Q: Hello Dr… My 12 year old started her periods Dec 2019, in 2018 she used to have small sights of blood, but last year Dec it was a full on period. Now since February this year 2020 she has not got her period. Is this normal?

A: A ‘regular’ menstrual cycle is supposedly one in which the cycle (the length of time from the 1st day of a menstrual period to the first day of the next menstrual period) is about 28 days but there is nothing abnormal about cycles that fall outside of this range. It could range from about 24 days to 34 days with ovulation happening at mid cycle. Indeed, in some women each period appears to have a different cycle.

The menstrual flow lasts between 2 to 8 days A reduction in flow (scanty period) is called hypomenrrhea (pronounced hai-po-men-oria) and a reduction in the number of days of flow to less than 3 days is called oligomenorrhea (oli-go-men-oria). Now at the onset of puberty, the flow and cycle can vary from one cycle to the other resulting in skipped or irregular periods; the same goes for the other extreme of life (old age).

What do people refer to as irregular periods? Well, if the time between each period changes, or the length of days of the period changes or indeed when the quantity of blood lost during each period changes, the period is termed irregular. What can cause these changes? They include:

Changes in hormone levels, as is common in the puberty period (like in the 13-year old) or menopausal period
Stress

Excessive weight loss or excessive weight gain

Crash dieting (when you want to lose all the weight you added in 5 years in one week :D)

Intense physical activity
Fibroids

Problems with the thyroid (hyperthyroidism)
Polycystic Ovary Disease (PCOD)
Scarring from previous surgery in the uterus like D and C
Pregnancy cannot be overlooked as a cause of irregular bleeding and has to be checked out. The bleeding may be an implantation bleed
Breast feeding mothers may also experience irregular periods as the hormones released may delay return of menstruation. Remember, however, that this is not an effective means of contraception.

So, it’s always a good idea to keep a record of your periods: length of cycles, number of days the period lasts, presence of pain etc. If you keep a chart of this over time, you would be able to know what is normal for you.

Treatment of irregular periods depends on cause: fibroids, PCOD, hyperthyroidism all have to be treated. If irregularity is due to stress, learning coping mechanisms or relaxation techniques may help. Reduce weight or go easy on your exercise routine, if weight issues are a problem. So, each individual case is different but may not necessarily lead to infertility. The gynaecologist will advice based on specific history and circumstance(s).

However, be sure to see your doctor if your period is consistently below 21 days or more than 35 days, if you menstruate for longer than one week, bleed in between periods or experience severe cramp.

I hope this helps