Irregular Menstrual Bleed...

IRREGULAR MENSTRUAL PERIODS

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:

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

Examples of abnormal menstruation include the following:

Amenorrhea:-

A condition in which a woman's periods stops 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 between ages 45 and 55.

Oligomenorrhea - Refers to periods that occur infrequently.

Dysmenorrhea - Refers to painful periods and severe menstrual cramps. However some discomfort during the cycle is normal for most women.

Abnormal uterine bleeding - Could 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.

Menorrhagia - is the medical term for menstrual periods that come with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don't experience blood loss severe enough to be defined as menorrhagia.

CAUSES

• Pregnancy

Pregnancy can cause a woman to miss her period or experience spotting. Other symptoms of early pregnancy may include:

• fatigue
• morning sickness
• nausea
• sensitivity to odors
• breast tingling or tenderness

If one misses a period or notice changes in periods and has had unprotected sex, a pregnancy test can be taken at home or better still one should see a doctor to find out if they are pregnant.

If a pregnant person experiences sharp, stabbing pain in the pelvis or abdomen that lasts more than a few minutes, they should see their doctor right away to rule out ectopic pregnancy or miscarriage.

• Perimenopause

Perimenopause is the transition phase before one enters menopause. It usually begins in the 40s, though it can occur earlier.

Beginning with changes to the menstrual cycle, one may experience signs and symptoms lasting from 4 to 8 years. Fluctuating estrogen levels during this time can cause menstrual cycles to get longer or shorter.

Signs and symptoms of perimenopause include:

• Mood swings
• Vaginal dryness
• Hot flashes
• Night sweats
• Difficulty sleeping

• Hormonal birth control

Hormonal birth control pills and intra-uterine devices (IUDs) that contain hormones can cause irregular bleeding.

Whereas an IUD may cause heavy bleeding, some birth control pills may cause spotting between periods and result in much lighter periods.

• Breastfeeding

Prolactin is a hormone that happens to be responsible for breast milk production. This hormone suppresses the reproductive hormones resulting in very light periods or no period at all during the period of breastfeeding.

Regular monthly periods should normally return shortly after breastfeeding stops.

• Polycystic ovary syndrome (PCOS)

The most common sign of PCOS are irregular periods. A woman with PCOS, may miss periods and have heavy bleeding when menstruating.

PCOS can also cause:

• Weight gain
• Infertility
• Excess facial and body hair
• Male-pattern baldness

• Thyroid problems

An underactive thyroid may cause longer, heavier periods.

Some studies have established that a large percentage of women with menstrual irregularities also had thyroid disorders.

Hypothyroidism, or an underactive thyroid, can cause longer, heavier periods and increased cramping. One may also experience fatigue, sensitivity to cold, and weight gain.

High levels of thyroid hormones, as seen with hyperthyroidism, can cause shorter, lighter periods. One may also experience:

• Goiter (Swelling at the base of the neck) is another common sign of a thyroid disorder.
• Sudden loss of weight
• Anxiety and nervousness
• Heart palpitations

• 7. Uterine fibroids

Fibroids are muscular tumors that develop in the walls of the uterus. Most fibroids are noncancerous and sizes can range from as small as an apple seed to the size of a grapefruit.

These growths can cause very painful periods and heavy bleeding enough to cause anemia. One may also experience:

• Pain in the lower back
• Pain during sex
• Pelvic pain or pressure
• Pain in the legs

Most fibroids do not require treatment. Symptoms can be managed with over-the-counter (OTC) pain medications and an iron supplement if anemia develops.

• Endometriosis

Endometriosis affects close to 10% of women of reproductive age. This is a condition in which the tissue that normally lines the uterus grows outside the uterus.

Endometriosis causes very painful, even debilitating menstrual cramps. Endometriosis also causes heavy bleeding, prolonged periods, and bleeding between periods.

Other symptoms of endometriosis may include:

• Infertility
• Painful bowel movements
• Gastrointestinal pain
• Pain during and after intercourse

The only way to diagnose endometriosis is by exploratory surgery. Currently, there is no cure for the condition. Symptoms can only be managed with medication or hormone therapy.

• Being overweight

Obesity is known to cause a lot of menstrual irregularities. Being overweight impacts hormone and insulin levels, which can interfere with the menstrual cycle.

Rapid weight gain can also cause menstrual irregularities. Weight gain and irregular periods are common signs of PCOS and hypothyroidism, and should be evaluated by a doctor.

• Extreme weight loss and eating disorders

Excessive or rapid weight loss can cause monthly periods to stop. Not consuming enough calories can interfere with the production of the hormones needed for ovulation. Along with stopped periods, one may also experience fatigue, headaches, and hair loss.

See the doctor if:

• One has lost a lot of weight without trying
• One has an eating disorder

• Excessive exercise

Intense or too much exercise has been proven to interfere with the hormones responsible for menstruation.

Female athletes and other women who participate in intensive physical activities, often develop amenorrhea which is missed or stopped periods.

Cutting back on training and increasing calorie intake can help restore normal periods.

• Stress

Stress can interfere with one's menstrual cycle by temporarily interfering with the part of the brain that controls the hormones that regulate the cycle. The normal periods should return to normal after the stress decreases.

• Medications

Certain medications such as the following can also interfere with one's menstrual cycle:

• Blood thinners
• Hormone replacement therapy
• Medications for thyroid
• Drugs for epilepsy
• Antidepressants
• Drugs for chemotherapy
• Aspirin and ibuprofen

People should speak to their doctors about changing medications.

• Cervical and endometrial cancer

Cervical and endometrial cancers can cause changes to one's menstrual cycle, along with bleeding between periods or even with heavy periods. Other signs and symptoms of these cancers are bleeding during or after sex and unusual discharge.

It will benefit the patient to remember that these symptoms are more commonly caused by other issues. There will therefore be the need to speak to a doctor.

SYMPTOMS

With a blood loss of about 40 cc (3 tablespoons), blood flow averages about four or five days. It is important to remember that these are just averages. A person's 'normal' may fall outside of these ranges. For instance a blood loss of 80 cc (5 tablespoons) or more is considered an abnormally heavy flow.

Signs that the menstrual flow may be abnormally heavy include:

• Passing large blood clots in the menstrual flow
• Experiencing a menstrual flow that lasts more than a week
• Soaking through more than one sanitary pad in an hour for several hours
• Waking up during the night to change protection

Also, an abnormally heavy flow can cause the following symptoms, which may be an indication of anemia:

• Dizziness
• Fatigue
• Pale skin
• Shortness of breath

Even though every woman's cycle is different, irregularities such as bleeding mid-cycle or bleeding after intercourse are abnormal symptoms.

WHEN TO SEE A HEALTHCARE PROVIDER

Many are the possible causes of irregular periods which requires medical treatment. Make an appointment to see a doctor if:

• One uses more than one pad or tampon every hour or two
• One experiences other symptoms, such as unusual discharge or fever
• The periods stop for more than 3 months and there is no pregnancy
• The periods suddenly become irregular
• A period that lasts longer than 7 days
• One develops severe pain during menstruation
• One's periods are less than 21 days or more than 35 days apart
• One experiences spotting between periods

The doctor will ask for medical history and will want to know about:

• Any stress or emotional issues the individual may be experiencing
• Any changes to patient's weight
• Patient's sexual history
• How much they exercise

Medical tests may also be used to help diagnose the cause of the irregular bleeding, including:

• MRI
• CT scan
• A pelvic examination
• Abdominal ultrasound
• Blood tests
• Pelvic and transvaginal ultrasound

RISK FACTORS

A risk factor is something that increases one's likelihood of getting a disease or condition.

It is possible to develop a menstrual disorder with or without the risk factors listed below. However, the more risk factors one has, the greater the likelihood of developing a menstrual disorder.

Menorrhagia (Heavy Bleeding)

It is common for most women to experience heavy bleeding at some point during their reproductive years. Risk factors associated with menorrhagia include:

Obesity - Excess body fat is a risk factor for heavy menstrual bleeding. The hormones in fat tissues can convert into estrogen. When this happens, the endometrial lining thickens, which causes heavier menstrual bleeding.

Medical Conditions – A woman may be at increased risk for menorrhagia if she has one of the following gynecologic conditions:

• Endometriosis
• Pelvic infections
• Fibroids
• Uterine polyps
• Cancer of the uterus, cervix, or vagina
• Bleeding disorders

A woman may be at increased risk for menorrhagia if she has one of the following general conditions:

• Bleeding disorders or is taking anticoagulation medications
• Thyroid problems
• Systemic lupus erythematosus
• Diabetes

Age - Just after the onset of menstrual periods (menarche), teenagers may experience temporary menorrhagia. If one is approaching menopause, she may have heavier periods. Women who have menstrual periods at an older age than average may also be at risk for heavy menstrual bleeding.

Contraceptives – Women who use copper intrauterine devices (IUD), are slightly more likely to have heavy menstrual periods. On the other hand, IUDs with progestin are more likely to decrease menstrual bleeding. In most cases, oral contraceptives decrease menstrual bleeding. Women must contact their doctors if they have heavy bleeding while taking the pill.

Medications - Certain drugs (e.g. anticoagulants, anti-inflammatory medications, and chemotherapy drugs), can increase the risk of heavy bleeding.

Imbalances of Hormones and Other Body Chemicals - Some women have imbalances in estrogen and progesterone that can cause their menstrual periods to skip. In this case, there may be overgrowth of the lining of the uterus (endometrium), which can lead to very heavy bleeding when menstruation returns.

Amenorrhea (Lack of Menstruation)

Risk factors for amenorrhea include:

Excessive Physical Activity – Too much and very strenuous exercise, may put an individual at risk for primary or secondary amenorrhea. These will include female athletes who participate in ballet, gymnastics, rowing, long-distance running, and cycling.

Eating Disorders - Eating disorders (e.g. anorexia nervosa or bulimia nervosa), puts one at risk for amenorrhea. This may be due to inadequate nutrition, low body fat, rapid weight loss, and hormonal and psychological factors.

Stress - Menstrual periods may skip if a person is going through major changes in life, or has problems with work, school, or even relationships. A change in environment, such as moving, can cause one to miss periods. It may appear that emotional stress prevents the brain from sending certain signals to the ovaries.

Medical Conditions - Amenorrhea is normally not indicative of a serious medical problem. However, amenorrhea is largely the results from medical problems such as:

• Chronic illness
• Pituitary insufficiency
• Imperforate hymen
• Discontinuation of Oral Contraceptives
• Ovaries not releasing an egg every month
• Polycystic ovary syndrome
• Hypothyroidism
• Pituitary tumors (nonmalignant)
• Turner syndrome (a chromosomal disorder)
• Cushing's disease
• Asherman's syndrome
• Excessive levels of the hormone androgen
• Absence of a vagina or uterus
• Radiation treatment
• Chemotherapy

If one stops taking oral contraceptives, it is possible that she would not have menstrual period for several months.

DIAGNOSIS

The doctor will most likely ask about the patient's medical history and menstrual cycles. She may be asked to keep a diary of bleeding and non-bleeding days, including possibly notes on how heavy the flow was and how much sanitary protection was needed to control the flow.

The doctor will do a physical exam and may recommend tests or procedures such as:

Endometrial biopsy - The doctor may take a sample of tissue from the inside of the uterus and send it to the laboratory to be examined by a pathologist.

Blood tests - A sample of blood may be analyzed for iron deficiency (anemia) and other conditions, such as thyroid disorders or abnormalities regarding blood-clotting.

Ultrasound - This imaging method makes use of sound waves to produce images of the uterus, ovaries and pelvis.

Pap test - In this test, cells from the patient's cervix are collected and tested for infection, inflammation or changes that may be cancerous or that could lead to cancer.

Based on the results of the initial tests, the doctor may recommend further testing, including:

• Sono-hysterography - During this test, a fluid is injected through a tube into the uterus by way of the vagina and cervix. The doctor then uses ultrasound to look for problems in the lining of the uterus.
• Hysteroscopy - This entails the insertion of a thin, lighted instrument through the vagina and cervix into the uterus, this will allow the doctor to see the inside of the uterus and possibly identify problems.

Doctors can only be certain of a diagnosis of menorrhagia after they must have ruled out other menstrual disorders, medical conditions or medications as possible causes.

TREATMENT

One would probably not need treatment for irregular periods unless perhaps the need arises to be treated for another condition that may be affecting the menstrual cycle.

Two most common causes of irregular periods in women are polycystic ovary syndrome (PCOS) and hypothyroidism. In general, the goal of treatment is to restore the balance of these hormones in the body.

In case a person has PCOS, the doctor may recommend birth control pills or other hormones to trigger the periods. In cases that has underactive thyroid (hypothyroidism), one may need to take thyroid hormones.

Other things that may help include:

Changing birth control - If a woman experiences irregular periods after 3 months of hormonal birth control, our doctors may recommend resorting to another type of birth control.

Lifestyle changes – Certain women encounter changes in their period because they exercise too much and or too rigorously. One may need to make workouts less intense, or exercise less often. Learning how to manage stress and possibly also talking with a counselor may be helpful. Changes in a person's weight if extreme, can affect menstrual periods, for example weight gain can make it harder for the body to ovulate.

Hormone therapy (HT) - Often times irregular menstrual cycles are due to a lack of or imbalance in certain hormones in the body. Doctors often prescribe oral contraceptives that contain estrogen and progesterone (which are hormones), to help control irregular periods. A hormone medication called progestin can also help trigger periods. If a woman has irregular periods and is trying to get pregnant, doctors may prescribe other hormone treatments.

Surgery - Scarring or structural problems in the uterus (womb) or fallopian tubes may lead to irregular periods. Doctors may recommend surgery to correct any structural problems or birth defects, particularly in those who want to have children.

PREVENTION

Here are some recommendations for self-care:

Try to maintain a healthy lifestyle by exercising moderately and eating nutritious foods. Weight losses must be done gradually instead of turning to diets that drastically limit the calorie and food intake.

Make sure to get enough rest.

Practice stress reduction and relaxation techniques.

Athletes must cut back on prolonged or intense exercise routines. Those excessive sports activities can cause irregular periods.

Birth control pills or other contraceptive methods must be used as directed.