Menstrual abnormalities include irregular menstrual cycle, heavy bleeding and painful menstruation. Irregular menses denotes variation in the length of a menstrual cycle. A menstrual cycle is the period between the first day of bleeding of one cycle to the onset of next period of bleeding. A normal menstrual cycle is 28 days but it can vary between 21 to 35 days. The bleeding last 2 to 7 days. So, a women can have her cycle every 28 days that last for 4 days with light bleeding or the same women can have another cycle that is 32 days long and lasts 7 days with more than light bleeding and still be “within the normal range” for her. Menstrual cycles are usually irregular and longer during early years of menarche that becomes regular and shorter as the person grows older.
Menstruation is usually painless and some discomfort is normal. Severe abdominal pain associated with cramps is called dysmenorrhea and is not normal.
Abnormalities of menstrual cycle can be associated with abnormal amount,duration and interval (usually heavy and prolonged) of bleeding called menorrhagia and metrorrhagia. When both occur at the same time, it is called menometrorrhagia.
Abnormalities of Menstrual Cycle
- Amenorrhea is the complete absence of menstruation for more than 90 days unless the woman is pregnant. It is called secondary amenorrhea if the women had periods before. If a girl hasn’t had her first period by 15 years or with three years of breast development it is called primary amenorrhea.
- Oligomenorrhea is less than frequent periods.
- Polymenorrhea is periods occurring too frequently usually less than every 21 days.
Abnormalities of Bleeding during Menstruation
- Menorrhagia is heavy or excessive bleeding during menstruation.
- Metrorrhagia is irregular and sometimes prolonged bleeding that occurs in between normal menstrual cycles.
- Dysmenorrhea is painful menstruation.
Diseases and condition that cause one type of abnormality usually also causes other abnormalities. All those causes are considered together here:
- Normal physiological changes in hormone levels: Pregnancy and breastfeeding causes amenorrhea. Perimenopausal women experience infrequent and short periods.
- Lifestyle and psychological factors: stress, traveling, frequent lack of sleep and other illness that disrupts daily routine can affect menstrual cycles. Excessive exercise, weight loss or weight gain, eating disorder can affect menstrual cycles.
- Polycystic ovarian disease: As the name suggests, small fluid filled cysts form in the ovaries. The ovaries produce large amounts of male hormones and cause irregular menses or stop menstruating completely. In addition to menstrual irregularities, these women are obese and have excessive hair in the body (hirsutism).
- Premature ovarian failure: In this case, a woman’s ovary fails to produce eggs before age 40 and menstrual cycle stops completely. Women who are receiving chemotherapy, radiation therapy or who has family history of ovarian failure are more likely to have these conditions.
- Pelvic inflammatory disease: Infection of female reproductive organs can cause irregular and abnormal bleeding.
- Family planning measures: can cause irregular menstruation like depo provera and intrauterine device (copper-T). Menstrual cycle may remain irregular up to 6 months after stopping oral contraceptive pills.
- Endocrine diseases: hyperactive adrenal glands, diabetes mellitus (poorly controlled), congenital adrenal hyperplasia, hyper or hyperactive thyroid gland.
- Tumors of uterus: endometriosis and uterine fibroids cause painful menstruation. Uterine fibroids can also cause excessive bleeding.
- Others: uterine cancer, bleeding disorders, taking blood thinning medicines.
When to seek medical care
Seek medical care and attention if irregular menstruation is accompanied by following features:
- Heavy bleeding, fainting like features, feeling of weakness due to heavy bleeding
- Bleeding in between periods
- Bleeding for more than 7 days
- If more than three periods are missed in a year unless pregnant
- Severe pain which is not managed with paracetamol
- Frequent period or a period occurring in less than 21 days
Diagnosis is based on the history and physical examination. If you notice abnormalities in your menstrual cycle, you should keep a diary of cycle length, amount and duration of bleeding and other associated symptoms and bring it to the doctors visit. Your doctor will perform a physical and pelvic exam. You may need a pelvic ultrasound of the reproductive organs. Your doctor will decide if you need endometrial biopsy. Vaginal cultures will also be done to rule out infection.
Treatment of menstrual abnormalities depends on treatment of underlying cause.
- Menstrual irregularity caused by family planning methods can be managed by switching the method of family planning.
- Eating and other psychological disorders related menstrual irregularities should be managed by psychiatrists.
- Hormonal therapy may be needed to stop the bleeding and to make the cycle caused by fibroids and endometriosis more regular. In severe cases surgery might be need to remove the fibroids. A hysterectomy is the ultimate treatment for these conditions.
- Treatment of PCOS involves weight loss, OCP, metformin if pregnancy is not desired. If pregnancy is desired, ovulation stimulating medication are given.
- Maintenance of a healthy weight by changing in eating pattern and exercise is very helpful.
- Endocrine problems such as hypothyroidism & hyperthyroidism should be identified and treated early to prevent other reproductive disorders.
- Pain medication can be used to alleviate pain from endometriosis and fibroids.
- Iron pills and iron containing food should be taken to prevent and treat anemia associated with heavy blood loss.