photo by me_and_the_sysop

Every few weeks, Dr. Vanessa Cullins, a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America, will be answering your questions here. To ask her your own question, click here.

Dear Dr. Vanessa,

I’m 37 and for all my menstrual life I’ve been regular as clockwork, 29 days each cycle. And then suddenly in the last few months, my cycle has been all over the place — sometimes as low as 22 days long, and other times back up to 29 days. The only thing I’ve heard of that can do this to your period is menopause — could these be the beginning signs?! Is it possible to start experiencing symptoms at my age? And if these are early signs, does that mean I can no longer get pregnant?

— Ms. Irregular

Dear M.I.,

As we grow older, our bodies begin making less of the hormones estrogen and progesterone, and this could be the reason that your cycle has been unpredictable lately. The gradual change leading up to menopause is called perimenopause. Perimenopause usually happens around ages 45 to 50, but can begin as early as the late 30s. It usually starts about two years earlier for women who smoke than for those who don’t. Perimenopause is a stop-start process that can take a few months or can last up to 12 years.

It may be that you have stopped ovulating regularly and are having what is called dysfunctional uterine bleeding (DUB). DUB is very common. It is caused by hormonal imbalances which may be stimulated by excessive exercise, dieting, stress, or getting older.

DUB is diagnosed by ruling out other conditions that may cause irregular periods. Other causes include pregnancy, sexually transmitted infection, polyps on the cervix, hypothyroidism, cervical cancer, and using certain forms of hormonal birth control, such as the pill or the shot. The cause of your irregular period may be short- or long-term, and completely harmless or more serious. Because there are so many causes for the bleeding you describe, you must be evaluated by your health care provider.

There are many ways for your health care provider to figure out the cause or diagnose what you’ve been experiencing. Your provider will probably give you a pregnancy test to rule that out. You may also have blood tests to measure various hormones . You should also have a pelvic exam. Your health care provider may use ultrasound or a tool called a hysteroscope — a thin, telescope-like instrument with a light — to see inside your uterus. Another common test for someone with your symptoms is an endometrial biopsy — a small piece of the lining of your uterus is taken and tested it to see if there are any abnormalities and see if your hormones are in balance.

After your tests, your health care provider will be able to advise you about whether you need any treatment, and if so, what your treatment options are. Rest assured that if a problem is found, there are many treatment options for all of these possible causes.

Your period may not be regular, but that doesn’t mean you cannot get pregnant. Be sure to use birth control consistently if you’d like to avoid pregnancy — whether or not you have had a period recently. If you’d like to have a child, once the cause of your irregular periods is diagnosed, your health care provider will be best able to advise you about how best to expand your family.

Best wishes for your sexual health,

Vanessa
Planned Parenthood

Vanessa Cullins, MD, MPH, MBA, is a board-certified obstetrician/gynecologist and vice president for medical affairs at Planned Parenthood® Federation of America.