Irregular Periods: Symptoms, Causes & Which Doctor to See

What counts as an irregular period?

A menstrual cycle is counted from the first day of one period to the first day of the next. For most adults it lasts between 21 and 35 days, and bleeding lasts up to about seven days. A cycle that varies by a few days each month is normal. Periods are considered irregular when the gap is regularly outside that range, when cycle length changes by more than about a week from month to month, or when periods stop for three months or more without pregnancy.

Irregular bleeding also includes bleeding between periods, bleeding after sex and any bleeding after menopause. These patterns have different causes from simply late or early periods and need specific assessment.

• Cycles shorter than 21 days or longer than 35 days
• Cycle length varying a lot month to month
• No period for three months or more
• Bleeding between periods or after sex
• Periods lasting more than seven days
• Any bleeding after menopause

What causes irregular periods?

Ovulation drives a regular cycle. Anything that disturbs the signals between the brain, the ovaries and the womb can make periods irregular. Pregnancy is the first thing to rule out. Polycystic ovary syndrome (PCOS) is one of the most common causes in young women and is often accompanied by acne, excess facial or body hair, weight gain or difficulty conceiving.

Thyroid disorders, raised prolactin, significant weight loss or gain, intense exercise, eating disorders, illness, travel, night shifts and stress can all affect ovulation. Hormonal contraception, emergency contraception and some medicines change bleeding patterns. Structural causes such as fibroids, polyps or adenomyosis more often cause heavy or between-period bleeding than missed periods.

• Pregnancy or breastfeeding
• Puberty and perimenopause
• Polycystic ovary syndrome
• Thyroid disease and high prolactin
• Stress, poor sleep and shift work
• Rapid weight change or excessive exercise
• Fibroids, polyps or changes in the womb lining
• Hormonal contraception and some medicines

When is irregular bleeding an emergency?

Most irregular periods can be assessed at a planned appointment. Some situations need same-day care. If any of the following apply, go to the nearest emergency department or call 112 or 108.

A positive pregnancy test with one-sided lower abdominal pain or shoulder-tip pain can be an ectopic pregnancy, which is a medical emergency even if bleeding is light.

• Soaking through a pad or tampon every hour for more than two hours
• Passing large clots with dizziness, fainting or breathlessness
• Severe lower abdominal pain
• A positive pregnancy test with pain or bleeding
• Shoulder-tip pain with abdominal pain
• Fever with abdominal pain or foul-smelling discharge

Which doctor should I see for irregular periods?

A gynaecologist is the specialist for irregular periods, heavy bleeding and bleeding between periods. At Lotus, the obstetrics and gynaecology team assesses menstrual problems, PCOS, fibroids and fertility concerns. When thyroid, diabetes or weight issues are involved, the gynaecologist may work alongside an endocrinologist or physician.

Make an appointment if your periods have changed from your usual pattern, have been irregular for several months, last longer than seven days, or come with symptoms such as acne, facial hair growth, weight gain, tiredness, hair thinning or difficulty conceiving. Do not wait if you are over 45 and have new irregular or between-period bleeding, or if you have any bleeding after menopause.

• Change from your usual cycle pattern
• No periods for three months (and not pregnant)
• Bleeding between periods or after sex
• Heavy bleeding affecting daily life
• Signs of PCOS or thyroid problems
• Trying to conceive with irregular cycles

What happens at the gynaecology consultation?

The gynaecologist asks about your cycle history, the last few period dates, flow, pain, contraception, pregnancy plans, weight change, sleep, stress, medicines and family history. A period tracking app or a simple diary of bleeding days is very helpful, so bring it along.

Examination may include weight, blood pressure, signs of excess androgen such as acne or hair growth, and the thyroid. A pelvic examination is offered when relevant and is done with your consent and a chaperone. Unmarried and younger patients can discuss whether an abdominal rather than internal ultrasound is suitable.

It helps to be open about sexual activity, contraception and any chance of pregnancy, even if it feels awkward; the information is confidential and directly affects which tests are safe and useful. If you are anxious about the examination, say so, and the gynaecologist can explain each step before starting.

• Record period start and end dates for three months
• Note heavy days and clot size
• Bring previous ultrasound and blood reports
• List all medicines and supplements
• Mention any plans for pregnancy

Which tests are done for irregular periods?

A pregnancy test comes first. Blood tests are chosen based on your symptoms rather than as a fixed panel. A pelvic ultrasound looks at the womb lining, ovaries, fibroids and polyps; a transvaginal scan gives clearer pictures, but an abdominal scan is an alternative.

If there is persistent between-period bleeding or other risk factors, particularly in women over 45, the gynaecologist may recommend sampling the womb lining (endometrial biopsy) or a hysteroscopy to look inside the womb.

Some hormone tests are timed to the early days of the cycle, so you may be asked to return on a particular day for blood to be taken.

• Urine or blood pregnancy test
• Complete blood count for anaemia
• Thyroid function (TSH)
• Prolactin
• Hormones such as LH, FSH and testosterone when PCOS is suspected
• Blood sugar or HbA1c
• Pelvic ultrasound
• Endometrial biopsy or hysteroscopy in selected cases

How are irregular periods treated?

Treatment depends on the cause and on what matters to you: regular cycles, lighter bleeding, contraception, relief from acne or hair growth, or pregnancy. If the cause is stress, weight change or exercise, addressing those may be enough. In PCOS, losing even 5 to 10 percent of body weight can restore ovulation in some women.

Hormonal options such as the combined pill, cyclical progestogen or a hormonal intrauterine device (LNG-IUS) regulate bleeding and protect the womb lining. Non-hormonal medicines such as tranexamic acid reduce heavy flow. Thyroid problems and high prolactin are treated directly. Polyps and some fibroids can be removed by hysteroscopy, and larger fibroids may need further procedures. Ovulation induction is used when pregnancy is the goal.

• Lifestyle changes for weight, sleep and stress
• Hormonal pills or intrauterine system
• Tranexamic acid or anti-inflammatory medicines for heavy bleeding
• Treatment of thyroid or prolactin problems
• Metformin in selected women with PCOS
• Iron for anaemia
• Hysteroscopic removal of polyps or fibroids
• Fertility treatment when trying to conceive

How can I support a regular cycle?

Regular meals with enough protein, vegetables and whole grains such as ragi, jowar and dal support hormone balance and help prevent anaemia, which is common in Indian women and worsens fatigue during heavy periods. Limit sugary drinks, bakery items and fried snacks if you have PCOS or are gaining weight.

Long work hours, late screens and night shifts common in Bengaluru’s IT and service sectors disturb sleep, which can affect cycles. Aim for consistent sleep times, at least 150 minutes of moderate activity a week such as brisk walking, cycling or yoga, and avoid crash diets. Keep tracking your cycle so you notice changes early.

• Track periods with an app or diary
• Eat regular, balanced meals
• Include iron-rich foods such as greens, pulses and ragi
• Keep a consistent sleep routine
• Exercise regularly but avoid extreme training
• Seek help for stress, anxiety or disordered eating

When should I follow up for irregular periods?

Most treatments are reviewed after three to six months to see whether bleeding has improved and side effects are acceptable. If you have PCOS, regular checks of weight, blood pressure, blood sugar and cholesterol are advised over the years.

Return sooner if bleeding becomes heavier, you develop pain, you have bleeding between periods or after sex, or you want to plan a pregnancy.

• Review three to six months after starting treatment
• Long-term metabolic checks in PCOS
• Earlier review for new or heavier bleeding
• Preconception visit if planning pregnancy