What causes menstrual irregularity? 20 possible conditions

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What Is Menorrhagia?

The duration and severity of menstrual bleeding varies from woman to woman. If a woman’s menstrual period is excessively heavy, prolonged, or irregular, it is called menorrhagia.

Symptoms of menorrhagia include a menstrual period that lasts longer than seven days and bleeding is so heavy that you must change your tampon or pad more than once per hour. You should see your doctor if you have excessively heavy or prolonged menstrual periods that interfere with your daily life.

Excessive bleeding can cause anemia (iron deficiency) or signal an underlying medical condition. In most cases, abnormal periods can be successfully treated.

What Is a Normal Menstrual Period?

The length of the menstrual cycle and amount of blood flow is unique to each woman. However, most women have a cycle that ranges from 24 to 34 days. Blood flow averages about four or five days, with a blood loss of about 40 cc (3 tablespoons). It is important to remember that these are just averages and that your “normal” may fall outside of these ranges.

Symptoms of Abnormal Menstrual Periods

A blood loss of 80cc (5 tablespoons) or more is considered an abnormally heavy flow. Signs that your flow may be abnormally heavy include:

  • You are soaking through more than one tampon or sanitary pad in an hour, for several hours at a time.
  • You need to double-up on sanitary pads or need both a tampon and a pad.
  • You wake up during the night because you need to change protection.
  • You notice large blood clots in your flow.
  • Your period lasts more than a week.
  • You can’t participate in your normal activities because your flow is too heavy.
  • You have signs of anemia, which include fatigue, pale skin, shortness of breath and dizziness.

While every woman’s cycle is different, irregularities such as bleeding mid-cycle or bleeding after intercourse are considered abnormal symptoms.

What to Do About Heavy or Irregular Menstrual Periods

Keep track of your menstrual cycles, how long your blood flow lasts, and how many tampons or sanitary pads you use during each cycle. This information will be helpful at your next gynecological appointment. Avoid products that contain aspirin because they may increase bleeding.

When to Seek Medical Care

You should see your gynecologist once a year for a check-up. However, you should make an appointment right away if you have:

  • bleeding or spotting between periods
  • bleeding or spotting after intercourse
  • bleeding or spotting while pregnant
  • bleeding or spotting after menopause
  • periods that require more than one tampon or sanitary pad in an hour, for two or three consecutive hours
  • periods that consistently last for more than a week
  • severe pain
  • fever
  • abnormal discharge or abnormal odor
  • unexplained weight gain or loss
  • unusual hair growth, new acne, or discharge from your nipples

Risks of Heavy Menstrual Periods

Heavy blood flow is not always a sign that something is wrong. However, excessive loss of blood can deplete the body’s supply of iron and cause anemia. A mild case of anemia can cause fatigue and weakness. A more severe case can result in headaches, dizziness, shortness of breath, and rapid heart rate.

A very heavy flow can also cause painful cramping (dysmenorrhea), which sometimes requires medication.

Diagnosing Heavy or Irregular Menstrual Periods

If you have abnormal menstrual periods, your doctor will probably begin with a pelvic examination. You should also be prepared to give your medical history and list all the medications and supplements you are taking.

Depending on your specific symptoms, diagnostic testing may include:

  • a pap smear to check for various infections or cancerous cells
  • blood tests to check for anemia, blood-clotting problems, and thyroid function
  • pelvic ultrasound to produce images of your uterus, ovaries, and pelvis
  • endometrial biopsy to analyze a sample of uterine tissue
  • hysteroscopy to view the inside of your uterus
  • pregnancy test

Causes of Heavy or Irregular Menstrual Periods

Heavy or irregular periods can be caused by a variety of factors, including:

Medications: Some anti-inflammatory drugs, anticoagulants, or hormone medications can affect menstrual bleeding.

  • Intrauterine devices (IUD): Heavy bleeding can be a side effect of intrauterine devices used for birth control.
  • Hormonal imbalance, abnormal thyroid or pituitary function: The build-up of the lining of the uterus is regulated by the hormones estrogen and progesterone. An excess of these hormones can cause heavy bleeding. Hormone imbalances are most common among girls who began mestruating in the past year and a half, and women who are getting close to menopause.
  • Pelvic inflammatory disease or other infections
  • Endometriosis: This is a condition in which tissue that lines the inside of the uterus begins to grow elsewhere inside the body, which can cause heavy bleeding as well as pain.
  • Fibroids: Noncancerous tumors in the uterus can cause heavy bleeding or long periods.
  • Polyps: Benign growths in the uterine lining (endometrium) can cause a heavy or prolonged period.
  • Ovary dysfunction: Lack of ovulation (anovulation) results in a lack of progesterone, causing heavy periods.
  • Adenomyosis: When glands from the uterine lining embed in uterine muscle, heavy bleeding can occur.
  • Complications of pregnancy: Contact your doctor if you bleed during pregnancy. Normal pregnancy interrupts menstruation; however, some spotting during pregnancy, especially during the first trimester, is often nothing to worry about. Seek immediate medical attention if you bleed heavily during pregnancy, it can be a sign that the fertilized egg has implanted in the fallopian tube rather than the uterus (ectopic pregnancy). It can also indicate a miscarriage.
  • Bleeding disorders: Heavy menstrual bleeding can be caused by some inherited blood disorders that affect clotting.
  • Cancer: Cervical, ovarian, or uterine cancer can all cause heavy bleeding, but this is rare.

Treatment for Heavy or Irregular Menstrual Periods

Treatment will be based on your overall health, the reason for your menstrual abnormalities, and your reproductive history and future plans. Any underlying medical conditions, such as thyroid dysfunction, will need to be addressed.

Medication

Mild blood loss can be reduced with the use of nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, and anemia can be treated with iron supplements. If your irregularities are caused by medications, you can work with your doctor to find alternatives. Hormonal imbalances may be treated with hormone replacement injections. Oral contraceptives can also be used to regulate your cycle and shorten periods.

Medical Procedures

Dilation and curettage (D&C) is a procedure in which the doctor dilates your cervix and scrapes tissue from the lining of your uterus. This is a fairly common procedure and generally cuts down on menstrual bleeding.

Cancerous tumors are generally removed through surgery. Surgery is also an option to treat fibroids, but is not always necessary. Polyps can be removed in a procedure called a hysteroscopy, in which the doctor uses a lighted tube to view the uterus and remove the polyp.

Endometrial ablation is a procedure used in women who have had no success with medications to control heavy bleeding and related symptoms. In this procedure, the doctor will destroy the uterine lining, leaving little or no menstrual flow. Endometrial resection removes the uterine lining. This procedure significantly decreases your chances of a future pregnancy, so women who plan on having children should discuss other possible treatment options.

Hysterectomy is the surgical removal of the uterus and cervix, and may be recommended in the case of cancers, to remove fibroids, and to treat endometriosis that has not responded to other less-invasive forms of treatment. A hysterectomy will end your ability to bear children. If necessary, the ovaries are also removed, resulting in premature menopause.

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See a list of possible causes in order from the most common to the least.

1

Heavy, Prolonged, or Irregular Menstrual Periods

Menstrual periods that are heavy, prolonged, or irregular are abnormal. There are many possible causes for an abnormal period. These include: hormonal imbalances growths in the ovaries or uterus irregular growth of th...

Read more »

2

Pregnancy

Bleeding or spotting, increased need to urinate, tender breasts, fatigue, nausea, and missed period are signs of pregnancy.

Read more »

3

Menopause

Menopause is a natural biological process in women that marks the permanent end of menstruation and fertility. Hot flashes, vaginal dryness or pain, and frequent urination are signs.

Read more »

4

Obesity

Obesity is defined as having a body mass index (BMI) of 30 or more. BMI is calculated using a person's weight and height. It can lead to other conditions like diabetes, heart disease, and cancer.

Read more »

5

What is Fertility?

Infertility is not just a woman's problem - men can be infertile, too. In fact, men and women are equally likely to have a fertility problem

Read more »

6

Dysfunctional Uterine Bleeding (DUB)

DUB is a condition that causes vaginal bleeding to occur outside a woman's regular menstrual cycle. It may be accompanied by bloating and breast tenderness.

Read more »

7

Hypothyroidism

The thyroid gland produces a hormone that controls how your cells use energy (metabolize). Hypothyroidism occurs when the body doesn't produce enough. Untreated, it can cause comlications like obesity and heart disease.

Read more »

8

Graves' Disease

Graves disease is an autoimmune disorder that leads to hyperthyroidism and causes thyroid swelling.

Read more »

9

Ovarian Cancer

The ovaries are small, almond-shaped organs located on either side of the uterus that produce eggs. As the disease progresses, symptoms include back pain and indigestion.

Read more »

10

Endometriosis

Endometriosis is a disorder in which the endometrium grows outside your uterine cavity. The endometrium is the tissue which makes up the inside surface of your uterus. Endometriosis occurs when this lining grows on th...

Read more »

11

Hyperthyroidism

The thyroid gland is a small butterfly-shaped gland located at the front of the neck below your Adam's apple. It produces tetraiodothyronine (T4) and triiodothyronine (T3), two hormones which control how your cells us...

Read more »

12

Hashimoto's Disease

Hashimoto's disease damages your thyroid function. It is also called chronic lymphocytic thyroiditis or just chronic thyroiditis. Hashimoto's is the most common cause of hypothyroidism, an underactive thyroid.Th...

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13

Ovarian Cysts

The ovaries are part of the female reproductive system. They are located in the lower abdomen on both sides of the uterus. Women have two ovaries that produce eggs, as well as the hormones estrogen an...

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14

Von Willebrand Disease

Von Willebrand disease is a bleeding disorder caused by a deficiency of von Willebrand factor (VWF). To understand this disease, you need to understand a little bit about how blood clotting works. Platelets ar...

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15

Endometrial Cancer (Cancer of the Uterine Endometrium)

Cancer of the uterine endometrium, also known as endometrial cancer, is a type of cancer that starts in the inner lining of your uterus. This lining is called the endometrium. According to the National Cancer Institute...

Read more »

16

Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is an infection of the reproductive organs in women. The pelvis is located in the lower abdomen and includes the fallopian tubes, the ovaries, the cervix, and the uterus. According t...

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17

Polycystic Ovarian Syndrome

Polycystic ovarian syndrome, or PCOS, is a condition in which a woman's levels of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries)...

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18

Infertility

Infertility is defined as not being able to become pregnant after a year of trying - or after six months, if you are 35 or older (Mayo Clinic). And it's not just a woman's problem. One-third of infertility cases are du...

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19

Gigantism

Gigantism is a rare condition that causes abnormal growth in children. It occurs when a child's body produces too much growth hormone. Early diagnosis is important. Prompt treatment can stop or slow the changes that ma...

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20

Excessive Or Unwanted Hair In Women

Excessive or unwanted hair that grows on a woman's body and face is called hirsutism . All women have facial and body hair, but this hair is usually very fine and light in color. The main difference between norma...

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This feature is for informational purposes only and should not be used to diagnose.
Please consult a healthcare professional if you have health concerns.
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