A menstrual cycle involves natural hormonal changes that prepare the body for potential pregnancy, culminating in the shedding of the uterine lining, known as a period. While most people experience a period about once a month, observing bleeding more frequently can cause concern.
What Defines a Regular Menstrual Cycle
A typical menstrual cycle, measured from the first day of one period to the day before the next, commonly lasts around 28 days, though 21 to 35 days is considered normal for adults. Menstrual bleeding usually continues for 2 to 7 days, with total blood loss ranging from 5 to 80 milliliters (1 to 5 tablespoons).
Bleeding is often heaviest during the first two days. The color of menstrual blood can vary, appearing bright red during heavier flow and becoming pink or brown on lighter days. While slight variations in cycle length or flow are common, consistently shorter cycles, such as having a period twice a month, are considered a deviation from this regular pattern.
Common Explanations for Shorter Cycles
Several common factors, often related to lifestyle or hormonal shifts, can lead to shorter menstrual cycles or breakthrough bleeding mistaken for a second period. Hormonal fluctuations are frequent, especially during adolescence, as cycles establish, or during perimenopause, as the body transitions towards menopause. In adolescence, it can take up to three years for cycles to become regular. Perimenopause can also cause periods to become more or less frequent before stopping entirely.
Significant stress can influence the menstrual cycle by affecting hormone levels, leading to irregular periods or shorter cycles. The body’s stress response can disrupt the hypothalamic-pituitary-ovarian (HPO) axis, which regulates hormones necessary for menstruation. Changes in body weight, particularly rapid gain or loss, or excessive physical activity, can also impact hormonal balance and cycle length. Additionally, starting or stopping certain hormonal birth control methods, like contraceptive pills or intrauterine devices (IUDs), often causes irregular bleeding or shorter cycles as the body adjusts.
Underlying Medical Reasons for Frequent Bleeding
Beyond common variations, certain medical conditions can contribute to frequent or irregular bleeding. Uterine fibroids, noncancerous growths in the uterus, can cause heavier, longer periods or bleeding between cycles. These growths vary in size and location, influencing the extent of bleeding. Endometrial polyps, overgrowths of the uterine lining, are another source of irregular bleeding, including spotting or heavier flow.
Thyroid disorders, such as an overactive or underactive thyroid, can disrupt the hormonal regulation of the menstrual cycle, leading to changes in period frequency. Polycystic Ovary Syndrome (PCOS), a hormonal disorder, is also associated with irregular or frequent periods due to hormonal imbalances. Certain sexually transmitted infections (STIs) can cause inflammation of the cervix, resulting in bleeding, especially after sex. Pregnancy complications, such as an ectopic pregnancy or a miscarriage, can also manifest as frequent bleeding. Some medications, including certain blood thinners or hormone therapies, can also have frequent bleeding as a side effect.
When to Consult a Healthcare Professional
While occasional irregularities can occur, certain symptoms warrant a consultation with a healthcare professional. If bleeding is consistently very heavy, such as soaking through one or more pads or tampons every hour for several hours, or if blood clots larger than a quarter are passed, medical attention is advised. Experiencing severe pain that interferes with daily activities during periods is also a reason to seek evaluation.
Bleeding or spotting that occurs consistently between periods, after sexual intercourse, or after menopause should prompt a visit to a doctor. Any vaginal bleeding occurring a year or more after the last menstrual period is considered abnormal and requires investigation. If frequent periods are persistent, unexplained, or accompanied by other concerning symptoms, a medical assessment can help determine the underlying cause.
Approaches to Managing Frequent Periods
When frequent periods become a concern, healthcare professionals typically begin with a thorough evaluation to identify the cause. This often involves a physical examination, including a pelvic exam, to check for abnormalities. Blood tests may be ordered to assess hormone levels, check for anemia due to blood loss, or screen for thyroid issues. Imaging studies, such as a pelvic ultrasound, are commonly used to visualize reproductive organs and detect conditions like fibroids or polyps.
Depending on the diagnosis, management approaches vary. Lifestyle adjustments like stress reduction, dietary modifications, or changes in exercise routines can help regulate cycles. Hormonal therapies, such as birth control pills or hormone-releasing IUDs, are frequently used to stabilize hormone levels and control bleeding patterns. For structural issues like fibroids or polyps, surgical interventions, such as hysteroscopy to remove growths, may be recommended to address the source of the frequent bleeding.