Irregular Menstruation

Menstruation is a cycle starts from one lunar month at puberty to the whole reproductive period till menopause. It is a cyclical process that occurs every month. Every month, the lining of uterus prepares under the action of female hormones which sheds at the end of the cycle called menstruation as bleeding from the vagina. The normal length of the menstrual cycle is 28 + 2days, varies in every individual woman. The bleeding may last from 2 to 7 days.
Irregular menstruation is when the normal menstrual cycle lengthens to more than 35 days or more. During a regular cycle, the time of ovulation and shedding of lining is predictable. This prediction helps women trying to conceive.

Irregular periods are also called oligomenorrhea. The irregularity can result due to a change in the contraception method, mainly because of hormone imbalance, endurance exercises or around the time of the menopause. Irregular periods can also be noticed during menarche. During menarche, it may take up to 2 years for a regular cycle to establish. However, if the irregularity of periods persists it should be medically supervised. Irregular menstruation not only includes the variability of time but also the considerably changing patterns of the amount of bloodshed during or in between the period presence of clots larger than 2,5 centimeter in diameter. The main symptom is when the cycles are longer lasts for 35 days or more.

• Symptoms of irregular menstruation
• Absence of menses for more than a month.
• The time gap between two consecutive cycles expands.
• Blood loss varies in every period it may be profuse or scanty.
• Larger clots may be present.
• Spotting in between periods.
• Extreme weight loss or weight gain.
• Bloating.
• Excess hair growth.
• Acne.

Causes of irregular menstruation

Many things are responsible for irregular menstruation. Estrogen and progesterone keep the normal menstrual cycle in check. An imbalance in the secretion of theses hormones disrupts the otherwise normal menstrual cycle and disturbs the bleeding patterns. This is the only reason why the women during menarche and menopause have an irregular cycle.

Apart from hormone imbalance, other common causes of irregular menstruation include:

• Intrauterine device (IUD)
• Birth control pills or other contraceptive medications
• Strenuous exercise
• Polycystic ovary syndrome (PCOS)
• Endometriosis
• Ectopic pregnancy
• PID
• Pregnancy, childbirth or breastfeeding
• Stress
• Eating disorders like bulimia or anorexia
• Overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism)
• Uterine polyps
• Uterine fibroids
• Cancer of uterus or cervix

Polycystic ovarian syndrome (PCOS): Ovulation is absent or difficult in females suffering from PCOS. It is a condition in which there are several small, fluid-filled sacs called cysts to develop inside the ovaries. Because the egg is not released every month from the ovaries, ovary no longer secretes the hormones estrogen and progesterone to regulate menstruation. The levels of the male sex hormone, androgen, or testosterone are higher in women suffering from PCOS. Insulin plays a major role in disturbing the ovulatory cycle by the production of more testosterone in women suffering from PCOS. Studies show almost 10 to 20 % of women of reproductive age group are affected with PCOS.

Symptoms include obesity, acne, irregular or no periods, and excess hair growth.

Complications of irregular menstruation

Irregular menstruation can sometimes lead to serious health issues that further lead to conception and fertility problems.

• Headaches
• Dizziness
• Rapid breathing, distress while breathing
• Rapid pulse rate
• Dysmenorrhea

Preventive measure to avoid risks of irregular menstruation:

• Sustaining healthy lifestyle habits helps to reduce the risk of causes of irregular menstruation.
• Enough rest and proper exercise regularly to maintain a healthy weight
• Reduce stress.
• Follow a healthy diet
• Use the contraceptive medication as directed by the physician.
• Change sanitary napkins, tampons approximately after 4 to 6 hours to avoid infection and toxic shock syndrome.
  
  

Diagnosis: if any aspect of a regular menstrual cycle is disturbed the following lab tests are ordered to confirm the diagnosis after performing a thorough physical examination.

Blood test including a pregnancy test is performed to rule out pregnancy, hormonal levels (TSH, cortisol, prolactin, FSH, DHEA, 17-hydroxyprogesterone) and infection.

Ultrasonography, X-ray, Pap smear, Biopsy

Treatment

Treatment solely depends on the cause of irregularity in menstruation.

No treatment is required during puberty and menopause, as irregular menstruation is only due to adjustment of the body to the transformation of life and reproductive organs.

• Birth control: If the irregular bleeding is due to contraceptive measures and pills, consultation and advice of gynecologists are mandatory.
• PCOS, obesity, overweight: Menstruation can be stabilized only by losing weight as very little insulin is to be produced with a lower weight. Therefore, lower testosterone levels and a better chance of ovulation.
• Thyroid problems: Medication and radioactive iodine therapy or surgery (in some cases) are used to treat the underlying thyroid problem.
• Stress and eating disorders: Psychological therapy, relaxation techniques, diet management, counseling are mostly advised to the patients.
• Medication: Metformin, an insulin-controlling oral drug for type 2 diabetes, which can help ascertain ovulation and regular periods.

A low-dose birth control pill decreases androgen production. It is made up of a combination of estrogen and progesterone may help. This will help to correct abnormal bleeding.

Irregular menstruation, when to consult a doctor

• Absence or missed period in a sexually active female can be a sign of pregnancy. A visit should be paid to a doctor.
• Previously regular menstruation suddenly became irregular.
• A complete absence of menstruation.
• Acne and excess hair growth on the face, chin, chest, or abdomen.
• Periods last longer than 7 days, are heavy, profuse or appear in between the cycle, duration of a cycle is lesser than 21 days.
• Period comes less often than every 45 days.
• Intense cramping or abdominal pain.
• Irregular menstruation cycle for 3 years or more.