Women's Health Community

Dear Anon: If you happen to be on some kind of hormonal birth control (pill/patch/ring/Mirena) the most likely explanation would be "normal" breakthrough bleeding/spotting due to the hormones in the birth control. However, if you are not using hormones then the following is my best GUESS.

The most common reason for a menstrual pattern like you have described is not having an ovulation every month. In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month. The good news is that you have enough estrogen to make a lining that does shed.

In a normal cycle, progesterone production increases following ovulation and release of an egg.. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period.

So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—as a missed/late period. Alternatively the lining can begin to shed under its own weight producing prolonged, or erratic, bleeding.

Causes for not ovulating include: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with spouse,money), increased body weight, anorexia, rotating shifts at work, etc. Certainly, ovulations can become more erratic in our 40's as well.

Some other possible causes of erratic spotting can include a new chlamydia infection (unlikely if you are both monogamous). polyps of the lining of the uterus, but this is usually more of a chronic occurrence.

If your erratic bleeding persists, or you develop other symptoms (eg pelvic pain from an infection or ovarian cyst) see your GYN or local family planning clinic.

Yours,
Jane

thanks for info jane, not on any pills just turned 43 this yr but over last few yrs been weird feelings....maybe im starting the change....i was very active before my cycle i was lifting alot and very busy day on the farm with gardening ...etc so maybe all the excercise and exertion brought it early? just had my obgyn exam in july and ovarian cysts were now normal size, pap and breast exam ok so i take it its not from that....my vit D was very low like 17 ...im sure that affects our hormones somehow i was reading ...any truth to vit D /hormone corelation? oh i made error in my post it was twice in aug but the third time was beging sept 7th....if part of the begining of the change is this ok ? i felt like crying at small things ....like no control over emotions....skin feels dryer on face...noticed i gain easier with weight mid sect now....than in my 30s....

Dear healus: Exertion can prompt erratic bleeding in women who have a less stable uterine lining. This could pertain to both hormone users and to someone who may have missed an ovulation.

While the average duration of perimenopause is 4-5 years (with actual menopause averaging age 50.5) the range for perimenopause can be from 0-10 years years in length. Thus you MIGHT be in very early perimenopause. For most women cycle changes become for apparent in their 40's.

Low Vitamin D levels are not specifically predictive of menstrual function. Too bad, as vitamin levels are relatively easy to check.

Despite the normal GYN exam in July, if you continue to have erratic bleeding patterns, you should follow up with your GYN. They may want to rule out other causes of the bleeding before ascribing it to "normal" early perimenopause.

Yours,
Jane

Hi Ms. Jane,

My name's Caitlin and I am 21. I'm not sure if this fits on this board since I'm young, but I have a question about my cycle. I have always had a long cycle (a/b 5 weeks) I know this is normal for those just starting out, but mine never did go down to a more "normal" length. Now that I've started tracking it with a tracker, I'm a little concerned. The app says that my cycle is 40-41 days and then goth of my period is 6-7 days. This is the way it's always been, but when I try to look up about the length all I find is that the normal length is between 26-30 up to 35 and that 40/41 is definitely well past normal. The only other places I seem to find the long cycles discussed is on infertility sites and on menopausal sites. I'm not, nor have I ever been sexually active. I don't have plans for children anytime soon, but I would like at least 2 in the future. This long cycle isn't a sign of infertility, is it? I am slightly overweight, but it has never affected the regularity of the cycle. My mother said she assumes that as long as it's regular I should be fine. I've never really had any major issues either.

Am I worrying over nothing? Is this a sign I may struggle with infertility if I wait until my thirties to have kids? Thanks for any advice! Oh, and my Dr. said I can wait to have "that" exam, thank goodness! A question about that too... Is it as awful as I imagine? It seems horribly invasive, and embarrassing just being that exposed. Are you suppose to shave and all that before? Sorry about the random end of this post. I really want to know about the cycle thing, I just figured while I had your proverbial ear I could ask a couple of other questions:)

Thanks for any help and info you can give me!

Sincerely,

Caitlin

Dear Caitlin: I'll leave the question about how a GYN exam feels to another reader. Suffice it to say I would rather have 100 GYN exams than one dental procedure! As a clinician I can attest that the GYN is not really looking at someone's genitals in any other way other than looking for a problem--and being afraid that we're missing something. You certainly do not have to shave, douche, or do anything cosmetically before an exam. A GYN will have seen just about any genital appearance you can imagine (pierced, shaved, tatooed, etc.) what to speak about blood and vaginal secretions.

OK, your cycle. Those "normal" parameters are statistically based. There will still be some normal women on both sides of the bell curve. If you cycle has always been 41 days and very regular that should have no impact on your fertility UNLESS you are not ovulating monthly. There are several ways to document ovulations: basal body temperature charting (cheap), ovulation predictor kits (expensive), progesterone blood tests (most expensive). Either at your GYN exam or certainly if you you have been trying to conceive for a year without results you can get specific recommendations about ovulation monitoring. Your own GYN can also give you the most "for sure" answer about cycle length after a GYN exam and thorough history.

Thanks for writing!

Yours,
Jane