The period is periodically mental, it has no chill. It understandably comes as not the most pleasant time of the month when unfertilised eggs feel just.. ‘meh’. Uncanny truth: women can tolerate a lot during these days. Women work long hours, sit exams, and care for families, while society encourages them to ‘’just use tampons and go surfing’’. However, if you tolerate much, it is easy to lose a touch with your body and neglect your physical wellbeing.

The menstrual cycle can tell us a lot about what is going on in our bodies and female health in general. To put it simply: smooth and regular menstrual cycles are biomarkers of good endocrine and reproductive health, while irregular periods are red flags that something is going on that requires attention. Let’s discuss how not to miss the often-confusing messages our bodies send us and find out where cycle disruptions might come from and why it is detrimental to our health.

The average menstrual cycle lasts 28 days, but periods are considered healthy if they are between 24 and 38 days.¹ Menstrual cycles are considered irregular if the time between periods is inconsistent. Sometimes, such variation in the length of a single menstrual cycle happens due to natural hormonal shifts, like puberty, menopause or breastfeeding. Stress, endurance exercise, weight loss, hormonal birth control and other medications can contribute to period irregularities. No need to panic about it: occasional irregular periods are quite common. The problem arises when the irregularity becomes chronic.

Prolonged cycle disruption is usually a sign of an underlying health condition that messes with your hormonal balance. If the duration of the cycle is less than 24 days, then it might be a luteal phase defect. This condition is typically caused by oestrogen dominance, in which oestrogen levels rise too high in relation to progesterone levels.² The opposite situation happens when the cycle is longer than 38 days, which might be the consequence of polycystic ovarian syndrome (PCOS). Abnormally high levels of androgens can prevent or delay ovulation.³ The thyroid hormones also help control the timing of ovulation and periods, and when they are overproduced (hyperthyroidism) or not produced enough (hypothyroidism), periods can become more or less frequent.^4,5 Other conditions associated with hormonal imbalances and irregular periods include type 1 diabetes, endometriosis, eating disorders, primary ovarian insufficiency (POI) and some forms of cancer.⁶

You might wonder yourself – what if I don’t have any of those conditions? Does it really matter that the duration of my periods fluctuates, if they come anyway? The answer is simple: yes, it does. Even if you don’t feel complications right now, eventually you will. Long-term menstrual irregularity raises the risk of a bunch of different conditions, for instance, infertility.  Firstly, due to irregular periods, the body may stop releasing eggs at all, resulting in difficulty getting pregnant.⁷ Secondly, ovulation is a source of oestrogen, which helps in keeping the bones and blood vessels strong. Irregular periods may contribute to the risk of osteoporosis and cardiovascular diseases in women.⁸ If periods are frequent or heavy, excessive blood loss may cause an iron deficiency and anaemia.⁹ Irregular periods also raise the risk of developing endometrial hyperplasia and endometrial cancer.¹⁰

To ensure you have healthy menstrual cycle patterns, try these 3 simple lifestyle interventions. Use them only as a supportive therapy, while having regular check-ups with your GP, gynaecologist or endocrinologist.

1. Watch your weight gain: studies show that obesity is likely to contribute to irregular periods because fat cells impact hormone levels through disrupted insulin signalling.¹¹ Losing excessive weight helps to regulate the cycle.¹² Extreme weight loss and very low BMI can also cause irregular menstruation, so it is important to maintain your healthy weight.¹³
2. Exercise regularly: exercising not only helps to regulate your periods but also reduces the intensity and duration of pain associated with the menstrual cycle. Daily physical activity and maintaining a healthy weight are crucial for hormonal balance and insulin sensitivity.¹⁴ Excessive exercise can lead to stress and high levels of cortisol, which also interrupt the menstrual cycle. ¹⁵
3. Check your microelements: Vitamin deficiencies can lead to irregular or absent periods. For instance, sufficient vitamin D level is a crucial aspect in managing cycle disruptions for people with PCOS.^16,17 Make sure your diet is diverse, balanced and rich in nutrients and always consult with your GP  before taking any food supplements.

References:

1. Fraser I, Critchley H, Broder M, et al. The FIGO Recommendations on Terminologies and Definitions for Normal and Abnormal Uterine Bleeding. Seminars in Reproductive Medicine. 2011;29(05):383-390.
2. Palomba S, Santagni S, La Sala GB. Progesterone administration for luteal phase deficiency in human reproduction: an old or new issue? Journal of Ovarian Research. 2015;8(1).
3. Welt CK, Carmina E. Lifecycle of Polycystic Ovary Syndrome (PCOS): From In Utero to Menopause. The Journal of Clinical Endocrinology & Metabolism. 2013;98(12):4629-4638.
4. Bates JN, Kohn TP, Pastuszak AW. Effect of Thyroid Hormone Derangements on Sexual Function in Men and Women. Sexual Medicine Reviews. 2020;8(2):217-230.
5. Blick C, Jialal I. Thyrotoxicosis. NIH. 2020. https://www.ncbi.nlm.nih.gov/books/NBK482216/
6. Riaz Y, Parekh U. Oligomenorrhea. NIH. 2020. https://www.ncbi.nlm.nih.gov/books/NBK560575//
7. Hamilton-Fairley D, Taylor A. Anovulation. BMJ. 2003;327(7414):546-549.
8. Riaz Y, Parekh U. Oligomenorrhea. NIH. 2020. https://www.ncbi.nlm.nih.gov/books/NBK560575//
9. Sultan C. Pediatric and adolescent gynecology. Evidence-based clinical practice. Preface. Endocrine Development. 2004;7:IX-X.
10. Harris HR, Titus LJ, Cramer DW, Terry KL. Long and irregular menstrual cycles, polycystic ovary syndrome, and ovarian cancer risk in a population-based case-control study. International Journal of Cancer. 2016;140(2):285-291.
11. Wei S, Schmidt MD, Dwyer T, Norman RJ, Venn AJ. Obesity and Menstrual Irregularity: Associations With SHBG, Testosterone, and Insulin. Obesity. 2009;17(5):1070-1076.
12. Marzouk TM, Sayed Ahmed WA. Effect of Dietary Weight Loss on Menstrual Regularity in Obese Young Adult Women with Polycystic Ovary Syndrome. Journal of Pediatric and Adolescent Gynecology. 2015;28(6):457-461.
13. Hamilton-Fairley D, Taylor A. Anovulation. BMJ. 2003;327(7414):546-549.
14. Cronk N, Zweig A, Deane K. Is exercise an effective treatment for dysmenorrhea? Evidence-Based Practice. 2020. 
15. Nose-Ogura S, Harada M, Hiraike O, et al. Management of the female athlete triad. Journal of Obstetrics and Gynaecology Research. 2018;44(6):1007-1014.
16. Jukic A, Steiner AZ, Baird DD. Lower plasma 25-hydroxyvitamin D is associated with irregular menstrual cycles in a cross-sectional study. Reproductive Biology and Endocrinology. 2015;13(1):20. doi:10.1186/s12958-015-0012-5
17. Tehrani HG, Mostajeran F, Shahsavari S. The effect of calcium and vitamin D supplementation on menstrual cycle, body mass index and hyperandrogenism state of women with poly cystic ovarian syndrome. Journal of research in medical sciences: the official journal of Isfahan University of Medical Sciences. 2014;19(9):875-880.