Q: My period is irregular this month. Why is this happening?

A: I have recently received an increased number of calls from worried teenagers concerned that their menstrual cycle is not regular. They are calling with complaints that their cycle is days or weeks late, and this has never happened to them before. These teens have no prior history of cycle irregularity, underlying health conditions that could be attributed to changes in their cycle, or concerns they are pregnant.

Normal menstrual cycles in teens occur every 21 to 45 days. Menstrual cycles should not last longer than seven days, and teens should not be changing greater than seven pads or tampons on the heaviest day. Tracking menstrual cycles is encouraged and is helpful information to share with your doctor.

Late or missed menstrual cycles can sometimes be caused by life changes. In these current times, with many unknowns about the COVID-19 pandemic, teens are faced with new stressors such as stay-at-home orders, social distancing, and school closures. Their normal schedule of activities has been drastically altered, and for some, these changes have been stressful. Stress can affect both mental and physical health. Therefore, stress can be a contributing factor in irregular menstrual cycles. Helping teens manage and navigate stress is important, and parents and guardians can help by modeling positive behaviors for stress reduction.

Here are some suggestions to reduce stress:

  • Participate in activities that make you happy and bring joy. For example, listen to music, sing, read a new novel, write poetry, paint or draw.

  • Engage in physical activity. There are currently many free online exercise classes including yoga, dance, weight training, etc. Try something new.

  • Stay connected with family and friends by video conferencing or telephone calls.

  • Create new family rituals. Have breakfast for dinner and dine in your pajamas or dress in evening wear attire for a fancy dinner, have a board game night, or plant a garden.

  • Get enough sleep. Teens need eight to 10 hours of sleep each night. Limit screen time before bed. Avoid caffeine late in the evening.

  • Eat healthy. Eating mostly sugary and greasy foods can create highs and lows in energy levels. Instead, work on increasing intake of vegetables, fruit, and whole grains. Try new recipes and cook together.

  • Spend time in nature. Go for a walk or bike ride.

  • Learn about mindfulness. Take an online class about this practice.

There can be other causes of missed cycles, such as a recent illness, extreme exercise habits, or weight changes (loss or gain). It is important to remember that pregnancy should be ruled out in teens engaging in unprotected sexual intercourse or those using birth control, which might have failed. Teenagers who have recurrent irregular cycles or miss a menstrual cycle for three consecutive months should also seek evaluation by a health-care professional to complete a further evaluation.

Rachael L. Polis is a pediatric and adolescent gynecologist at Crozer-Keystone Health System.