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Menstrual Irregularities

Overview

The average girl starts her period at the age of 12, called Menarche. On average, a normal menstrual cycle lasts for about 21 to 35 days in women. When the cycle becomes less or more than the said number of days or a heavier or lighter than normal period is experienced, it is known as Menstrual Irregularity. It may be associated with abdominal pain or cramping. 

Although it is normal to have irregularity in menstruation a few times after the first period, it takes time for hormones to balance out, and it can vary from girl to girl. Still, if it persists, one must get in touch with a health practitioner. 

Menstrual irregularities can affect a patient's health; of most concern is anemia, which happens due to increased blood loss and causes symptoms like fatigue, paleness, shortness of breath, and feeling constantly tired. It may also pose a threat to fertility. It is managed by finding out and eradicating the underlying disorder.

Causes

There can be many causes of menstrual irregularity most common are discussed as follows;

  • Stress
  • Extreme weight loss or excessive exercising 
  • Polycystic ovaries or ovarian failure 
  • Pelvic inflammatory disease
  • Fibroids
  • Hormonal imbalance 
  • Drug-induced; such as certain blood thinners, anticoagulant drugs, and steroids
  • Ectopic pregnancy (when a fertilized egg is implanted outside the uterus, for example, within the fallopian tube )
  • Endometriosis
  • Uterine cancer 
  • Cervical cancer 

Types

Menstrual irregularities are of different types;

  • Amenorrhea: It is the absence of menstruation.
  • Oligomenorrhea: Having light periods
  • Menorrhagia: It is excessive (heavy) bleeding during periods 
  • Dysmenorrhea: It is a period associated with pain 
  • Metrorrhagia: It is abnormal bleeding that is not associated with menstruation. It can occur in between the periods. 
  • Premenstrual syndrome: It is the time before having menses, during which women experience pain and cramps in the abdominal area, bloating, irritability, acne, cravings, and excessive fatigue. 
  • Premenstrual dysphoric disorder (PMDD) comprises more serious mood changes like irritability and depression a week before menses.

Risk Factors

Following traits can increase your chances of having menstrual irregularities;

  • Being excessively overweight or underweight

  • Stress

  • Smoking 

  • Exercise

  • Bleeding disorder

  • pregnancy history

Epidemiology

Menstrual irregularities are very common. Many women present to their doctors with either heavy bleeding or irregular cycles. According to CDC, Heavy bleeding (menorrhagia) affects more than 10 million American women every year. 

Signs And Symptoms

You may feel the following signs and symptoms:

  • Missing more than 3 or more periods in a row
  • Menstruation occurring in less than 21 days than last period 
  • Menstruation lasting for more than seven days 
  • Period accompanied with extreme abdominal pain and associated with vomiting
  • Heavy bleeding
  • Tiredness 
  • Shortness of breath 

Diagnosis

If you have any of the above symptoms, you may need to consult your physician as it poses a threat to your general health or may point towards a serious underlying disorder. Your doctor will take a detailed history and perform a physical examination. You may be advised to undergo a few investigations like; 

Blood tests; may be performed to determine hemoglobin levels, some hormone levels like Testosterone, TSH, Cortisol, Prolactin, FSH, LH, HCG, etc. Bleeding and clotting tests to rule out bleeding disorders.

Pelvic ultrasound is used to assess organs and structures within the female pelvis.

Pap smear: In this test,  cells are collected from your cervix to check for cancer.

Hysteroscopy; in this procedure, a tiny camera is inserted into the uterus to help the doctor find abnormalities.

Endometrial biopsy; a sample of the uterine lining is taken and sent to the laboratory for further analysis.

Differential Diagnosis

The abnormal uterine bleeding can point out to the underlying disorders like;

  • Cervical disease
  • Intrauterine device ( copper T or hormone-releasing devices for contraception)
  • Endometriosis (when the tissue similar to endometrium grows outside the uterus like ovary, fallopian tubes, etc)
  • Endometritis (inflammation of uterine lining)
  • Polyps
  • Submucosa myomas
  • Endometrial hyperplasia
  • Cancer, tumors 
  • Systemic disease like that of liver, kidney, thyroid disorders
  • Eating disorders
  • Endocrine causes or hormonal disorders
  • Ovulatory dysfunction 
  • Pelvic inflammatory disease (PID)

Treatment

Treatment depends on the underlying cause resulting in a problem with the menstrual cycle.

Birth control pills relieve symptoms of PMS as well as help regulate flow. In the case of hormonal disorder, one may receive hormonal replacements. Antibiotics are used to treat pelvic inflammatory diseases. Tranexamic acid is used to control heavy bleeding during menstrual bleeding. Other medications and procedures include;

  • Medroxyprogesterone 
  • Oral contraceptives 
  • Cyclin progestin 
  • Hormone releasing intrauterine device
  • Tranexamic Acid
  • NSAID heating pad 
  • Surgical removal of fibrosis or polyp’s hysterectomy   
  • Uterine artery embolization 

Prognosis

If the diagnosis is made, treatment can be started for the causative disorder to be treated. If left untreated, women can have complications like anemia, tiredness, infertility, miscarriages, cancers. 

Lifestyle Modification

Following steps should be taken to prevent yourself from suffering the issues of menstrual irregularities.

  • One should aim to manage stress and maintain healthy body weight by adopting a balanced diet along with exercise.
  • Ginger, papaya, cinnamon, aloe Vera, turmeric, pineapple are beneficial for health in case of menstrual irregularities. 
  • Meditation and yoga are effective methods. 
  • Getting enough vitamin D is also essential in promoting health and supporting a healthy menstrual cycle. 
  • Birth control pills should be used as directed by health physicians.
  • Proper use of sanitary napkins and safe contraceptive methods should be used to prevent infections. 
  • Patients should seek a doctor’s advice and go for a regular checkup.