What to do? Irregular periods/abnormal periods

What is abnormal menstruation?

Most women have menstrual periods that last four to seven days. A woman’s period usually occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days.

Examples of menstrual problems include:

  • Periods that occur less than 21 days or more than 35 days apart
  • Missing three or more periods in a row
  • Menstrual flow that is much heavier or lighter than usual
  • Periods that last longer than seven days
  • Periods that are accompanied by pain, cramping, nausea, or vomiting
  • Bleeding or spotting that happens between periods, after menopause, or following sex

Examples of abnormal menstruation include the following:

Amenorrhea is a condition in which a woman’s periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven’t started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.

    • Oligomenorrhea refers to periods that occur infrequently.
    • Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.
    • Abnormal uterine bleeding may apply to a variety of menstrual irregularities, including: a heavier menstrual flow; a period that lasts longer than seven days; or bleeding or spotting between periods, after sex, or after menopause.

What causes abnormal menstruation?

There are many causes of abnormal periods, ranging from stress to more serious underlying medical conditions:

      • Stress and lifestyle factors. Gaining or losing a significant amount of weight, dieting, changes in exercise routines, travel, illness, or other disruptions in a woman’s daily routine can have an impact on her menstrual cycle.
      • Birth control pills. Most birth control pills contain a combination of the hormones oestrogen and progestin (some contain progestin alone). The pills prevent pregnancy by keeping the ovaries from releasing eggs.
      • Uterine polyps or fibroids. Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumours that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumours are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.
      • Contraceptives: Mirena intrauterine system and copper intrauterine contraceptive devices can also cause irregular periods however this happens in the first few months of its insertion.
      • Thyroid disorder. A thyroid disorder is another possible but rare cause of irregular periods (the thyroid gland, found in the neck, produces hormones that maintain the body’s metabolism
      • Pelvic inflammatory disease. Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. Bacteria may enter the vagina via sexual contact and then spread to the uterus and upper genital tract
      • Polycystic ovary syndrome. In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. These can often been seen on ultrasound. The hormonal changes can prevent eggs from maturing, and so ovulation may not take place consistently. This leads to abnormal levels of hormones causing the irregular thickening of the lining of womb, which leads to irregular periods.
      • Premature ovarian insufficiency. This condition occurs in women under age 40 whose ovaries do not function normally. The menstrual cycle stops, similar to menopause. This can also occur in patients who are being treated for cancer with chemotherapy and radiation, or if you have a family history of premature ovarian insufficiency or certain chromosomal abnormalities. If this condition occurs, see your physician.

Other causes of abnormal menstruation include:

      • Uterine cancer or cervical cancer
      • Medications, such as steroids or anticoagulant drugs (blood thinners)
      • Medical conditions, such as bleeding disorders, an under- or overactive thyroid gland, or pituitary disorders that affect hormonal balance

How is abnormal menstruation diagnosed?

      • If any aspect of your menstrual cycle has changed, you should keep an accurate record of when your period begins and ends, including the amount of flow and whether you pass large blood clots. Keep track of any other symptoms, such as bleeding between periods and menstrual cramps or pain.

I prefer the following investigations

      • Blood tests to rule out anemia or other medical disorders
      • Vaginal cultures, to look for infections
      • A pelvic ultrasound to check for uterine fibroids, polyps, or an ovarian cyst
      • An endometrial biopsy, in which a sample of tissue is removed from the lining of the uterus, to diagnose endometriosis, hormonal imbalance, or cancerous cells.

How is abnormal menstruation treated?

      • The treatment of abnormal menstruation depends on the underlying cause. I carry out all the investigations and then will look into best possibilities to treat the problem.
        Following are the few treatment options which I may consider.
      • Regulation of the menstrual cycle: Hormones such as oestrogen or progestin might be prescribed to help control heavy bleeding.
      • Pain control: Mild to moderate pain or cramps might be lessened by taking an over-the-counter pain reliever, such as ibuprofen. Aspirin is not recommended because it might cause heavier bleeding. Taking a warm bath or shower or using a heating pad might help to relieve cramps.
      • Uterine fibroids: These can be treated medically and/or surgically. Initially, most fibroids that are causing mild symptoms can be treated with over-the-counter pain relievers. If fibroids do not respond to medication, there are a variety of surgical options that can remove them or lessen their size and symptoms. The type of procedure will depend on the size, type, and location of the fibroids. A myomectomy is the simple removal of a fibroid. In severe cases where the fibroids are large or cause heavy bleeding or pain, a hysterectomy might be necessary. During a hysterectomy, the fibroids are removed along with the uterus. Other options include uterine artery embolization, which cuts off the blood supply to the active fibroid tissue.
      • Endometriosis: Although there is no cure for endometriosis, over-the-counter or prescription pain relievers may help to lessen the discomfort. Hormone treatments such as birth control pills may help prevent overgrowth of uterine tissue and reduce the amount of blood loss during periods. In more severe cases, a gonadotropin-releasing hormone agonist or progestin may be used to temporarily stop menstrual periods. In severe cases, surgery may be necessary to remove excess endometrial tissue growing in the pelvis or abdomen. A hysterectomy might be required as a last resort if the uterus has been severely damaged.

How can the risk of abnormal menstruation be reduced?

Here are some recommendations for self-care:

    • Try to maintain a healthy lifestyle by exercising moderately and eating low-fat foods. If you have to lose weight, do so gradually instead of turning to diets that drastically limit your calorie and food intake.
    • Make sure you get enough rest.
    • Practice stress reduction and relaxation techniques.
    • If you are an athlete, cut back on prolonged or intense exercise routines. Excessive sports activities can cause irregular periods.
    • Use birth control pills or other contraceptive methods as directed.
    • Change your tampons or sanitary napkins approximately every 4 to 6 hours to avoid toxic shock syndrome and prevent infections.