What are the Causes of Menstrual Irregularity? What Should Be Considered?

Obstetrics and Gynecology Specialist Op. Dr. İhsan Atabay gave information on the subject. Menstrual bleeding occurs as a result of hormonal effects and cyclical changes in the endometrium layer in the inner part of the uterus. What women who complain about menstrual irregularity actually talk about is that the amount of bleeding is less or more, or that the bleeding time is short or long. Sometimes, frequent periods or long delays are the main complaints. Sometimes, people may complain of intermittent bleeding outside of the menstrual period. Sometimes there may be a combination of all these complaints.

What is the normal menstrual cycle that should be?

The first day of menstruation is the first day of bleeding. The period from the first day of one period to the first day of the other period, and if it is between 21-35 days, this is called the normal menstrual cycle. It is considered normal that the number of days with total bleeding is between 2 and 8 days, and a blood loss of 20-60 ml in each menstrual period.

Sometimes the time elapsed between two periods may vary. Or, there may not be the same amount of bleeding in each menstrual period. If the person is menstruating in accordance with the normal menstrual criteria mentioned above, then the menstruation is considered regular. The menstrual cycle and hormonal system are not punctual like clockwork. Many factors such as seasonal changes, stress, illness, and drug use can affect the hormonal system and therefore the menstrual cycle.

What are the causes of menstrual irregularity? Why does menstrual irregularity occur?

Some of the conditions that can cause menstrual irregularity can be listed as follows;

• Polyp
• adenomyosis
• Myoma
• Cancer and precancerous conditions in the uterus, cervix, or ovaries
• coagulation disorder
• ovulation problems
• Endometrial (uterine inner tissue) causes

For a regular menstrual cycle, the hormonal mechanism between the hypothalamus and pituitary in the brain and the ovaries must work regularly. In young girls, the hypothalamus-pituitary-ovarian axis may not work properly in the first years of menstruation and in the advanced age close to menopause. For this reason, menstruation can be quite irregular during this period. However, cancerous formations should also be kept in mind in irregular bleeding, especially in the period close to menopause.

What tests should be done when there is menstrual irregularity?

• Beta-HCG (Pregnancy Test): Pregnancy should be ruled out. For this reason, Beta-HCG test is done first.
• Coagulation tests: Tests such as APTT, PT, INR should be done to find out if there is a problem in the person's coagulation system.
• TSH (Thyroid tests): Sometimes thyroid diseases can be the cause of irregular menstruation.
• Prolactin: It is a hormone produced in the pituitary gland in the brain. Prolactinoma refers to a tumor in the pituitary gland. Sometimes, the menstrual cycle may be disrupted due to the high amount of prolactin secreted from the pituitary tumor. Therefore, the basis of menstrual irregularity may be a pituitary tumor. To investigate this, the level of prolactin in the blood is measured.
• FSH, LH and estrogen (estradiol): These are the tests performed on the 2-3rd or 4th days of the menstrual cycle. It is done to measure the reserve of the ovaries. A low ovarian reserve can be a sign of impending menopause or early menopause. Menstrual irregularity is not uncommon in people who are in the premenopausal period.
• DHEAS: It is sometimes used to rule out adrenal gland pathologies in the presence of other problems in addition to menstrual irregularity.
• Smear Test: The source of bleeding that is thought to be irregular menstruation may be the cervix instead of the uterus. For this reason, a person with irregular menstrual bleeding should be screened for cervical cancer with a smear test.
• Infection screening: If the person has both menstrual irregularity and complaints of bad odor and discharge, the causes of bleeding due to infection are investigated.
• Ultrasound and Hysteroscopy: With these methods, other bleeding causes such as fibroids, polyps and tumors are investigated.

How is menstrual irregularity treated?

Non-steroidal anti-inflammatory drugs, anti-bleeding drugs, menstrual pills, hormone-based pills and injections, hormonal spirals or surgical procedures may be the first choice in treatment. Sometimes more than one treatment method can be applied at the same time. Treatment for menstrual irregularity; It varies from person to person depending on the underlying cause, type of menstrual irregularity, age and many other factors. Your doctor will share with you the treatment options that are suitable for you. The choice of the person is also very important here. It would be appropriate to plan the treatment together with your doctor by evaluating the advantages and disadvantages of each method.