Written by Dr.M.D.Mazumdar, MD
The length of a normal menstrual cycle is 28 days, plus/minus 7 days. That is, a period may occur 7 days before the expected date of the period or may be normally delayed for 7 days beyond the expected date. But, if the delay is more than 35 (28+7) days, then the cause of the delay needs to be investigated.
Periods can be delayed for a single cycle or it can be delayed in every cycle. If the delay is in only a single cycle, the most likely cause is a temporary cause like stress. If the periods are delayed but regular in every cycle, then the chances are that the woman has a naturally long menstrual cycle and that this delay in her periods is normal for her.
A long cycle may be normal in some women. So, some women may get their periods normally after every 45 days or 60 days. It may even run in the family. As long as the periods are regular (even if they occur after more than 35 days), it is compatible with fertility and good health and is not a cause for infertility.
But if the periods are irregular in duration, then other causes should be suspected. Most irregular periods which are due to temporary causes like stress, settle down and regularize spontaneously in about 3 months.
If the periods are delayed or irregular for more than 3 cycles, then a medical examination and investigation is definitely called for.
Delayed periods usually occur due to lack of ovulation. If ovulation occurs, periods will generally occur. Estrogen and progesterone secreted by the ovaries during the ovarian cycle causes the endometrium or inner uterine lining to develop. If pregnancy does not occur in that month, the endometrium sheds with bleeding and a menstrual period occurs.
The menstrual period occurs within 14 -16 days of ovulation. This is because the life of the ovum is only 14 -16 days. Once the ovum is released at ovulation, it can have only two options. If
fertilized, a pregnancy will occur and the fertilized ovum will develop into a new individual. If not fertilized, it will degenerate and die within 14-16 days. So, when the periods are delayed, it is due to delay of ovulation.
A normal luteal phase (or progestogenic phase) is always of the same duration - 14 days. The length of the estrogenic or follicular phase (the time before ovulation) is usually what determines the length of the cycle. In some cases, a low progesterone level can cause a short luteal phase and early periods. But progesterone levels usually do not cause a delayed period.
In some women, periods can occur in the absence of ovulation - these type of periods are called anovulatory periods. There is no luteal phase since there is no ovulation. Periods may be early or late or even regular.
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A long cycle may be normal in some individuals. So, some women may get their periods normally after every 45 days or 60 days. It may even run in the family. As long as the periods are regular (even if they occur after more than 35 days), it is compatible with fertility and good health and is not a cause for infertility.
A low thyroid hormone level (hypothyroidism), a high prolactin level (hyperprolactinemia), a high insulin level (hyperinsulinism) and high levels of androgens and cortisones can suppress ovulation and delay periods.
Treatment is as per the cause. If the cause is hormonal, medicines to bring the hormone levels to normal is necessary. If conditions like PCOS, or anorexia nervosa is the cause, then appropriate treatment should be started. If tests rule out any underlying abnormalities, and it is diagnosed to be due to stress, exercise, dieting etc. then assurance is all that is necessary.
Any results positive for a chromosomal problem should however be probed further and managed as necessary.
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