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Irregular menses: Is it normal?

What is Irregular Menses?

Menses, also known as menstruation or periods, is the normal monthly vaginal bleeding in females that occurs due to the shedding of the uterus. This bleeding usually lasts around 5 days. It can affect girls and women from the age of 12 to 51, when their bodies are ovulating and producing eggs for reproduction. A typical menstrual cycle lasts approximately 28 days, though it may vary by a few days each time.

A pink clock, flowers and sanitary pad

Irregular menses is when the length of a female's menstrual cycle, or gap between periods, constantly changes. A female with irregular menses may miss her periods, have early or late periods with a menstrual cycle lasting a lot shorter or longer than a typical cycle (less than 21 days or more than 35 days), and/or have excessive bleeding during her periods. There are three types of irregular menses:

  • Amenorrhea: Not having any periods for at least three menstrual cycles
  • Oligomenorrhea: Having periods more than 35 days apart
  • Menorrhagia: Heavy bleeding that lasts more than a week

What are the main causes of Irregular Menses?

A. Hormones

Excessive weight loss, weight gain, exercise, diet, stress or anxiety, as well as some underlying conditions such as diabetes, can negatively affect the production and circulation of hormones in the body. Extreme changes to the levels of hormones in the body can wreak havoc with hormone balance and cause periods to be delayed or missed.

Similarly, some hormonal contraception methods and medications such as birth control pills or intrauterine systems contain hormones such as oestrogen and progestin, which prevent the ovaries from releasing eggs. Due to the sudden change in hormone levels when going on or off these hormonal contraceptives, the regularity of menses can be affected.

B. Fibroids

Fibroids are non-cancerous growths in the lining of the uterus, which may put pressure against the uterine lining and cause excess bleeding and pain during periods. Additionally, the uterus may not contract properly due to the hindrance from the fibroids, affecting its ability to stop the bleeding and resulting in heavier periods.

C. Endometriosis

Endometriosis occurs when the uterine lining, also known as endometrial tissue, starts to grow outside the uterus such as the ovaries, fallopian tubes, or worse, the intestines. This condition may cause abnormal bleeding, as well as cramps or pain before and during periods.

D. Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease is a bacterial infection that causes the female reproductive system to be inflamed. Bacteria may enter the vagina via sexual contact, gynecologic procedures, childbirth, miscarriage, or abortion, and then spread to other parts of the genital tract.

E. Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome is a metabolic and hormonal disorder which occurs when the ovaries make large amounts of male hormones such as testosterone, which can prevent eggs from maturing, and so ovulation may not take place consistently.

Diagnoses and Tests

Irregular menses is easily identified by the use of a period tracker, which monitors a female's menstrual cycle. This can be done by marking the first day of your period on a calendar in a calendar, a notebook, or a period tracking app. Within a few months, you will be able to see if your periods are relatively regular or constantly changing each month.

If you have irregular menses, it is recommended to consult a medical professional. A physical examination, which may include pelvic ultrasound examinations, blood tests, vaginal cultures, endometrial biopsies and laparoscopy, can be done to identify the specific cause of the irregular periods.

What are the complications of Irregular Menses?

Irregular menses is a common condition which affects approximately 14% to 25% of females of reproductive age in the world. Although irregular periods are not usually harmful, persistent or long-term irregularity may raise the risk of other conditions, such as:

  • Infertility: Irregular periods may occur when the body does not ovulate, which means that a person may face difficulty in getting pregnant.
  • Osteoporosis: Oestrogen, which is produced during ovulation, helps to keep the bones strong. If a female does not ovulate, she may be at a higher risk for osteoporosis.
  • Cardiovascular disease: As a result of not ovulating, the lack of oestrogen may raise the risk of cardiovascular disease.
  • Iron deficiency anemia: As blood contains iron, excessive bleeding during periods can cause a person to lose enough blood to cause an iron deficiency.
  • Endometrial hyperplasia: If a person has irregular periods, the uterus lining becomes unusually thick as it does not shed as often as it is supposed to. This condition is known as endometrial hyperplasia, and increases the risk of endometrial cancer.

Treatment

A. Hormone Therapy

If the cause of irregular periods is hormone imbalance, hormone therapy can help to raise hormone levels and counteract the effects of not ovulating. It can also make periods regular and makes it easier to manage or reduce the symptoms of underlying conditions, which may improve quality of life.

B. Lifestyle Changes

If the cause of irregular periods is excessive weight loss, weight gain, exercise, diet,stress or anxiety, a person may be able to lower the risk of the condition effectively without the use of any treatment, by making positive changes to their lifestyle choices:

  • Regular physical activity
  • Diet adjustments and nutrition therapy
  • Staying mentally and socially active

C. Surgery

If the cause of irregular periods is fibroids, scarring or structural problems in the female reproductive system, there are a variety of surgical options that can remove them or lessen their size and symptoms. For fibroids, the following procedures are recommended:

  • Myomectomy: simple removal of a fibroid
  • Hysterectomy: removal of a fibroid along with the uterus
  • Uterine artery embolization: cutting off of blood supply to the active fibroid tissue

Prevention

As the saying goes, "Prevention is better than cure." To keep yourself safe from irregular menses, practise the following prevention methods:

  • Maintain a healthy lifestyle
  • Reduce stress and anxiety
  • Change your tampons or sanitary napkins regularly during periods

For more information or if you require a medical consultation, please contact My Healthcare Collective here.