A delayed period in a healthy woman once in a while during their fertile age may be attributed to
various temporary internal and external factors and that is perfectly fine. But having irregular or delayed
periods regularly is something that would need attention and probably medicinal or accessory
management.
Usually, a healthy woman gets her periods at an interval of 28 days. The 14th day of this cycle, which is
the 14th day from the first day of the periods is when the ovulation takes place. The egg descends from
the ovary through the fallopian tube and it takes 14 days for the egg to move from the ovary to the
uterus through the fallopian tubes. On the 14th day from the beginning of a period, the ovulation takes
place and if fertilization does not take place, the endometrial layer of the uterus is shed and expelled out
with the unfertilized ovum and blood. This is called menstruation. If the time of ovulation is preponed
or postponed in women, the date of their periods also might change. Hence the menstrual cycle may be
anywhere from 24 to 38 days and this is not considered as irregular menses.
If a menstrual cycle alters for three months consecutively in a woman who had regular menses
previously, then it is considered as an irregularity in the menses. The menstrual cycle is controlled by the
estrogen and progesterone hormones in women and if there is any imbalance in these hormones, there
may be problems with the menses. The menstrual bleeding may be seen for 2 to 8 days in women. A
woman may be said to have irregular menses if she has a delayed period, has excessive bleeding during
menses, or she has periods which do not stop completely and continue for many days.
The reasons for an irregular menses can be multiple. If the periods are seen to be irregular after the age
of 40 years, it may be due to the changes in the body as part of the process of menopause. This is known
as the perimenopausal stage. If the actual menopause is to take place at 50 years, the changes start
around the age of 44 or 45. There may be changes in the estrogen hormone and they may experience a
reduced flow during menses, absence of menses in some months, or they may have excess bleeding
during menses. All these may be seen in the perimenopausal stage. These changes may be investigated
by a doctor to make sure that it is a part of the perimenopausal stage.
Menstrual irregularity is also seen in people who have excessive anxiety or stress. The irregularity in
menstruation due to increased tension is seen even in teenage girls during their exams. Such instances
are also seen in young women during stressful situations like a wedding or when planning for a
pregnancy, or in situations like the death of a loved one.
Women who exercise strenuously, are on crash diets, or skip meals in order to reduce weight, may all
see that their periods are either delayed or earlier than expected. Also, women who are on
contraceptive pills or use copper T, or birth control ring for contraception may have delayed menses or
increased bleeding during menses. Nursing mothers and women who suffered an abortion may also
have delayed menses due to the hormonal changes. But it is must be understood that a delay in periods
may not create any problem in conceiving.
In addition to all these factors, there are also a few disease conditions which may lead to the irregularity
in periods. The most common is PCOD (polycystic ovarian disease). 87% of the women with irregular
periods now, when examined, are found to have PCOD. Even young girls are seen to have PCOD now-a-
days. Lifestyle issues, insulin resistance in women with a family history of diabetes, obesity, etc. leads to
estrogen imbalance and increased in androgen and thereby PCOD. They may develop moustache or may
have thinning of hair on the scalp, may become obese, or get discolorations on the body. Also, there
may be increased acne on the face, potbelly, etc.
Thyroid dysfunction is another important underlying disease condition that causes menstrual
irregularity. 44% of women with irregular periods may have thyroid dysfunctions of either
hypothyroidism or hyperthyroidism. Some women may have both thyroid dysfunction and PCOD in
addition to small infections in the uterus and pelvic inflammatory diseases (any kind of sexual disease or
bacterial infections may be together known as pelvic inflammatory disease) which may all contribute to
irregularity of menstruation. These conditions may be associated with lower abdominal pain.
Similarly, fibroids in the uterus also may cause irregular periods or heavy menstrual bleeding and
abdominal pain.
Investigation and confirmation of the reason behind the irregular menses by a doctor is the first step
towards formulating a treatment plan for irregular menstruation as the management would differ
according to the underlying cause.