Irregular Periods

1 Irregular Periods Summary

Irregular menstrual periods are considered a condition characterized by any of the following three changes:

  • Change in timing between periods
  • Change in the quantity of blood lost during periods
  • Change in the number of days for which each period lasts

Irregular periods are categorized as irregular menstrual bleeding, absent menstrual bleeding, heavy menstrual bleeding, heavy and prolonged menstrual bleeding, or light menstrual bleeding.

  • Irregular menstrual bleeding: This irregularity is characterized by bleeding that extends more than twenty days during an individual menstrual cycle. This may continue for more than a year, leading to heavy blood loss.
  • Absent menstrual bleeding: Also known as amenorrhea, in this condition, bleeding is not noticed for ninety days or more.
  • Heavy menstrual bleeding: As the name indicates, in this menstrual irregularity, heavy loss of blood may affect a woman’s physical, social, and emotional features. It may occur alone or in combination with other symptoms.
  • Heavy and prolonged menstrual bleeding: In this irregularity, blood loss is heavy and continues for a long duration. It is less common compared to heavy menstrual bleeding, and the causative factors and treatment method of the two are different.
  • Light menstrual bleeding: Bleeding during an individual cycle is less than normal.

Some of the accompanying symptoms of irregular menstrual periods are fatigue, pale skin, shortness of breath, and dizziness. Consistent irregularities in menstrual periods need medical attention.

Some irregularities that require a doctor’s attention include bleeding between periods, bleeding while pregnant, and bleeding after menopause. Abnormal discharge or odor from the vagina, severe pain, fever, unexplained weight loss, unusual hair loss, discharge from the nipple, and heavy bleeding also warrant medical attention.

The menstrual cycle’s normal pattern is maintained by hormones, and any imbalance in them may lead to irregularities in the period. Changes in the levels of estrogen and progesterone are one of the common causes of menstrual irregularities. Thus, it is common among girls entering puberty and women approaching menopause.

Other causes of irregular periods are the use of intrauterine devices, excessive exercise, certain medications, changing birth control pills, polycystic ovary disease, pregnancy, stress, hyperthyroidism, polyps, and uterine fibroids. Scarring in the lining of the uterus may also lead to irregular periods.

A review of one’s medical history and a pelvic examination are important parts of the diagnosis. It may also include a pap smear test, blood tests, pelvic ultrasound, endometrial biopsy, sonohysterogram, and pregnancy test, if needed.

The tests are based on the probable cause of menstrual irregularities. Treatment also varies with the cause. Medications like non-steroidal anti-inflammatory drugs (NSAIDs), iron supplements, hormone replacement therapy, and oral contraceptives are indicated for the treatment of irregular periods, depending on the cause.

Medical procedures like dilation and curettage (D&C), surgery, endometrial ablation, and hysterectomy are also suggested for normalizing menstrual periods and reducing bleeding.

Excessive loss of blood due to irregularities may lead to anemia. Mild anemia causes fatigue and weakness, while severe anemia leads to headaches, dizziness, shortness of breath, and rapid heart rate. It may also lead to complications like abdominal cramps that are very painful.

What Is Oligomenorrhea?

Irregular changes in the frequency of menstrual bleeds is called oligomenorrhea. In this condition, a woman will experience infrequent, irregular menstrual periods, which can be fewer than six to eight per year, or light menstruation. The term can be described using words such as “scanty” or “infrequent.” Women may go days or even weeks before the normal menstrual cycle starts. In most women, until the age of sixteen, the menstrual cycle is normal, and if, after this time, your periods have become irregular or infrequent, you may be suffering from this medical condition. Some women with this condition have difficulty conceiving and other infertility issues.

The signs pertaining to this medical condition are as follows:

  • During menstruation, one may experience heavy bleeding.
  • Periods fewer than four to nine times a year
  • Bones which are easily fractured or broken
  • A thirty-five-day gap between menstrual cycles
  • Abnormal gaps between menstrual cycles
  • Severe pain or discomfort prior to and during periods
  • A feeling of heaviness during the menstrual cycle
  • If the menstrual cycle is unpredictable, it can lead to infertility.

Women in whom oligomenorrhea is related to the female athlete triad may experience the below symptoms:

  • Frequent stress fractures, particularly in the bones of the hips, lower legs, or spine
  • Abnormal pattern of eating or an extremely restrictive diet
  • Dip in blood pressure or low blood pressure
  • Abnormal heart rhythm

2 Causes

Irregular menstrual periods may be caused by multiple factors. Many lifestyle factors can result in irregularities in periods. These include: 

  • Excessive weight gain or weight loss: Being very thin or overweight or obese may result in irregularities in the menstrual cycle. In some extreme cases, it may result in the complete absence of periods.
  • Stress or emotional problems: Chronic stress or anxiety about a specific problem can affect the hormonal balance in the body, leading to missed periods or irregularity in the menstrual cycle.
  • Over-exercising: Extreme exercising, as in endurance athletes, may affect the menstrual cycle and the bleeding pattern. Extreme dieting also has a similar effect, leading to irregular menstrual periods.

Contraceptives are known to affect the menstrual cycle in different ways: use of intrauterine devices and contraceptive pills may cause spotting between periods; intrauterine devices may result in heavy bleeding during menstrual periods or severe pain during periods; during the first use of the contraceptive pill, small bleeds are common and usually stop within the first few months of use.

Polycystic ovary syndrome (PCOS) are characterized by cysts in the ovaries. Cysts are small, fluid-filled sacs that form in the ovary. PCOS affects ovulation and may often lead to light bleeding or no periods at all. PCOS leads to increased levels of testosterone, affecting the normal balance of hormones in the body.

Gynecological problems like early miscarriage, or problems in the ovaries may also lead to irregularities in periods.

Pelvic inflammatory disease is an infection that leads to menstrual irregularities. In endometriosis, the uterine tissue may start growing elsewhere in the body, causing severe pain and heavy bleeding.
Thyroid disorders are a rare cause of menstrual irregularity. Hyperthyroidism is often implicated in irregular periods.

Inherited blood disorders that affect the clotting of blood may result in heavy menstrual bleeding.

Cancers or benign growths in the ovaries, cervix, or uterus lead to heavy menstrual bleeding. Non-malignant growths in the uterus cause heavy bleeding or increased duration of menstrual periods, leading to heavy blood loss. The prolonged period is characteristic of benign growths in the uterus. These polyps are a common cause of irregular periods in women. 

Lack of ovulation, also known as anovulation, reduces the level of progesterone. Progesterone is a hormone involved in maintaining the regular menstrual cycle. Reduced levels of this hormone may lead to heavy menstrual bleeding.

Adenomyosis is a condition characterized by the embedding of uterine glands in uterine muscle. This condition is also implicated in heavy menstrual bleeding.

It is normal to have spotting during pregnancy. Ectopic pregnancy is a condition in which implantation occurs in the fallopian tube and is characterized by heavy bleeding.

Certain medications are also implicated in the development of irregularities during a menstrual cycle. Anti-inflammatory drugs, anticoagulants, and hormone therapy may lead to menstrual irregularities.

Other medical conditions that may lead to irregular periods include sexually transmitted diseases and diabetes. Irregularities are common at the beginning of puberty and during perimenopause.

The causes of oligomenorrhea is also similar to irregular periods:

  • Hormonal imbalances
  • Use of oral contraceptives pills
  • PCOS, or polycystic ovarian syndrome, which is a common occurrence in women nowadays
  • Certain chronic illness, such as secreting tumors, estrogen levels, diabetes, or osteoporosis
  • Lack of communication between the hypothalamus, ovaries, and pituitary glands, leading to irregular menstruations
  • Thyrotoxicosis, Grave’s disease, and Willi syndrome
  • Inflammatory bowel syndrome, which can also be accompanied by weight loss, abdominal pain, or diarrhea

Uterine disorders, such as adenomyosis, endometrial hyperplasia, or fibroids

5 Reasons for Irregular Periods

3 Diagnosis and Treatment

A review of one’s medical history and evaluation of signs and symptoms along with a pelvic examination are the diagnostic steps for irregular periods. Information is also needed about current medications, health conditions, and health supplements used. Other tests recommended include a Pap smear, blood tests, pelvic ultrasound, endometrial biopsy, and pregnancy test. A woman should mention any health problems during infancy or childhood when she had her first period, and since then how frequently periods have occurred. If she is aware of any, she should mention any family history of irregular menstrual periods. The woman should also tell the doctor about any discharge from the breasts, hot flashes, adult acne, growth of facial or chest hair, headache, or impaired vision. The doctor will ask about any medications, herbs, or vitamins used by the patient; any recent stress or gynecological procedures; any changes in diet, weight, or exercise pattern; or any illnesses.

A Pap smear test, or pap test, as it is normally known, is used in the screening of cervical cancer. In this procedure, sample cells are scraped from the opening of the cervix.

Blood tests enable doctors to find chances of anemia, blood-clotting diseases, and hyperthyroidism. A pelvic ultrasound is the most common imaging technique used in the detection of problems with the uterus, ovaries, and pelvis. The lab technician may ask for blood tests to be done, which will measure hormone levels. In some cases, a magnetic resonance imaging (MRI) test can be done to check for any hypothalamic or pituitary gland abnormalities in the brain. If the doctor suspects any chromosomal abnormality, a chromosomal analysis may be suggested. In order to identify any abnormalities of the uterus, cervix, and vagina, a pelvic ultrasound may be recommended.

An endometrial biopsy is the test used to evaluate the health of uterine tissues. In a biopsy, a sample of uterine tissue is collected for analysis. The same procedure may also be used for a diagnostic hysteroscopy, an imaging study used to visualize the inner parts of the uterus.

In this procedure, a small, flexible tube is inserted into the uterus. A hysteroscopy may be used to remove a polyp as well. A sonohysterogram is an ultrasound study that helps visualize the uterine cavity. It will help identify polyps and fibroids in the uterus. A pregnancy test is recommended if pregnancy is suspected.

Treatment is usually individualized based on the overall health of the patient, the cause of the irregularity, medical history, and signs and symptoms. Information on onset, duration of symptoms, current medications, and a history of chronic diseases may also influence the type of treatment used.

Treating the underlying disease is important in dealing with irregular periods. Medications commonly used in the procedure include non-steroidal anti-inflammatory drugs, iron supplements, hormone therapy, and oral contraceptives.

Ibuprofen and naproxen are useful in reducing the blood loss due to irregular menstrual periods. Iron supplements are useful in treating anemia caused by the excessive loss of blood.

Hormone replacement injections are ideal for treating hormonal imbalances that result from the irregular menstrual period. Hormone replacement therapy helps maintain the normal hormonal balance in the body and normalizes the menstrual cycle. For a short period, oral contraceptives are useful in controlling the menstrual cycle.

Certain medical procedures are also used to reduce blood loss and to control menstrual irregularities. D&C is a procedure used to dilate the cervix. The uterine tissues are then scraped off to reduce the loss of blood.

Cancerous tumors are removed surgically. Surgery may also be indicated for the treatment of fibroids, but may not always be necessary. Polyps are removed by hysteroscopy.

Endometrial ablation is recommended when conventional treatment methods are not useful in controlling heavy bleeding. The uterine lining is destroyed using ablation, controlling the menstrual bleeding. Uterine lining can also be removed by endometrial resection.

A hysterectomy is a procedure in which the uterus is completely removed to control tumors and fibroids. It is useful in controlling irregular periods that do not respond to endometrial ablation or other techniques. Removal of the ovaries is suggested in some cases, depending on the need.

Home remedies for irregular periods include:

  • Coriander: In two cups of water, boil one teaspoon of coriander seeds until it is reduced to half, then strain and drink it three times daily. Drink one week before menses.
  • Carrots: Drink one glass of carrot juice daily for three months.
  • Fennel: In a glass of water, soak three tablespoons of fennel overnight. Strain it the next morning and drink. Drink this daily for one month.
  • Papaya: Make ripened papaya juice and drink it daily for three months. Drink it one week before menses, but not during.
  • Sesame: Dry roast sesame seeds for four to five minutes. Grind the seeds with one teaspoon of jaggery and make a fine powder. Consume this mixture daily on an empty stomach fifteen days before menses.

Other helpful herbs include dong quai (Angelica sinensis), black cohosh (Cimicifuga racemosa), and chaste tree (Vitex agnus-castus). The herbal preparations that help bring on the menstrual period are known as emmenagogues. Meditation, guided imagery, and visualization can also relieve emotional stress and help treat oligomenorrhea.

Dietary Changes

Adequate protein, essential fatty acids, and fresh fruits, vegetables, and whole grains are included in adequate nutrition and diet. This is important for every woman, especially if she does strenuous exercises regularly or if she has any deficiencies. Female athletes should consult a nutritionist to check if they are eating a proper, well-balanced diet and whether that is enough for them to maintain a healthy weight for their height. Girls participating in dance or sports are at a greater risk of developing eating disorders than ones involved in sports like softball, weight-lifting, or basketball. In such cases, vitamin D or calcium supplements should be given to these athletes in order to lower the risk of osteoporosis.

Prognosis

Women with oligomenorrhea, even those with PCOS, have been successfully treated with hormones. They have restored their fertility, begun ovulating during menstrual periods, and have frequent periods. However, the outlook is less positive for women who do not show any response to hormones or who continue to have conditions that cause oligomenorrhea. Women with oligomenorrhea may have difficulty conceiving and may need to take fertility drugs. The risk of osteoporosis, repeated bone fractures, and cardiovascular disease increases later in life. Women having irregular periods are more prone to developing uterine cancer. Female athletes who develop osteoporosis or bone loss in their early twenties or late teens are at risk of developing arthritis as well.

Risks

Models, dancers (especially ballet dancers), and professional athletes are the most prone to oligomenorrhea. Since they undergo strenuous physical training and strict diets and have to keep their weight down, they are subject to menstrual irregularities. Women with poor nutrition habits, those suffering from eating disorders, such as anorexia nervosa, or who do excessive exercise are also equally at risk. Women with female athlete triad, hormonal dysfunctions, chronic diseases, and those using drugs are also at risk.

Complications

The following complications may develop due to late periods:

Women with oligomenorrhea have less of a chance of becoming pregnant. It is not because the body is unsuitable, rather, it is because the irregular menstrual cycle makes planning conception difficult. Hence, oligomenorrhea can become a serious issue for those who want to become pregnant, so it is important to get treatment for it. Medications can increase the chances of conceiving by restoring the body’s ovulation.

Prevention

Oligomenorrhea can be prevented only in women whose low body-fat-to-weight ratio is keeping them from maintaining a regular menstrual cycle. For female athletes, less vigorous training schedules and adequate nutrition might help prevent oligomenorrhea. If hormonal imbalance has caused oligomenorrhea, it cannot be prevented, but it can be treated.

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