Irregular Periods
What causes irregular periods in adolescents?
Irregular menstrual cycles are common in the adolescents and does not necessarily mean that there is anything wrong. Menstrual bleeding, that is your period, occurs due to several factors which result in the lining of the uterus (called the endometrium), shedding. This bleeding is the culmination of several factors including a finely controlled pathway known as the ‘HPO axis’. The HPO axis refers to the pathway between the Hypothalamus (an area in your brain), the Pituitary gland (a hormonal factory at the base of your brain), and the Ovaries. When periods first occur (known as ‘menarche’), the HPO axis is immature, and therefore this beautiful sequence of events does not occur consistently. This results in irregular periods. With time, the HPO axis becomes more mature, and the sequence of hormonal events is more regular and consistent.
If irregular periods are common, how do I know if my period is irregular?
Defining a “normal” menstrual cycle in adolescents is challenging due to limited high quality data in this age group, and frequently adult ranges are used for adolescents, even though it is acknowledged that there are numerous physiological differences between adults and adolescents.
The time since menarche is important; the longer it has been since menarche, the more regular menstrual cycles become. This is largely because of the HPO axis becoming mature. It can take up to 8 years post menarche for the HPO axis to mature.
It is recommended that if you are more than 3 years post menarche, if your period occurs between 3 and 5 weekly, this is considered ‘regular.’ If it is more frequent, or less frequent that this, it is important to consult your GP, or discuss with Mikhaila. This does not necessarily mean there is anything wrong, however it is important that you are thoroughly assessed to determine the best plan for you.
What could be causing an irregular period?
There are numerous causes of irregular periods in teens. As mentioned above, the most common cause if an immature HPO axis, which often improves with time.
Other causes include:
Lifestyle factors (exercise, nutrition, body weight, stress)
General health (chronic illness or severe acute illness)
Hormonal imbalances
Ovarian factors
Mikhaila will take a through history from you to determine the cause if your case. She may recommend blood tests to help determine the cause.
What is polycystic ovarian syndrome (PCOS)? Could this be causing irregular periods in teens?
Polycystic ovarian syndrome is a condition that arises from increased levels of insulin (a hormone that regulates glucose levels in your blood), resulting in an imbalance of female and male hormones, leading to various symptoms including irregular periods, acne, unwanted hair growth. It is estimated that across the world, PCOS affects one in 8 women of reproductive age.
PCOS is challenging to diagnose in adolescents given the diagnostic criteria used in adults, can be a normal component of adolescents’ development. For example, irregular periods and acne are more common, and the ultrasound criteria for PCOS in adults is also considered ‘normal’ in an adolescent age group. Mikhaila will assess you for potential PCOS, and if you have risk factors, it is important that we discuss early interventions including lifestyle, nutrition and potential medication options to reduce the longer-term impacts on your reproductive and general health. It is not uncommon in the adolescent age group that a definite diagnosis of PCOS is not given due to the challenges above. Regardless of the diagnosis however, treatment can still be commenced, and a follow up plan will be given to you that may include repeat testing once the HPO is more mature.
How do I manage irregular periods?
The approach to an irregular period is individual, and depends on the underlying cause, whether the irregularity is bothersome for you and whether there are any additional factors impacting your menstrual health.
If you have any medical conditions causing your irregular periods, it is important that these are treated, which can often regulate your cycle.
If it is determined that there are some factors within your lifestyle that may be contributing to an irregular period, we will discuss nutrition, exercise and activities and overall health. There is excellent evidence in those with lifestyle factors including PCOS, there is increasing evidence that optimising nutrition and medication.
Regardless of the underlying cause, if the unpredictability fo your period is troublesome, there are several options we will discuss that may be suitable for you including lifestyle factors or hormonal medication.
When should I see Dr Mikhaila?
If you are worried that your period is irregular, or if it is not improving with time, please give us a call to make an appointment with Mikhaila.
Melbourne Gynaecological Care
If you’re ready to start your journey to better health with one of Melbourne’s best gynaecologists, Mikhaila welcomes you to make an appointment.