3 Signs Your Period Is Not Really a Period
Irregular periods? They might not be periods at all. Instead, they might be the breakthrough bleeding of anovulatory cycles.
What does that mean?
A real period is the bleed that comes at the end of an ovulatory menstrual cycle. In other words, it’s the bleed that comes after ovulation and the making of progesterone.
Any other kind of bleed is either:
- the breakthrough bleed of an anovulatory cycle, or
- a pill-bleed.
They’re not real periods.
Here are three easy ways to know if you’re having anovulatory cycles and what to do about it.
But first, what is an ovulatory cycle?
A proper menstrual cycle is defined by ovulation as the main central event, with a pre-ovulatory (follicular) phase and a post-ovulatory (luteal) phase. It looks like this.
The follicular phase takes anywhere from 7 to 21 days (32 days if you’re a teenager), and the luteal phase takes pretty close to exactly 14 days (10-16 days). It all adds up to a healthy menstrual cycle of anywhere between 21 to 35 days (45 days if you’re a teenager).
👉Tip: To determine the length of your menstrual cycle, start counting from your first day of heavy bleeding. That’s “day 1.” The days of light spotting that come before your heavy day are not part of this cycle; they are the final days of your previous cycle.
An ovulatory cycle has a healthy level of both estrogen and progesterone, which is important because progesterone prevents bleeding that is too heavy or too long. A healthy “ovulatory” cycle results in a bleed that lasts 2-7 days with no more than 80 mL of menstrual fluid over all the days of the period.
An anovulatory “cycle” happens when the ovaries tried to ovulate but did not succeed. It’s not a cycle because it’s missing the main event (ovulation) and it’s missing progesterone. It looks like this.
With an anovulatory cycle, you have no ovulation, no luteal phase, and no progesterone. But you still have estrogen so you will eventually get a breakthrough bleed.
An anovulatory cycle has high estrogen but no progesterone. It’s the classic “estrogen dominance” picture, but I don’t like that term.
No progesterone means you have “unopposed estrogen,” which can cause endometrial hyperplasia (thickening of the uterine lining) and bleeding that is too heavy or goes on for too many days.
The “NO progesterone” of an anovulatory cycle is different from the “lowish progesterone” of an ovulatory cycle when you just didn’t make as much progesterone as you would have liked.
👉 Confused about progesterone? Read The Right Way to Test Progesterone.
What causes anovulatory cycles?
It’s normal to have the occasional anovulatory cycle.
If they happen all the time, it’s because of one of the following situations:
- being young and just starting periods (menarche)
- recovering from hypothalamic amenorrhea (undereating)
- recovering from hormonal birth control
- perimenopause (second puberty)
- progestin-only birth control including the implant and the hormonal IUD. (Read The Serious Downside to Contraceptives Injections and Implants.)
How do you know if you’re having anovulatory cycles?
3 Signs of an anovulatory cycle
- Bleeding that lasts too long
A healthy periods lasts 2-7 days and loses no more than 80 mL of menstrual fluid over all the days of the period. If you bleed for more than 7 days, it’s a good sign that you had an anovulatory cycle. An anovulatory bleed can be light or normal or very, very heavy. Read How to Treat Heavy Periods with Diet and Natural Progesterone.
- A cycle that’s too short
Counting from “day 1” to “day 1,” a healthy menstrual cycle is anywhere from 21 to 35 days (45 days if you’re a teenager). If your cycle is less than 21 days, you almost certainly had an anovulatory cycle.
- A cycle that’s too long
If your cycle is more than 35 days (45 days if you’re a teenager), then it’s possible you had an anovulatory cycle. It’s also possible you just had a very long follicular phase. It’s not possible to have a luteal phase longer than 16 days (except with pregnancy and the rare situation of a corpus luteum cyst).
Testing for ovulation
You can try to confirm ovulation and progesterone with a blood test, but be sure to test at the right time! I’ve spoken to many women who think they’re not ovulating (and have progesterone deficiency) when in reality, they’re just fine. They were just testing on the wrong day. Read The Right Way to Test Progesterone.
The simplest way to confirm ovulation is to track your temperatures. The lack of a temperature rise (luteal phase) is a pretty clear indication that you did not ovulate.
Pill-bleeds are not periods
This should go without saying, but the other kind of anovulatory cycle is a pill-bleed. A pill-bleed is different from other anovulatory bleeds in that there’s no estradiol. Both estradiol and progesterone are suppressed by contraceptive drugs. It looks like this.
The body’s own hormones are completely suppressed (flat-lined) much like menopause.
Contraceptive drugs (estrogen and progestin) are present but they’re not depicted in this graph because they are not hormones. A pill-bleed is a withdrawal bleed from the contraceptive drugs.
How to treat anovulatory cycles
If you’re not ovulating, the solution is to figure out “WHY not” and then treat that.
For example, if the underlying problem is PCOS, then identify your type of PCOS and treat that.
If the underlying problem is recovery from hypothalamic amenorrhea, then eat more food and more carbohydrate for at least six months.
I discuss other reasons for irregular periods or anovulatory cycles in Period Repair Manual.