You think you are bleeding down there, but you’re not! You think you’re just sweaty down there but you are actually bleeding! What a confusion!
Typically, menstrual periods last four to seven days. Examples of menstrual problems include periods that occur less than 21 days or more than 35 days apart, missing three or more periods in row, and menstrual flow that is much heavier or lighter than usual.
What is abnormal menstruation?
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 abnormal menstruation include the following:
- Amenorrhea is a condition in which a woman’s periods have stopped 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 for women between ages 45 and 55). Young women who haven’t started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.
- Oligomenorrhea refers to periods that occur infrequently.
- Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.
- Abnormal uterine bleeding may 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.
Causes
A number of factors increase the chance of irregular menstruation. Most are related to hormone production. The two hormones that impact menstruation are estrogen and progesterone. These are the hormones that regulate the cycle.
- Hormonal influences
Life cycle changes that influence the hormonal balance include puberty, menopause, pregnancy, and childbirth, and breastfeeding. During puberty, the body undergoes major changes. It can take several years for the estrogen and progesterone to reach a balance, and irregular periods are common at this time. Before menopause, women often have irregular periods, and the amount of blood shed may vary. Menopause occurs when 12 months have passed since the woman’s last menstrual period. After the menopause, a woman will no longer have periods. During pregnancy, menstruation ceases, and most women do not have periods while they are breast-feeding. - Contraceptives can cause irregular bleeding.
An intrauterine device (IUD) may cause heavy bleeding, while the contraceptive pill can cause spotting between periods. When a woman first uses the contraceptive pill, she may experience small bleeds that are generally shorter and lighter than normal periods. These usually go away after a few months. - Uterine polyps or fibroids. Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumors that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumors are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.
- Endometriosis. The endometrial tissue that lines the uterus breaks down every month and is discharged with the menstrual flow. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs in the lower digestive tract and in the area between your rectum and uterus. Endometriosis may cause abnormal bleeding, cramps or pain before and during periods, and painful intercourse.
- Pelvic inflammatory disease. Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. Bacteria may enter the vagina via sexual contact and then spread to the uterus and upper genital tract. Bacteria might also enter the reproductive tract via gynecologic procedures or through childbirth, miscarriage, or abortion. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods, pain in the pelvic and lower abdominal areas, fever, nausea, vomiting, or diarrhea. Full STD screening is vital.
- Polycystic ovary syndrome. In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. These can often be seen on an ultrasound. The hormonal changes can prevent eggs from maturing, and so ovulation may not take place consistently. Sometimes a woman with polycystic ovary syndrome will have irregular periods or stop menstruating completely. In addition, the condition is associated with obesity, infertility and hirsutism (excessive body hair growth and acne). This condition may be caused by a hormonal imbalance, although the exact cause is unknown. Treatment of PCOS depends on whether a woman desires pregnancy. If pregnancy is not a goal, then weight loss, oral contraceptive pills, and the medication Metformin® (an insulin sensitizer used in diabetes) can regulate a woman’s cycles. If pregnancy is desired, ovulation-stimulating medications can be tried.
- Premature ovarian insufficiency. This condition occurs in women under age 40 whose ovaries do not function normally. The menstrual cycle stops, similar to menopause. This can occur in patients who are being treated for cancer with chemotherapy and radiation, or if you have a family history of premature ovarian insufficiency or certain chromosomal abnormalities.
Other changes that are associated with irregular periods include:
- extreme weight loss
- extreme weight gain
- emotional stress
- eating disorders, such as anorexia or bulimia
- endurance exercise, for example, marathon running.
- A number of disorders are also linked to missed or irregular menstruation.
Treatment
Treatment, if needed, will depend on the cause.
Puberty and menopause: Irregular periods that occur during puberty or as the woman approaches menopause do not usually need treatment.
Birth control: If irregular bleeding is due to contraception, and it continues for several months, the patient should go back to the clinic or get a second opinion as it clearly shows something is just not right!
PCOS and obesity: In cases of PCOS, overweight, or obesity losing weight may help stabilize menstruation. A lower weight means the body does not need to produce so much insulin. This leads to lower testosterone levels and a better chance of ovulating.
Thyroid problems: Treatment for the underlying problem is likely to be prescribed. This may include medication, radioactive iodine therapy or surgery.
Stress and eating disorders: Psychological therapy may help if emotional stress, an eating disorder, or sudden weight loss have triggered irregular periods. This may include relaxation techniques, stress management, and talking to a therapist.
Medication
The doctor may prescribe metformin, an insulin-lowering oral drug for type 2 diabetes, which can help ensure ovulation and regular periods. A low-dose birth control pill that contains a combination of estrogen and progesterone may help. This will decrease androgen production and will help to correct abnormal bleeding.
Alternatively, taking progesterone for 10 to 14 days each month is likely to regulate the periods.
Most of the conditions will be easier to understand once you come in for a consultation.
