Irregular Menstrual periods – Causes, Diagnosis and Treatment

Irregular menstrual periods can cause  great concern and stress in many girls.

If you’ve noticed that your periods aren’t following a regular pattern – maybe they come too early, too late, or skip a month entirely – you are not alone. Many women experience irregular menstrual periods at some point in their lives, and while it can be frustrating or even worrying, the good news is that,  in  most causes, it  can be treated.

What are Irregular Menstrual Periods?

An irregular menstrual period refers to variations in the menstrual cycle length, amount of bleeding, or skipped periods. There may be:

• Periods that come earlier or later than expected
• Missed periods
• Heavier or lighter bleeding than usual
• Bleeding between periods

While an occasional irregular cycle is not usually a cause for alarm, persistent irregularities may indicate an underlying health issue that needs medical attention.

What are  Normal Menstrual Periods?

A typical, normal menstrual cycle lasts about 21 to 35 days, counting from the first day of one period to the first day of the next. Most women have cycles that are fairly regular—within a few days each month—but some variation is completely normal.

Periods usually begin during puberty, around age 11–14, and continue until menopause, which usually happens between ages 45–55.

If your period suddenly changes—like it starts coming much earlier or later than usual, becomes unusually heavy or light, or disappears altogether—it is  called an  irregular period.

Irregular menstrual periods are most common around the time of puberty and around the time of menopause.

Causes of Irregular Menstrual Periods

There are many reasons why menstrual cycles might become irregular. Some are temporary and harmless, while others may need more attention.

Irregular cycles can be caused by a range of physiological, hormonal, lifestyle, and medical factors.

Hormonal Causes of Irregular Menstrual Periods:

• Polycystic Ovary Syndrome (PCOS) – PCOS is one of  the most  common causes of irregular periods. It is a hormonal condition in which the ovaries fail to ovulate ( produce an egg) every month. It is characterized by irregular periods, increased level of male hormones like testosterone and DHEAS and a typical  necklace like pattern in the ovaries on ultrasound.  Weight gain and increased hair growth on the face or chest is common.
• Thyroid disorders – Both hyperthyroidism and hypothyroidism (overactive or underactive thyroid ) can disrupt menstrual cycles.  Hypothyroidism is a condition in which the level of thyroid hormones is low in the body affecting ovulation and resulting in irregular periods.

• High Prolactin levels – Prolactin is a hormone produced in the  pituitary gland. A high level may affect ovulation.
• Perimenopause – Perimenopause is the  transition phase before menopause.  Hormonal shifts before menopause may cause irregular cycles
• Primary ovarian insufficiency –  This is a condition in which the ovaries  become inactive or subactive and fail to  ovulate. It is usually  a side effect of chemotherapy and radiation in women  undergoing cancer treatment. It can also occur in some women who have an autoimmune disorder.

Lifestyle causes of Irregular menstrual Periods

The normal menstrual cycle may be affected by changes or interruptions in the normal lifestyle. Some examples of lifestyle factors include:

• High levels of stress – Chronic stress affects hormonal balance
• Excessive exercise – Excessive exercises, especially in athletes, marathon runners or sometimes ballerinas and gymnasts, can also cause irregularity in the menstrual periods.
• Weight fluctuations – Sudden gain or loss of weight can impact menstruation. Gaining  2 to 3 pounds a day, or 5 pounds a week, or gaining  5% or more of your body weight in a month is not normal and may affect your periods.  Sudden weight loss is also not healthy.
• Breastfeeding – Breastfeeding is associated with high levels of the hormone prolactin – this high level may affect ovulation as well the menstrual periods. Loss of the periods at this time is called lactational amenorrhea.
• Eating disorders such as anorexia or bulimia are common causes of menstrual irregularity.
• Changes in the birth control method –A change in the brth control method from one type to another may cause a temporary irregularity  or delay in the periods.  Going on or off birth control pills can also affect menstruation. You may have irregular or missed periods for up to six months after discontinuing birth control pills.

Underlying Health Causes of Irregular Periods

• Certain medications – Including antipsychotics, chemotherapy drugs, and hormonal contraceptives. like steroids or anti-coagulant medicines  (blood thinners) can  affect the periods.
• Uterine abnormalities – Like fibroids or polyps can cause bleeding or spotting on and off.  Adhesions (scarring) inside the uterus (called  Asherman’s syndrome)  affect the growth of the  endometrium.
• Chronic illnesses – Diabetes, celiac disease, and liver or kidney disorders are sometimes associated with irregular periods.

• Endometriosis – Endometriosis   is a  long-term (chronic) condition  in which  endometrial tissue develops in regions other than the uterus. It can grow  on the tubes, ovaries or surrounding tissue  causing severe pain during the periods as well as irregular periods.
• Pelvic inflammatory disease – Pelvic Inflammatory  (PID) is an infection of the womb, ovaries and/or fallopian tubes. It is caused by sexually transmitted diseases like Chlamydia trahcomatis or by bacteria like E.coli which enter from the vagina. Infection of the uterus is also called Endometritis.  Signs and symptoms of PID include greenish, foul-smelling, and abundant vaginal discharge, irregular menstruation, and lower abdominal pain.
• Fibroids or polyps – These are benign,  non-cancerous growths that can develop in the uterus or the cervix and cause irregular periods
• Adenomyosis – Adenomyosis is a condition in which tissue that normally grows within the inside the uterus ( the endometrium) grows into the muscular wall of the uterus.
• Adhesions or scars inside the uterus – Adhesions can occur inside the uterus after surgeries like D&C or Cesarean section or surgical abortion.  It is called Asherman’s syndrome.
• Bleeding disorders:  A bleeding or blood clotting disorder can cause irregular or heavy  bleeding. It is quite rare.
• Uterine cancer or ovarian cancer: Uterine cancers can cause changes in the intensity, duration, or frequency of bleeding.  These cancers can also cause bleeding in between periods or during sex.

How is the cause of Irregular menstrual bleeding diagnosed?

Diagnosis of the cause of an irregular period starts with a medical history. Your  doctor  will ask about your menstrual history – the timing and duration of the your periods,  how long they have been irregular, if there is pain during your periods, whether you use any birth control methods, whether you have ever been pregnant etc.

There will also be a  clinical assessment, which will include a  physical examination as well as a pelvic examination.

You may also need some specific tests:

Pelvic ultrasound: An Ultrasound can help find out if  the cause of the irregular periods is due to conditions like uterine fibroids, polyps, or an ovarian cyst. It can also help identify PCOD.

Blood Tests: Tests for the thyroid hormone and Prolactin levels, your haemoglobin levels, blood sugar levels and any other abnormalities.

Pap Smear : To identify causes in the cervix like an infection or cervical cell changes.

Endometrial biopsy: This is a procedure in which your doctor  takes a small part of the tissue from the lining of your uterus. It is  done only when conditions such as endometrial cancer is suspected.

 Management and Treatment

The treatment for irregular menstrual periods  depends on the cause.

In most cases, medicines is the first line of treatment. Possible medications include:

 Hormones: Pills containing a a combination of estrogen and progesterone ( like birth control pills)  can be used to treat conditions like  hormonal imbalances at the time of puberty or perimenopause. They  help adjust and regularize your menstrual cycle.

Other forms of hormones like  vaginal rings, progesterone  injections, or insertion of a hormonal  IUD or intrauterine device can also help.

HRT or Hormone replacement therapy can also help regularize periods during the menopause.

Thyroid hormone  supplements or medicines to decrease the Prolactin levels may be necessary.

Gonadotropin-releasing hormone agonists: These medications shrink fibroids and help control heavy bleeding, but they may temporarily disrupt menstrual cycles.

Antibiotics: If infectious is the reason for irregular bleeding, you may be prescribed antibiotics.

Tranexamic acid: This medicine is used to control and decrease  of heavy menstrual bleeding,  They are usually taken at the beginning of your period to regulate your menstrual flow.

Pain relievers: They help relieve mild to moderate pain or cramps.

Surgery : Surgery may be needed for conditions like Fibroids, polyps, ovarian cysts  or other tumors

Prevention

Can irregular periods be prevented?

Irregular menstrual periods, if due to lifestyle causes, can be prevented.

• Try to maintain a healthy lifestyle by exercising moderately and eating nutritious foods. If you want to lose weight, do it gradually instead of turning to diets that drastically limit your calorie and food intake.
• Avoid a high-risk lifestyle by avoiding most foods with oils, sugars, and fats
• Reduce sitting time. Try to avoid sitting continuously for more than 2 hours.
• Cut back on prolonged or intensive exercise routines.
• Rest and adequate sleep is important.
• Reduce stress and tension. This can be done by  practicing stress reduction and relaxation techniques. Meditation and listening to good music can also help.
• Change your tampons or sanitary pads every four to six hours to minimize getting toxic shock syndrome or acquiring other infections.

Frequently Asked Questions:

Q: When should I contact my doctor?

A: Please contact your doctor if –

• If you have not had your periods for more than 3 months at a stretch.
• If your periods are very painful. Extreme pain or cramping can be signs of an underlying issue like endometriosis.
• If your period is heavy enough for you to need to change your pad or tampon in less than 2 hours. Or  if you pass multiple large blood clots.
• If you bleed between period. – mid-cycle bleeding.
• If you have foul-smelling vaginal discharge.
• If the bleeding continues for more than seven days.
• If you bleed after menopause.
• If you bleed after sexual intercourse.
• Symptoms of toxic shock syndrome (TSS), such as fever, vomiting, diarrhea, fainting or dizziness.

Q: What will the doctor ask me?

A:  You doctor will ask you about your menstrual and birth control and pregnancy history –

• The first day of your last period (when it started).
• How many days your period usually lasts.
• What was the shortest time between your periods (from the first day of one period to the first day of the next).
• What was the longest time between your periods (from the first day of one period to the first day of the next).
• How often you need to change your period products on a heavy day
• If you are over 25, when you had your last pap smear test
• What birth control methods you are currently using  and what have you used earlier.
• Whether you have ever been pregnant or have undergone an abortion.

Keep a note of your period dates and symptoms using a calendar, a diary or an app.

Q: Is it normal for a Period to be irregular or delayed sometimes?

A: Yes, it is normal for menstrual periods to be sometimes  irregular. Periods can be irregular during the early teenage years, or during  the perimenopause. At these times, hormonal imbalance is quite common.

Other factors that can cause  irregular periods are stress, significant weight loss or gain, excessive exercise, and underlying medical conditions like polycystic ovary syndrome (PCOS) or thyroid disorders.

A delay of about 7 days is quite normal.

Q: Can I resolve my irregular periods at home?

A: If the irregular periods are due to lifestyle causes, then it can be resolved at home.

• Regular exercises and practicing yoga can help.
• Maintain a healthy weight.
• Try to decrease stress.
• Get adequate sleep.
• Exercise regularly.

Q:Which food is best for irregular periods?

A: A balanced diet rich in whole grains, beans, fruits, vegetables, and lean protein can help regulate periods. Some foods  like papaya and pineapple are said to be beneficial but  it is difficult to say if this is accurate.

Q: Should I Worry About Irregular Periods?

If your periods have been irregular for more than 3 months, you do need to worry.

• Talk to your doctor if you have had sex and have missed a period because you could be pregnant.
• You were having regular periods that then become irregular.
• You have symptoms of PCOD – extra body weight, extra hair growth on the face, chin, chest, or abdomen, lethargy..
• You start having periods that last longer than 7 days or are very heavy.
• If you get periods in 21 days or less.
• If you get periods after more than 45 days…
• You have severe cramping or abdominal pain.
• You have bleeding in between your periods.
• If you get bleeding after you have been menopausal for more than a year.

Irregular cycles are  quite common in many women.  But if the irregularity continues or if you have additional symptoms like heavy bleeding or pain, please consult your doctor as early as possible.