Menstrual cycle alteration means that your periods are different from what is usual for you. Cycles may become irregular, very short or very long, lighter or heavier, or stop for some time.
These changes are common at many moments in life. Often they are benign. Sometimes they are a sign that something needs attention, such as hormonal imbalance, pregnancy, benign uterine disease or other medical conditions.
In Lisbon, Dra. Joana Faria offers consultations about menstrual cycle alterations in Portuguese, English, French, and Spanish. The aim is to understand your history, identify possible causes and agree on a plan that fits your health, your day to day life and your fertility plans.
This page focuses on the cycle itself. For more information about painful periods and genital infections you can also read the pages on menstrual pain and genital infections.
What it is
A menstrual cycle is counted from the first day of one period to the first day of the next one. For many adult women, a usual cycle length is between about 21 and 35 days, with a fairly regular pattern from month to month.
We speak of menstrual cycle alteration when there is a clear change in this pattern. Common examples include:
- Cycles shorter than 21 days or longer than 35 days.
- Periods that last more than 7 days.
- Very heavy bleeding, with clots or the need to change protection very frequently.
- Bleeding between periods or after sexual intercourse.
- Periods that stop for several months without pregnancy.
- Cycles that suddenly become irregular after being regular for years.
Some life stages are naturally associated with more irregular cycles, such as the first years after the first period, the period after childbirth and the years close to menopause. Medicines, contraceptives and other health problems can also influence the cycle.
Possible causes include stress, weight changes, intense exercise, pregnancy, polycystic ovary syndrome, thyroid or prolactin problems, uterine fibroids or polyps, adenomyosis and endometrial changes, among others.
Main symptoms and when to worry
Not every variation is a reason to panic. At the same time, it is important not to normalise symptoms that are clearly affecting your life or your health.
You should consider booking a consultation if you notice:
- Cycles that are very irregular for more than three months, without a clear reason.
- Periods that are so heavy that you need to change pads or tampons every one or two hours for several hours in a row.
- Bleeding that lasts more than 7 days most of the time.
- Absence of periods for more than three months when you are not pregnant and not using hormones that stop menstruation.
- Bleeding between periods or after sexual intercourse.
- New cycle changes after 40 years of age.
You should seek urgent care if you have very heavy bleeding with dizziness, fainting, chest discomfort or difficulty breathing. Bleeding or strong pain in early pregnancy is also an emergency and should be evaluated quickly.
Diagnosis: exams and what to expect
The consultation usually starts with a detailed conversation about your cycle and your general health. Many patients find it useful to bring a menstrual calendar or app with dates and notes from the last months.
Depending on the situation, the evaluation may include:
- Clinical history
Questions about the age when you had your first period, the usual pattern of your cycles, pregnancies, miscarriages or abortions, contraception, medicines, weight changes and other medical conditions. - Pregnancy test
Often one of the first steps when periods are delayed or absent. - Gynecologic examination
Assessment of the external genital area, the vagina and the cervix, when it is appropriate and with your consent. - Pelvic ultrasound
Transvaginal or abdominal ultrasound to look at the uterus and ovaries, check the endometrium and identify fibroids, polyps, cysts or other changes. - Blood tests
Evaluation of anaemia, thyroid function, prolactin and other hormones, clotting or inflammation markers, depending on your case. - Additional exams when needed
In some situations, exams such as hysteroscopy or endometrial biopsy may be recommended to look at the inside of the uterus in more detail.
Not all women need all these tests. The plan is individual, guided by your age, your symptoms and what has already been tried so far.
Treatment options and follow up
Treatment depends on the cause of the cycle alteration and on your priorities. In many cases, several options are possible. Together with your doctor you can choose the approach that makes the most sense for you now, knowing that it can be adapted later.
Examples of options that may be discussed include:
- Lifestyle measures, such as changes in weight, stress management and adjustment of exercise, when these factors are contributing.
- Hormonal contraception to regulate the cycle, reduce heavy bleeding and protect the endometrium when appropriate.
- Non hormonal medicines to reduce menstrual flow and pain in selected situations.
- Specific treatment for conditions such as polycystic ovary syndrome, thyroid disease or high prolactin.
- Local treatments, hormone releasing intrauterine devices or surgery for benign uterine diseases like fibroids or polyps when indicated.
Follow up is very important. It helps to check if bleeding is improving, if anaemia is resolving and whether the plan is compatible with your life. If your situation or your projects change, the treatment can be adjusted rather than starting again from zero.
How Dra. Joana Faria approaches menstrual cycle alterations in practice
Dra. Joana Faria knows that changes in the cycle can create anxiety, especially when you read many different explanations online. Her approach is based on clear information and shared decisions.
In daily practice she:
- Starts by asking what worries you most and how cycle changes affect your day to day life.
- Explains what seems to be happening, what has been ruled out and what still needs to be clarified.
- Uses visual aids and simple language to describe how the uterus, ovaries and hormones interact.
- Adapts investigations and treatments to your plans regarding pregnancy and contraception.
- Creates a step by step plan so that you know what to expect and when to review the situation.
For many patients, understanding the reasons behind menstrual changes and having a clear plan makes it much easier to live with the cycle and to recognise when something really needs attention.
