Irregular Menstruation

Every woman can experience menstrual irregularity from time to time. Menstrual irregularity can be defined as the arrival of menstruation before/after initially expected.

The period from the beginning of one menstrual cycle to the beginning of the next is approximately 21-35 days. Most women go through 11-13 menstrual periods during the year. Values ​​close to this figure (1-2 less/more) are considered normal. For this reason, menstrual irregularity should be evaluated by looking at the values ​​that are normal for the person.

Bleeding should not contain clots and should not exceed 8 days. The amount of pads used in a day should be 2-3 pieces. Any deviations from these definitions can be perceived as menstrual irregularity.

Hormones may not be regular for several years from the date of first menstruation. This type of menstrual irregularity is normal. The same is true before the “perimenopause” and “menopause” periods, when menstruation is about to end. The cessation of menstruation, called menopause, begins 12 months after the last menstrual period. In addition to all these, menstrual irregularity can be seen in certain systemic diseases.

The complete cessation of menstruation is called “amenorrhea”.

Frequent and early menstruation; Menstrual cycles that last less than 21 days are called “polymenorrhea“. As a result, the number of menstrual bleeding in 1 year also increases.

It should always be taken into account that if the bleeding suddenly becomes more frequent in a woman who usually has menstrual bleeding at regular intervals, this bleeding may actually be a half interval bleeding.

infrequent menstruation and delays; Menstrual cycles that last longer than 35 days are called “oligomenorrhea”. As a result, menstrual bleeding occurs 3-4 times a year. Delays in menstruation are common during the period of fertility. Menstrual irregularities are usually caused by organic and hormonal reasons. When the organic cause is mentioned, changes in the anatomical structure of the female reproductive organs should come to mind.

What does it mean to menstruate?
Menstruation means shedding of the uterine tissue (endometrium) with bleeding. The menstrual period can be divided into 3 phases:

  • “Follicular Phase“, in which the first period egg is selected and matures until it reaches 20mm in diameter.
  • “Ovulation Phase” in which the second period mature egg is expelled from the ovary in the form of a small explosion.
  • The third period is the “Secretory Phase“, in which the uterus is prepared until the embryo is conceived.

If this cycle continues with pregnancy, menstruation will not be seen due to the changing hormone levels and special intrauterine mechanisms with the arrival of the intrauterine embryo. When there is no pregnancy, the prepared intrauterine tissue begins to shed due to the decrease in the level of progesterone hormone in the ovary. The cells and the substances that provide the connection between them are shed with bleeding.

What are the causes of menstrual irregularity?

  1. Stress: Gaining too much weight or losing weight, not eating enough, low-calorie diet programs, changes in exercise regimen, tension, diseases, travel and differences affecting daily life may cause menstrual irregularity.
  2. Birth Control Pills: The vast majority of birth control pills contain a combination of oestrogen and progesterone hormones (some of which contain only progesterone). These pills prevent the ovaries from releasing eggs, preventing pregnancy. The use or discontinuation of birth control pills can also cause changes in the menstrual cycle. It may take up to 6 months for the menstrual cycle to be restored. Women who use birth control pills containing only progesterone may experience bleeding between menstruation.
  3. Uterine Polyps or Fibroids: Uterine polyps are small (usually non-cancerous) growths found in the inner lining of the uterus. Fibroids are usually benign tumours originating from the uterine muscle. Their sizes can reach from 0.5mm to 10 to 15cm. They can cause heavy bleeding and pain. Depending on the size of the fibroid, they can put pressure on neighbouring organs.
  4. Endometriosis: Endometriosis occurs when the endometrial tissue that surrounds the uterus and is secreted from the body with menstrual flow every month begins to develop outside the uterus. Symptoms of endometriosis include cramps other than menstrual irregularity, pain during sexual intercourse, abnormal bleeding, pain before and after the menstrual period.
  5. Pelvic Inflammatory: It is a type of infection that affects the female reproductive system. Bacteria that enter the vagina through sexual contact can spread to the uterus and upper genital tract. At the same time, the factors causing this infection can spread to the reproductive organs during insertion and removal of the spiral, miscarriage, childbirth, abortion and similar interventions. Symptoms include menstrual irregularities, bad odour in the vagina, pain in the pelvis and lower abdomen, fever, nausea, vomiting, diarrhoea and vaginal discharge.
  6. Polycystic Ovary: In polycystic ovary syndrome, the ovaries produce more androgens (male hormones) than normal. Thus, fluid-filled sacs or cysts, may occur. High levels of androgens prevent the egg from being laid by preventing the development of eggs. This situation is mostly associated with obesity and excessive hair growth.
  7. Premature Ovarian Insufficiency: This is especially seen in women who are younger than 40 years of age and whose ovaries do not fully fulfil their duties. Menstrual bleeding is stopped. It can be seen genetically as well as due to chemotherapy and radiation therapy.

Other causes of menstrual irregularity;

  • Excessive weight gain or weight loss
  • Excessive exercise
  • Endometrial hyperplasia (thickening of the inner layer of the uterus)
  • Uterine cancer
  • Thyroid problems
  • Diabetes
  • Liver cirrhosis
  • Systemic lupus
  • Pregnancy complications (miscarriage or ectopic pregnancy)
  • Oestrogen supplements
  • Use of blood thinning drugs
  • Use of intrauterine devices for birth control
  • Steroids
  • Antidepressant use
  • Oestrogen and/or progesterone imbalance

What might be causing my infertility?
“Menopause” should evaluated for every non-menstrual woman regardless of age. Women can become menopausal even before the age of 40 or even 20. Although family history is very important, some genetic and chronic diseases, smoking, drugs and chemotherapy/radiotherapy can also cause early menopause. Especially women who want children should go to the doctor without delay in every menstrual irregularity.

  • Menstrual irregularity is present in cases with severe depression and sleep disorder as well as in life-threatening conditions such as anorexia and bulimia, which are more common especially in young people.
  • Testicular Feminization, people who are genetically male but with a female appearance never menstruate due to androgen (male hormone) insensitivity.
  • Turner Syndrome is a genetic disease that gives vague visual appearances such as short stature, flexible arms and a lower hairline on the nape due to a missing chromosome. Although it is rarely seen at a young age, it is mostly seen after menopause.
  • In cases of birth control pills, 3-month contraceptive injections, use of hormonal spirals, inability to heal the uterus after abortion (Asherman’s Syndrome), menstruation may not happen. These conditions are temporary and the menstrual cycle can be returned to normal with treatment.

As a result, the absence of menstruation is a condition that requires a doctor’s examination. Diagnosis and treatment should be made with a multidisciplinary approach in every woman who consults a doctor with the complaint of amenorrhea.

Menstruating Irregularly or excessively or for a long period of time

  • In case of irregular, excessive amount or duration of menstruation; Hormonal disorders, especially not ovulating (anovulation), fibroids, polyps, hyperplasia, cancer, infection, ectopic pregnancy, drug use, thyroid gland diseases and adenomyosis should be investigated.
  • If there is irregular menstrual bleeding as a diagnosis, it may be necessary to take a piece from the uterus (endometrial biopsy, pipelle biopsy) or hysteroscopy, if necessary.
  • Appropriate treatment is determined according to the diagnosis. Accordingly, sometimes treatment; While there may be several months of drug use, sometimes surgery may be necessary.

What is considered a normal amount of menstruation?
Menstruation should last 2-8 days as standard, and on average per day 3 pads should be used for bleeding. However, for those who use spirals, this period can be 10 days, and daily bleeding can increase up to the use of 4 pads. The belief that dirty blood will be lost if menstruation is high is wrong, and it is not dirty blood that is lost. Excessive bleeding can cause many problems, especially anaemia, in the woman. Painkillers used during menstruation in consultation with the doctor can reduce bleeding.

Excessive menstruation, especially in cases where it starts later, “myoma, polyp, hyperplasia, infection, cancer etc.” It is an indication of a pathology such as gynaecology and can be recognized by a simple gynaecological examination. Blood coagulation diseases and blood thinners (such as aspirin, heparin) can also increase bleeding and cause bleeding in the interim period of the menstrual cycle.

Does menstrual irregularity make it difficult to get pregnant?
Since menstrual irregularity may be an indication of ovulation disorder, it is very normal for women with this problem to have difficulties getting pregnant. A woman with menstrual irregularity should consult a doctor, especially if she wants to have children. The cause of the irregularity should be determined and treatment should be applied. Sometimes pregnancy can be achieved with very simple treatments, while in some cases it may be necessary to resort to in vitro fertilization, which is called advanced reproductive techniques.

What does our body require for a regular menstruation?

  • Many organs work together for menstruation in the female body. If the hypothalamus region in our brain, pituitary gland, thyroid gland in the neck region, adrenal glands, ovaries, uterus, vagina and vulva in the female external genital region are intact, menstruation occurs.
  • If there is a malfunction in any of these, if there are conditions such as illness, stress, hunger, excessive sports, or if the body gives an emergency signal on any issue, the menstrual cycle may be disrupted.

Why should a woman go to the doctor in case of menstrual irregularity or cessation?
If the patient seeks examination due to amenorrhea, the doctor first takes a detailed history about the patient. Then breast development, body development and body mass index (BMI) are checked. Genital organ examination is performed with ultrasound examinations and if hormonal disorder is suspected, hormone profile (FSH, LH, TSH, Estradiol; TSH) and biochemical values ​​are checked.

Examination of the external genitalia is necessary to see the development of secondary sex characteristics, to evaluate the vaginal opening, and to diagnose congenital genital organ development disorders and deviations. Sometimes a very simple tightness of the hymen (hymen imperferatus) can be the cause of amenorrhea and can be removed with a simple surgical intervention.

In cases of amenorrhea that develops later on as well as hormonal disorders in a menstruating woman, not being able to ovulate (anovulation) is investigated as well. Polycystic ovary syndrome (PCO) is one of the most common diseases. A young girl or woman who is not menstruating should consult a doctor and be thoroughly examined in order to investigate all these underlying congenital and subsequent causes.