Menstrual Irregularities: Causes, Symptoms and Treatment Methods
What Are Menstrual Irregularities?
A woman’s menstrual cycle depends on several fundamental factors:
- Hormonal Control
The hypothalamus and pituitary gland in the brain secrete hormones that stimulate the ovaries. These hormones support the maturation of the ovaries and the production of eggs.
- Ovarian Response
The ovaries respond to hormones secreted by the pituitary gland and produce hormones such as oestrogen and progesterone. These hormones cause the inner lining of the uterus, known as the endometrium, to thicken and become suitable for the implantation of a fertilised egg.
- Preparation of the Uterine Lining
The endometrium is prepared for the implantation of the embryo if pregnancy occurs. If pregnancy does not occur, this tissue is shed and menstruation takes place.
- Blood Flow
Blood flow within the uterus is important for the healthy functioning of the menstrual cycle. There should be no obstruction to blood flow.
This cycle generally repeats every 24–38 days. The duration of the cycle and the amount of bleeding may differ between women. Irregularities occurring outside this natural pattern are referred to as menstrual irregularities and may vary in terms of regularity, amount, frequency or duration.
What Causes Menstrual Irregularities?
Menstrual irregularities may have many different causes, ranging from hormonal imbalances to structural conditions. Some common causes of menstrual irregularities include:
- Hormonal Imbalances
The menstrual cycle may be affected by changes in hormone levels. Sudden decreases in hormone levels during ovulation may cause intermenstrual bleeding and irregular menstruation.
- Polyps
Polyps are small, benign tumours that develop in the inner lining of the uterus. They may cause menstrual irregularities and bleeding between periods.
- Adenomyosis
Adenomyosis is a condition in which tissue from the inner lining of the uterus grows into the uterine muscle. It may lead to painful and irregular menstrual bleeding.
- Fibroids
Fibroids are benign tumours of the uterus that may cause increased menstrual bleeding, pain and menstrual irregularities.
- Cancers
Endometrial cancer or ovarian cancer may cause abnormal bleeding as well as menstrual irregularities.
- Blood-Clotting Disorders
Conditions affecting the ability of the blood to clot may cause excessive menstrual bleeding and menstrual irregularities.
- Ovulation Disorders
Ovulation problems such as polycystic ovary syndrome may cause menstrual irregularities.
- Abnormalities of the Uterine Lining
Structural abnormalities affecting the inner lining of the uterus may disrupt the menstrual cycle and cause irregular bleeding.
- Medication Use
Oral contraceptive pills, hormonal treatments and certain other medications may cause changes and irregularities in the menstrual cycle.
- Stress and Lifestyle Changes
Psychological stress, excessive exercise, changes in body weight and changes in dietary habits may also affect the menstrual cycle.
A medical assessment is required to determine the cause of menstrual irregularities. This assessment includes a review of the patient’s medical history, a physical examination and any necessary investigations, such as hormone tests and ultrasonography. Appropriate treatment and management strategies can then be determined.
Who Experiences Menstrual Irregularities? What Are the Risk Factors?
Menstrual irregularities may occur in different age groups and in association with various health conditions. The groups in whom they are more commonly seen and the associated risk factors are listed below.
Who Is Affected?
Adolescent Girls During Menarche
Menstrual irregularities are common in adolescent girls whose menstrual cycles have recently begun because hormonal regulation has not yet been fully established. This period may generally last for two to three years.
Perimenopausal Women
Menstrual irregularities may be common before menopause due to changes in hormone levels. This period is characterised by menstrual cycles becoming increasingly irregular.
Women with Polycystic Ovary Syndrome
Polycystic ovary syndrome may cause ovulation disorders and irregular menstrual cycles.
Women with Thyroid Disorders
Excessive or insufficient production of thyroid hormones may affect the menstrual cycle.
Women with Weight-Related Problems
Excessive weight gain or significant weight loss may lead to hormonal imbalances and menstrual irregularities.
Women Experiencing Stress
Psychological and physical stress may affect the brain and disrupt the menstrual cycle.
Women with Systemic Diseases
Chronic diseases, such as liver and kidney diseases, may impair hormonal balance and lead to menstrual irregularities.
Medication Use
Oral contraceptive pills, hormonal treatments and certain other medications may affect the menstrual cycle and cause irregularities.
Risk Factors
Genetic Factors
A family history may increase the risk of developing certain menstrual irregularities.
Hormonal Imbalances
Changes in oestrogen and progesterone levels, in particular, may lead to irregularities in the menstrual cycle.
High Stress Levels
Being under constant and significant stress may cause hormonal imbalances and consequently lead to menstrual irregularities.
Diet and Lifestyle
An unbalanced diet, excessive exercise or inadequate nutrition may affect the menstrual cycle.
Chronic Diseases
Thyroid disorders, diabetes and other endocrine conditions may affect menstrual regularity.
Medications and Treatments
Hormonal treatments, certain medications and contraceptive methods may affect menstrual regularity.
Menstrual irregularities are generally not caused by a single factor. They may develop as a result of several contributing factors. If menstrual irregularities become persistent or cause significant discomfort, it is important to consult a healthcare professional.
What Are the Symptoms of Menstrual Irregularities?
Menstrual irregularities may present with several symptoms that can affect a woman’s general health and quality of life. These symptoms may include changes in the menstrual cycle, changes in the amount of bleeding and other related complaints.
Common symptoms of menstrual irregularities include:
Changes in the Menstrual Cycle
Short or Long Cycles
A menstrual cycle lasting fewer than 24 days, which is considered a short cycle, or longer than 38 days, which is considered a long cycle, may be a sign of menstrual irregularity.
Changes in the Duration of Menstruation
Menstrual bleeding lasting fewer than three days or more than eight days may also indicate an irregularity.
Changes in the Amount of Bleeding
Menstrual bleeding of less than 5 mL, which is considered very light, or more than 80 mL, which is considered excessive, may be a sign of menstrual irregularity.
Other Symptoms
Weakness and Fatigue
Prolonged and heavy menstrual bleeding may cause weakness and fatigue due to blood loss.
Dizziness
Severe and prolonged bleeding may cause dizziness as a result of reduced blood levels.
Anaemia
Excessive bleeding may lead to anaemia, a condition in which the body does not have enough red blood cells. Symptoms of anaemia include weakness, dizziness, pale skin and fatigue.
Severe Bleeding
Excessively prolonged and heavy menstrual bleeding may affect women’s health and require treatment.
Pain and Cramping
Irregular menstrual periods may cause uncomfortable symptoms such as abdominal pain and cramping in some women.
Additional Symptoms
Psychological and Emotional Symptoms
Emotional changes, stress and anxiety may accompany irregular menstrual cycles.
Changes in Body Weight
Weight gain or weight loss may also be associated with hormonal imbalances and may cause menstrual irregularities.
If symptoms of menstrual irregularity are experienced, it is important to consult an obstetrician and gynaecologist. The specialist can assess the symptoms, perform the necessary tests and recommend appropriate treatment methods. This is important for both regulating the menstrual cycle and improving general health.
Which Gynaecological Conditions May Be Indicated by Menstrual Irregularities?
Menstrual irregularities may be a sign of several gynaecological conditions and certain systemic health problems.
Gynaecological Conditions
Endometrial Polyps
Benign growths called polyps that develop in the inner lining of the uterus may cause menstrual irregularities, excessive bleeding and bleeding between periods.
Fibroids
Fibroids are benign tumours of the uterus that may cause menstrual irregularities, painful menstrual periods and excessive bleeding.
Adenomyosis
The growth of endometrial tissue into the uterine muscle may cause menstrual irregularities and severe menstrual pain.
Cervical Cancer
Cancer of the cervix may present with symptoms such as irregular menstrual bleeding, bleeding between periods and abnormal vaginal discharge.
Endometrial Cancer
Cancer developing in the inner lining of the uterus may cause irregular bleeding and an increase in the amount of bleeding, particularly in postmenopausal women.
Ovarian Cancer
Ovarian cancer may present with symptoms such as menstrual irregularities, abdominal pain and bloating.
Polycystic Ovary Syndrome
Polycystic ovary syndrome may cause ovulation disorders and irregular menstrual cycles. It may also be associated with symptoms such as excessive hair growth, acne and weight gain.
Thyroid Disorders
Excessive or insufficient production of thyroid hormones may cause menstrual irregularities. Conditions such as hypothyroidism and hyperthyroidism may produce these symptoms.
Hyperprolactinaemia
Excessive secretion of prolactin from the pituitary gland may cause menstrual irregularities and even amenorrhoea, or the absence of menstruation.
Chronic Diseases
Chronic liver disease, kidney disease and other systemic conditions may affect hormonal balance and cause menstrual irregularities.
Other Factors
Stress
Physical and psychological stress may disrupt hormonal balance and affect the menstrual cycle.
Diet and Lifestyle
Significant changes in body weight, excessive exercise or inadequate nutrition may also cause menstrual irregularities.
How Are Menstrual Irregularities Diagnosed?
A series of steps are followed to diagnose menstrual irregularities. This process includes understanding the patient’s symptoms, performing a physical examination and carrying out various tests.
- Medical History and Assessment of Symptoms
Evaluation of the Menstrual Cycle
Information is collected about the length of the menstrual cycle, the duration and amount of bleeding, and the frequency of irregularities.
Review of Medical History
Factors such as medications being used, hormonal treatments, previous health problems, accompanying medical conditions and family history are assessed.
- Gynaecological Examination
Physical Examination
A physical examination of the uterus, ovaries and fallopian tubes is performed. Both external and internal gynaecological examinations are carried out.
- Imaging Tests
Ultrasonography
Transabdominal or transvaginal ultrasonography may be used to visualise the uterus, ovaries and fallopian tubes. Polyps, fibroids, cysts and other structural abnormalities may be detected.
Magnetic Resonance Imaging
When considered necessary, magnetic resonance imaging may be performed to assess the uterus and surrounding structures in greater detail.
- Laboratory Tests
Hormone Profile
Blood tests are performed to assess hormone levels such as oestrogen, progesterone, follicle-stimulating hormone, luteinising hormone and prolactin. Thyroid function tests and other endocrine investigations may also be requested.
Complete Blood Count
A complete blood count may be performed to identify conditions such as anaemia.
- Additional Tests and Pathological Examinations
Endometrial Biopsy
If thickening or abnormal findings are detected in the inner lining of the uterus, an endometrial biopsy may be performed. This procedure involves taking a sample of endometrial tissue for pathological examination and assists in the investigation of malignant conditions such as cancer.
- Other Tests
Papanicolaou Test
A Pap smear may be performed to assess conditions such as cervical cancer.
Genetic Tests
Genetic testing may be considered, particularly in conditions such as polycystic ovary syndrome where a genetic predisposition may be present.
How Are Menstrual Irregularities Treated?
Treatment of menstrual irregularities should be individualised according to the patient’s age, medical history and the underlying cause of the irregularity. Methods and approaches used to treat menstrual irregularities include:
- Hormonal Treatment
Adolescent Girls
If irregularities occur after the first menstrual cycle has begun, the cycle is generally expected to regulate spontaneously over several years. However, hormonal treatment may be recommended if severe bleeding or other symptoms are present.
Perimenopausal and Menopausal Women
Hormone replacement therapy may be used. This treatment may help replace deficient oestrogen and progesterone hormones and regulate menstrual cycles.
- Medications and Medical Interventions
Oral Contraceptive Pills
Oral contraceptive pills may help regulate the menstrual cycle and control the amount of bleeding. They may also relieve certain menstrual irregularities and symptoms of premenstrual syndrome.
Progestin Treatment
Progesterone-containing medications may be used to manage menstrual irregularities. They may be particularly effective for ovulation problems or irregular menstrual periods.
Iron Supplements
In cases of anaemia caused by heavy bleeding, iron supplements and other vitamin and mineral supplements may be recommended.
- Surgical Intervention
Fibroids and Polyps
If fibroids or polyps in the uterus cause irregular menstrual periods, hysteroscopy and, where necessary, surgical intervention may be required. These procedures may involve removing the polyps or fibroids.
Fibroids
Depending on the location, size and number of the fibroids, surgical removal of the fibroids or, in some cases, complete removal of the uterus through hysterectomy may be required.
Endometrial Ablation
Endometrial ablation is a procedure involving the partial destruction of the inner lining of the uterus in women with severe and irregular bleeding. It may reduce or completely stop menstrual bleeding.
- Lifestyle and Dietary Changes
Stress Management
Reducing stress may help regulate the menstrual cycle. Yoga, meditation, regular exercise and adequate sleep may be beneficial.
Nutrition
A balanced diet, particularly one rich in iron and other vitamins, may help manage menstrual irregularities. Weight management and healthy lifestyle changes are also important.
- Treatment of Bleeding and Clotting Disorders
Clotting Disorders
If a bleeding disorder is identified, appropriate treatment and management strategies should be implemented. Antifibrinolytic medications or other haemostatic treatments may be used.
- Psychological Support
Emotional and Psychological Support
Menstrual irregularities may have psychological effects. Psychological support or therapy may assist with emotional recovery and stress management.
What Problems May Occur If Menstrual Irregularities Are Left Untreated?
Untreated menstrual irregularities may lead to various health problems and significantly affect quality of life. The main problems associated with untreated menstrual irregularities include:
- Physical Problems
Anaemia
Severe and persistent bleeding may lead to iron-deficiency anaemia. This condition may cause weakness, fatigue, dizziness, loss of appetite, intolerance to cold and skin problems.
Hormonal Imbalances
Long-term irregularities may cause hormonal imbalances to become persistent. This may lead to other health problems and additional hormonal disorders.
Infertility
Ovulation disorders and menstrual irregularities may affect the likelihood of pregnancy. Ovulation problems, in particular, may make it difficult to become pregnant.
- Psychological and Emotional Problems
Stress and Anxiety
Persistent irregularities and painful menstrual periods may cause emotional stress and anxiety. Women may experience psychological difficulties due to irregular bleeding.
Reduced Quality of Life
Heavy bleeding, frequently feeling unwell and other physical symptoms may make daily activities difficult and reduce quality of life.
- Failure to Detect Malignant Conditions
Cervical Cancer
Irregular and abnormal bleeding may be a symptom of malignant conditions such as cervical cancer. If left undiagnosed and untreated, these conditions may progress and cause more serious health problems.
Endometrial Cancer
The risk of endometrial cancer may be increased in women experiencing postmenopausal or irregular bleeding. Regular screening and assessment are therefore important.
Ovarian Cancer
Menstrual irregularities may be a symptom of ovarian cancer. Early diagnosis and treatment may improve the course of the disease.
- Chronic Health Problems
Polycystic Ovary Syndrome
Untreated menstrual irregularities may worsen hormonal conditions such as polycystic ovary syndrome. Polycystic ovary syndrome may increase the risk of metabolic syndrome, diabetes and heart disease.
Endometriosis
Untreated menstrual irregularities may cause conditions such as endometriosis to progress. This may lead to painful menstrual periods and reproductive problems.
- Long-Term Health Risks
Bone Health
Long-term hormonal irregularities may adversely affect bone health and increase the risk of osteoporosis.
General Health Problems
Irregularities involving the relevant hormones may have adverse effects on general health and affect other organ systems.
Can Menstrual Irregularities Prevent Pregnancy?
When menstrual periods are irregular, the process of becoming pregnant may be delayed or may not be possible because it is difficult to predict the timing of ovulation.
If the number of eggs is sufficient but ovulation does not occur, which is known as anovulation, this condition may be overcome with medical treatment.
Gynaecological problems such as menstrual irregularities require accurate diagnosis and treatment. If you are experiencing irregularities in your menstrual cycle, it is important to seek professional support from an obstetrician and gynaecologist. Always consult a specialist regarding any concerns about your health.
If you are experiencing menstrual irregularities and would like to receive further information, Prof. Dr Şadıman Kıykaç Altınbaş, a Specialist in Obstetrics and Gynaecology practising in Ankara, can provide a comprehensive assessment and treatment process.
Receiving support from a trusted specialist to protect your health and obtain information about the appropriate treatment methods is an important step. You may contact us to schedule an appointment and obtain further information.
