Young woman lies on sofa with stomach cramps

Most people know menstruation is normal vaginal bleeding that is part of the monthly cycle which prepares the body for a possible pregnancy. But you may have some questions about the regular—or irregular—ebb and flow of your cycle.

Tamara N. Kolev, MD, Assistant Professor, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, explains how mundane activities can affect your cycle and why one or two irregular periods is nothing to worry about.

Is it normal to have irregular periods? When should I worry about them?

Your menstrual cycle tells us about your overall health and hormone balance. Most people find that the time from the first day of one period to the first day of the next is about the same every month. This time span, called a cycle, can be anywhere from 22 to 35 days. Women on birth control tend to have periods that are shorter, lighter, or—depending on the birth control—disappear altogether.

If you have an irregular period once or twice, that’s probably fine. But, if you notice that you’re continually having irregular periods, it’s better to get evaluated to diagnose the underlying reason and get your body back in balance.

Why am I bleeding in between periods?

There are several reasons why some women have minor bleeding (spotting) between periods. It could be as simple as too much stress, too little sleep or certain medications.    The cause could also be a physical condition, such as fibroids, cervical or uterine polyps, or a chromosomal abnormality, all of which are generally non-cancerous (benign).If you’re at all concerned, you should check in with your primary care doctor or gynecologist.

If I exercise regularly, will my period be lighter–or will I even skip a period?

Exercise can help regulate your periods. When you exercise, your body releases hormones such as endorphins and serotonin, which can also help with menstrual pain, cramps, and mood disturbance. But if you exercise too much—especially if you also don’t eat enough—you may skip a period because your body needs a certain amount of body fat to produce estrogen and maintain the hormonal balance required to have normal periods.

What about diet and weight gain, will either—or both—affect my period?

Gaining or losing a few pounds shouldn’t affect your menstrual cycle. But if your weight changes dramatically, especially if it happens quickly, it can affect your periods. Along the same lines, if you’re not getting enough calories and nutrients to maintain a healthy hormonal balance and produce enough estrogen, your periods may become irregular or may skip a month altogether.

In terms of your daily eating habits, there is growing evidence that what you eat can affect premenstrual syndrome symptoms, such as mood swings, bloating, and fatigue. It can help to eat foods that are rich in omega-3 fatty acids, vitamin D, and calcium or take vitamin D or calcium supplements. Doctors also recommend reducing your intake of fat, salt, and caffeine. Additionally, not having enough iron in your system can make your periods shorter and less regular.  And if you have heavy bleeding when you menstruate, that may lower your iron level.

Alcohol use and smoking can also affect your period. While a glass or two of wine shouldn’t cause fluctuations, heavy drinking can disrupt your hormones and lead to late or irregular periods. Heavy smoking can shorten your menstrual cycle and make periods heavier and more painful.

How will stress and lack of sleep affect my period?

When your body is under stress, it can go into fight-or-flight mode, which may signal the body to overproduce certain stress hormones. This could change your overall hormonal balance. Lack of sleep, in particular, affects both stress hormones and melatonin levels. Melatonin is a hormone that helps to regulate the start of your period and the length of your cycle.   For this reason, changes in melatonin levels can affect your cycle. You may find your periods delayed, or they might skip a month altogether.

When should I see a doctor?

Typically, if you often have bleeding between periods or especially heavy bleeding, you should get it checked out. For premenopausal women, if you don’t have a regular cycle, or if you miss your periods regularly or for several months, you should be evaluated, even if you think the reason is excessive diet or exercise or not getting enough sleep. In general, if you’re at all concerned, make an appointment with your gynecologist for a check-up.

Can I get pregnant during my period?

If it’s truly your period, then no, you cannot get pregnant while menstruating. However, if you’ve been having irregular bleeding between periods, you may be unsure if the bleeding is a real period or if you are bleeding during ovulation. If you are bleeding while ovulating, then you could get pregnant.

Will my period change as I get older?

Yes. After menarche (onset of menses) your period may be irregular and unpredictable. But as you get older, certainly by your 20s, it should become more regular. As you get older, and you approach menopause, your periods will likely start to spread apart and become lighter and less regular. If, instead, they get heavier or more frequent, then it’s important to have that evaluated.

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