Irregular Menstruation in Teens: Why It Happens and How To Cope

There’s a wide range of “normal” when it comes to periods. And for teens’ cycles, there can be even more variation.

Long periods, short periods and periods that come seemingly at random — all are, frustratingly, common.

But how do you know when irregular menstruation in teens is a problem? And how can you cope?

Adolescent medicine specialist Ellen Rome, MD, shares insight and advice.

Understanding irregular menstruation

Periods don’t always follow the calendar, especially when they’re new to you. And irregular periods aren’t necessarily a sign that anything is wrong.

“In the first two years of having periods, only half of teens ovulate regularly,” Dr. Rome says. “That means that half don’t bleed regularly. And five years after starting their period, 1 in 5 teens still doesn’t ovulate monthly.”

So, yes, when your body is new to menstruating, you might have two periods in a month. Or go a couple of months without a period.

It can feel annoying, uncomfortable and downright unfair. But there’s a good chance that with time, it will become more predictable.

Possible causes of irregular periods

Irregular menstruation is often just a sign that your body is working out the kinks. But some health conditions can also be associated with irregular periods, including:

• Anemia
• Celiac disease
• Diabetes
• Eating disorders
• Hormonal disorders
• Inflammatory bowel disease
• Polymetabolic ovarian syndrome (PMOS, previously PCOS)
• Rheumatologic disease

Knowing what’s normal in your family can be a clue.

“Genetics can influence a lot,” Dr. Rome says. “If your biological sister, mother and aunts bled like clockwork from the first time on and you’re not, it’s worth looking into.”

When to seek medical advice

Periods aren’t always convenient, but they shouldn’t significantly derail your day either.

Specifically, Dr. Rome advises talking with a healthcare professional if:

• You’ve had your period for more than two years and skip two to three months at a time.
• Your period gets in the way of sleeping well, regularly attending school or taking part in extracurricular activities.
• Your periods last eight days or longer.
• Your bleeding is so heavy that you feel weak or faint.
• Over-the-counter medications don’t manage your pain and cramping.

“Basically, anything that worries you is a good reason,” Dr. Rome recommends. “If it’s ringing an alarm bell, it’s worth getting it checked out.”

Not sure where to start? Talk with a pediatrician, adolescent medicine physician or a gynecologist who treats teens.

Coping with irregular menstruation

You can’t always control when your period comes. But you can control how you prepare for it. And there are steps that may help.

Here’s what Dr. Rome recommends:

• Stay prepared. Keep period products and a change of clothes handy, so you can be ready for whatever may come, whenever it comes. Store extras in your purse, backpack, car, locker and anywhere else you may need them.
• Manage cramps. Talk with a healthcare provider about whether ibuprofen is safe for you. The correct dosage, says Dr. Rome, is 400 milligrams four times a day with no missed doses, from the time cramps start or your period starts (whichever comes first) through the expected number of days of cramps. Missed doses mean production of the messenger that causes the cramps (PGF2alpha, in medical terms). Once it’s made, you get cramps.
• Care for your mental health. Periods can come with a host of mood symptoms. Exercising and prioritizing your sleep may help. So can mental health treatment, including therapy and medication. If your periods cause severe mood swings, that’s worth treating. In addition to therapists, adolescent medicine physicians can help with the medical management of PMS and PMDD.
• Talk it out. Not everyone is comfortable discussing periods. But talking with trusted adults, like your parents or a school nurse, can help you get support and treatment.
• Consider treatment. Birth control pills, hormonal IUDs and other forms of hormonal contraception can help if your period is very heavy, painful or tough to predict. “Birth control does a lot more than prevent pregnancy,” Dr. Rome clarifies. “These treatments can help young people feel better, have less anxiety and go to school more regularly.”

Bottom line: Irregular periods in teens aren’t a reason to panic, but they’re not something to dismiss either. Talk with a healthcare provider about your concerns. You’re not alone. And help is available.