Why Do I Get My Period Twice A Month?

Getting your period twice a month can be worrisome; whether it comes out of the blue or is a consistent problem in your menstruation cycle.  Either way, it is beneficial to know what may be causing this phenomenon, and what next steps you can take to alleviate symptoms and stress around your period.

There is no single  simple answer as to why you may be experiencing periods twice a month.  Sometimes an irregular cycle may be considered ‘normal’ if you have just started menstruating  or if are experiencing significant amounts of stress or a change in body weight.  However, if two periods in one month either sporadically occur after many years of menstruation or occur each month you may have an underlying hormonal or reproductive health issue.

Overview

Periods are the bleeding that occurs as part of the menstruation cycle.  They can happen to anyone assigned female at birth (AFAB), as this cycle involves the monthly release of an egg from the ovary and the shedding of the uterine lining in the absence of pregnancy. According to the NHS, periods usually start between the ages of 12-18, depending on the onset of puberty. 

A menstrual cycle can last anywhere between 23-35 days, with bleeding occurring around 2-7 days in this time. It is normal for some to bleed for longer or with a larger volume of blood and vice versa. If you get your period every 14 days, this would be considered a short menstrual cycle that may indicate an underlying health issue.¹  

The causes of abnormal periods can be wide-ranging, so it may take a while for your healthcare practitioner to reach the correct diagnosis.  These may include hormonal disorders or abnormalities in the reproductive organs.  

Diagnosis and treatment for this menstrual issue are important as it can predispose you to further health complications.  

Options such as medication and management techniques should be recommended by your healthcare provider according to your specific health issue.  These should ultimately help to improve period regularity and treat any underlying health condition.  

Causes of two periods in one month

It is normal for some teenagers to experience  their period more than once a month when they have just begun menstruating due to fluctuations in hormones during puberty.  However, this should only be the case for a short term. If you have ongoing concerns about frequent menstrual bleeding, you should always consult your doctor. 

It is also common for period spotting (small droplets of blood) to appear between regular period cycles. Period spotting may be confused for a second period in the same month but you will usually be able to tell the difference by the amount of blood produced.

Sometimes two periods in one month can be put down to hormonal fluctuations that occur with some lifestyle changes.  For example, if you have been extremely stressed or made any major changes to your diet and exercise regime that may have caused you to gain or lose a lot of weight.  This may also be the case if you have recently decided to take a hormonal contraceptive pill. 

Having your period twice in one month could also indicate any one of the following conditions: 

• Uterine fibroids - abnormal masses of muscle and connective tissue found in the uterus due to high oestrogen levels
• Uterine polyps - growths of endometrial tissue that appear in the uterus around menopausal age
• Perimenopause - a transition stage between menstruation and menopause usually commencing between the ages of 35-50 where periods can become more irregular
• Hyperthyroidism & hypothyroidism - result of thyroid hormone levels that are too high (hyper) or too low (hypo)
• Premature ovarian failure - when the ovaries stop producing eggs before the usual menopause age
• Pelvic inflammatory disease - infection of any part of the reproductive system (vagina, cervix, uterus, ovary and oviducts) resulting from an untreated sexually transmitted disease (STD) or other non-sexually transmitted bacterial infection
• Endometriosis - when the uterine lining (endometrium) grows outside of the uterus causing pain, inflammation and abnormal or heavy menstrual bleeding
• Cervical cancer and other non-cancerous cervix cell abnormalities. 

If you have a confirmed or suspected pregnancy and experience vaginal bleeding, you should also see your doctor.  They can help assess the severity of the bleeding and determine whether the pregnancy may be at risk. 

Risk factors

Risk factors which could make you more prone to bleeding twice a month include: 

• Age - if you are at the very beginning of your period (age 12-18) or approaching the end of menstrual age (age 35+)
• Ethnicity - some conditions, like uterine fibroids, are thought affect those of African Caribbean ethnicity more than others
• Weight - some conditions (uterine polyps) occur more in overweight individuals due to increased oestrogen hormone levels
• Family history - having an immediate family member with the same predisposing health condition
• Lifestyle - smoking can accelerate issues with periods and ovulation in perimenopause and premature ovarian failure
• Certain treatments - surgeries, radiation or chemotherapy on or around the reproductive organs could cause problems that affect period regularity
• Unprotected sex - being sexually active increases your chances of contracting an STD which may affect your period

Complications 

Frequent periods can be linked to severe period pain and heavy menstrual bleeding.  While pain is a common symptom of most periods and everyone will bleed a different amount, conditions like endometriosis, pelvic inflammatory disease and uterine fibroids can cause more severe uterine contractions.  This can lead to periods that are accompanied by irregular pain or heavy flows that can have a big impact on your day-to-day life.

Frequent periods and a lot of bleeding may also lead to an iron deficiency (anaemia).  Low iron can cause symptoms like excessive tiredness, lightheadedness and depleted energy levels. 

Having abnormal periods due to conditions like uterine polyps, endometriosis and pelvic inflammatory disease may also cause infertility.  This is because damage to and abnormalities in the reproductive organs can hinder eggs from being released by the ovaries, fertilised by sperm and implanted in the uterine lining. 

Management and treatment 

Management and treatment options are available for complications that may arise during menstruation. Some of these options are:

• Painkillers can help to manage both period pain and heavy periods 
• Birth control methods such as the oral contraceptive pill and intrauterine devices (IUDs) can also be used to manage painful and heavy periods 
• Iron supplements can be taken to alleviate the symptoms of anaemia and prevent heavy period flows from causing further health issues
• Fertility treatment - if you are worried about infertility or are having difficulty conceiving your doctor may refer you to a fertility specialist

Lifestyle changes may also improve irregular periods as they can help to rebalance hormone levels.  These include:

• Stopping or reducing smoking
• Practising stress relieving activities. 
• Gaining weight if you are underweight.Losing weight if you are overweight

Treating the cause

Some causes of period irregularities can resolve on their own without treatment, for example:

• Periods should become more regular in teenage years with each cycle Perimenopausal irregularities should disappear as your body moves into menopause (when your period is absent for one year and doesn’t return)
• Uterine fibroid that have developed during menstruation age may disappear after you have went through menopause

However, your doctor may see fit to take urine and blood samples to test for signs of any related underlying health conditions creating an irregular cycle. You may also be referred for an ultrasound or a diagnostic surgical procedure (laparoscopy/hysteroscopy) to look for any abnormalities in the reproductive organs.

Once you receive a diagnosis, you may begin appropriate treatment. Common treatments that can help restore a normal menstrual cycle and ovulation cycle include:

• Hormone replacement therapy for thyroid disorders (hypothyroidism) and reproductive hormone imbalances (perimenopause & premature ovarian failure)
• Hormonal contraception (oral or device) to help balance oestrogen and other reproductive hormone levels throughout your cycle
• Surgery to remove abnormal growths in the uterus
• Antibiotics to treat an STD and pelvic inflammatory disease

Summary

Having problems with your period is frustrating and can impact your mental health as well as your physical well-being . This is especially true when you are experiencing discomfort and pain potentially as a result of an unknown health issue. Fortunately, there are many options that can be considered to obtain a diagnosis and receive treatment to correct a shorter cycle.  Taking steps to manage and treat irregular periods can ultimately help stop your symptoms, improve any underlying health conditions and reduce your chances of experiencing complications.