Irregular periods

Periods that no longer come at a steady interval. The NHS website gives the usual gap between periods and the point at which it counts the gap as irregular, and it says irregular periods are more likely as you near menopause.

The Pakistan Menopause Society uses the gap to mark the stages. Its recommendations describe early perimenopause as starting when the length of your cycle keeps changing by a week or more from one cycle to the next, and late perimenopause as the stage when you go two months or more without a period (sections 1.2.5 and 1.2.6).

It can look like this: a period every two or three weeks, or none for months at a time. Lighter one month, heavier the next. Spotting when you were not expecting anything.

Day to day, it feels like uncertainty. Pads in every handbag, just in case. Wondering, at 46, whether you might be pregnant.

The NHS website lists the start of menopause among the common causes of irregular periods, and the Pakistan Menopause Society dates the start of perimenopause from the point your cycle becomes irregular (section 1.2.4).

The NHS website lists other causes too, and they are worth ruling out: pregnancy, hormonal contraception such as the progestogen-only pill, the injection or the hormonal coil, losing or gaining a lot of weight, stress and anxiety, too much exercise, and conditions such as PCOS (now called polyendocrine metabolic ovarian syndrome) or thyroid problems.

• The NHS website suggests keeping track of your periods in an app or a diary, so you can see whether they are irregular. Symptom tracking covers how.
• The Pakistan Menopause Society asks doctors to document your bleeding pattern at the first visit and at follow-up (Tables 1 and 4). Your own record makes that easy.
• NICE NG23 and the Pakistan Menopause Society both say that for a healthy woman of 45 or over, perimenopause is identified from her symptoms and her cycle, without blood tests. Under 45, a doctor may test, and the guidelines set out when.

Irregular periods in themselves do not always need treatment. The NHS website says that when treatment is needed, it depends on the cause.

If perimenopause is the cause and you have other symptoms too, the NHS menopause page notes that taking HRT during perimenopause can make periods more regular. It adds that you may have some irregular bleeding or spotting at first, which should settle within 6 months, and to talk to a GP if it does not. Whether HRT suits you is your doctor's decision with you.

The NHS website says to see a GP if your periods are irregular, last longer than 7 days, come with bleeding between periods, or come with symptoms such as weight gain, tiredness, facial hair, or dry or oily skin.

The Pakistan Menopause Society lists unexplained bleeding between periods, bleeding after sex, and sudden heavy or prolonged bleeding among its red flags (section 2.3). And if a whole year passes with no period and then you bleed, that is bleeding after menopause, which always needs checking.

When you cannot predict your period, the questions pile up. Is this bleeding a period, or something else? When do you pray again? Do the fasts you missed count the same way? Women ask these every Ramadan and rarely get a clear answer, and the answers belong with a qualified scholar. Roshara does not rule on them. What helps, whoever you ask, is a record of your dates and how heavy each bleed was.

At home, a written record also means you only have to explain it once.