriosis, or adenomyosis, the Dr. explained. (Those last two occur when the tissue that lines the uterus starts to grow in places where it's not supposed to be.)

Dr. also singled out Polycystic ovarian syndrome, or PCOS, which causes frequent, irregular or prolonged periods, according to the doctors. Up to 10 % of reproductive-age women have it.

Another common culprit is a genetic bleeding disorder called  Von Willenbrand Disease, which leads to heavy or prolonged periods. 

7. You have an STI or another infection.

Sexually transmitted infections like gonorrhea and chlamydia can cause unexpected bleeding between periods, according to the Dr. (But they don't always have symptoms, so it's important to get tested regularly.)

"It can [also] be due to other infections that we may not even usually test for," she added. Pelvic inflammatory disease— which can be caused by STIs or other types of bacterial infections — could also be at fault.

8. You have some kind of benign growth.

Dr. said that certain harmless growths can crop up in your genital tract and affect your bleeding.

You might have polyps in the uterus or the cervix, for example. You could also have uterine fibroids— growths that aren't cancerous but can cause pain and bleeding.

9. You have cancer.

It's not fun to think about, but irregular bleeding can be linked to endometrial cancer, cervical cancer and uterine sarcoma (a cancer of the uterine muscle tissue), Dr explained. But she stressed that women shouldn't panic about cancer if they have one irregular cycle.

"Most of the time," she said, abnormal bleeding happens for "very benign reasons."

If you have three irregular cycles in a row, call your doctor.

A one-off irregular period may not be cause for alarm, Dr. said. If you call your gynecologist, he or she may advise you to wait a few more cycles to see if the irregularity persists. If it does, then it's time to see your doctor.

"If you've gone three cycles and it's irregular, you need to call," Dr. said. "[Or] if you're changing or pad or tampon every hour and that's lasting a full day, you need to call."

But whenever you're worried about your bleeding, it never hurts you to call your doctor's office just in case.

"I always tell my patients, 'If you're concerned, call.' Because we can reassure people, even if we say, 'OK, why don't you watch it for another cycle or two and then let me know,'" Dr. said. "If you want reassurance from your gynecologist, that's what we're here for."

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