A typical menstrual cycle lasts between 21 and 35 days, with bleeding occurring for 2 to 7 days. Experiencing a period more frequently than this, sometimes twice a month, can be an unexpected change. While some variations in cycle length can be normal, a persistent pattern of very short cycles often warrants attention to understand its cause.
Understanding Frequent Bleeding
When bleeding occurs more often than a typical cycle, it is medically referred to as polymenorrhea, meaning the time between the start of one period and the next is consistently shorter than 21 days. This differs from intermenstrual bleeding, which describes spotting or light bleeding between expected periods, rather than a full menstrual flow. A shorter cycle means the body completes its hormonal preparation for a period more rapidly, leading to more frequent shedding of the uterine lining. Observing the exact pattern and characteristics of the bleeding, such as flow and duration, helps differentiate between true periods and other types of bleeding.
Common Causes of Frequent Periods
Hormonal shifts often cause more frequent periods. During puberty, hormones are still developing, leading to irregular and sometimes shorter cycles. As individuals approach perimenopause, the transition before menopause, hormone levels like estrogen and progesterone fluctuate, often resulting in erratic and more frequent bleeding. An overactive thyroid (hyperthyroidism) can also disrupt reproductive hormones, leading to menstrual changes.
Contraceptive methods commonly alter bleeding patterns. Starting or changing hormonal birth control, such as pills, injections, implants, or hormonal IUDs, causes the body to adjust to new hormone levels. This adjustment can cause breakthrough bleeding or shorter cycles for the first few months. Stopping hormonal contraception can also lead to temporary irregularities as the body’s natural cycle re-establishes.
Structural conditions within the uterus can cause frequent bleeding. Uterine fibroids are non-cancerous muscle growths in or on the uterine wall, sometimes causing heavier or more frequent periods. Uterine polyps, small, soft growths in the uterine lining, can lead to irregular bleeding, including bleeding between periods or more frequent cycles. Adenomyosis, a condition where uterine lining-like tissue grows into the muscular wall of the uterus, can cause painful, heavy, and more frequent bleeding.
Infections affecting the reproductive system can also be a factor. Sexually transmitted infections (STIs) like chlamydia or gonorrhea can inflame the cervix or uterus. This inflammation can lead to irregular bleeding, including bleeding after intercourse or more frequent, lighter periods. Pelvic inflammatory disease (PID), a more severe infection of reproductive organs, can result in abnormal uterine bleeding, often with pain and fever.
Lifestyle factors influence menstrual cycle regularity. Significant changes in body weight, whether gain or loss, can disrupt hormonal balance and lead to menstrual irregularities, including shorter cycles. Extreme exercise, especially intense physical stress, can also impact hormonal signals regulating the menstrual cycle. Chronic stress can similarly interfere with the hypothalamus, a part of the brain that controls hormone release, affecting cycle length.
Certain medications can impact menstrual regularity. Blood thinners, for instance, can increase bleeding, potentially leading to heavier or more frequent periods. Some antidepressants, antipsychotics, and certain herbal supplements might also interfere with hormone levels or blood clotting, changing the menstrual cycle. Always discuss all medications with a healthcare provider to understand potential impacts.
When to Seek Medical Advice
If you suddenly begin experiencing periods twice a month, consult a healthcare professional. This is particularly true if the change is abrupt and not related to starting or stopping birth control. Heavy bleeding that involves soaking through multiple pads or tampons in an hour for several hours, or passing large blood clots, warrants immediate medical attention.
Other concerning symptoms that prompt a visit to a doctor include severe pelvic pain, fever, unusual or foul-smelling vaginal discharge, or symptoms of anemia such as dizziness and extreme fatigue. Any bleeding that occurs consistently between your expected periods or after sexual intercourse also needs medical evaluation. If these frequent periods are causing significant anxiety or interfering with your daily life, seeking professional advice can provide reassurance.
Diagnosis and Management Approaches
When evaluating frequent periods, a healthcare provider will begin by taking a detailed medical history. This includes questions about your menstrual pattern, any associated symptoms, recent life changes, and current medications. A physical examination, including a pelvic exam, is performed to check for any visible abnormalities or signs of infection.
Blood tests are a next step to assess hormone levels, such as thyroid-stimulating hormone, estrogen, and progesterone, to identify hormonal imbalances. A pregnancy test is performed to rule out pregnancy-related bleeding. An ultrasound of the pelvis is used to visualize the uterus and ovaries, helping to detect structural issues like fibroids, polyps, or ovarian cysts. Further procedures like a hysteroscopy, which involves inserting a thin, lighted scope into the uterus, may examine the uterine lining directly.
Management strategies depend on the underlying cause. If hormonal imbalances are present, hormonal therapies, such as adjusting birth control formulations or prescribing progesterone, may help regulate the cycle. Addressing underlying conditions, like treating an infection with antibiotics or managing a thyroid disorder with medication, can restore menstrual regularity. Lifestyle modifications, including stress management, dietary changes, and appropriate exercise, can support hormonal balance. In cases of structural issues like large fibroids or polyps, surgical removal may be recommended.