What Causes Menstrual Irregularity?

Menstrual irregularity

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

Symptoms of menorrhagia include

• a menstrual period that lasts longer than seven days
• bleeding 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, or iron deficiency. It may also signal an underlying medical condition. In most cases, your doctor can successfully treat abnormal periods.

Heavy or irregular periods can be due to a variety of factors, including:

Medications

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

Heavy bleeding can be a side effect of intrauterine devices (IUDs) used for birth control.

Hormone imbalances

The hormones estrogen and progesterone regulate the buildup of the lining of the uterus. An excess of these hormones can cause heavy bleeding.

Hormone imbalances are most common among girls who began menstruating in the past year and a half. They’re also common in women who are getting close to menopause.

Medical conditions

PID

Pelvic inflammatory disease (PID) and other infections can cause irregular periods.

Endometriosis

Endometriosis is another condition that can result in irregular periods. This is a condition in which tissue that lines the inside of the uterus begins to grow elsewhere inside the body. This can cause heavy bleeding, as well as pain.

Inherited blood disorder

Heavy menstrual bleeding can be due to some inherited blood disorders that affect clotting.

Benign growths or cancers

Cervical, ovarian, or uterine cancer can all cause heavy bleeding, but these conditions are not common. Benign, or noncancerous, tumors in the uterus can cause heavy bleeding or long periods.

Benign growths in the uterine lining (endometrium) can also cause a heavy or prolonged period. These growths are known as polyps, when the growth is made up of endometrial tissue. They’re referred to as fibroids, when the growth is made up of muscle tissue.

Other possible causes

Anovulation

Lack of ovulation, or anovulation, results in a lack of the hormone progesterone, causing heavy periods.

Adenomyosis

When glands from the uterine lining embed in uterine muscle, heavy bleeding can occur. This is known as adenomyosis.

Ectopic pregnancy

Contact your doctor if you bleed during pregnancy. Normal pregnancy interrupts menstruation. 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 implanted in the fallopian tube rather than the uterus, which is called an ectopic pregnancy. It can also indicate a miscarriage.

Your doctor will be able to help you determine what’s causing any bleeding during pregnancy.

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’s important to remember that these are just averages. Your “normal” may fall outside of these ranges. A blood loss of 80 cc (5 tablespoons) or more is considered an abnormally heavy flow.

Signs that your menstrual flow may be abnormally heavy include:

• soaking through more than one tampon or sanitary pad in an hour for several hours at a time
• waking up during the night because you need to change protection
• passing large blood clots in your menstrual flow
• experiencing a menstrual flow that lasts more than a week

Also, an abnormally heavy flow can cause you to experience the following symptoms, which may be an indication of anemia:

• fatigue
• pale skin
• shortness of breath
• dizziness

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

You should see your gynecologist regularly for a checkup. However, make an appointment right away if you have bleeding or spotting in the following circumstances:

• between periods
• after sex
• while pregnant
• after menopause

Other indicators that you should contact your doctor include the following:

• if your periods consistently last for more than a week
• if you require more than one tampon or sanitary pad in an hour, for several hours in a row
• severe pain
• fever
• abnormal discharge or odor
• unexplained weight gain or loss
• unusual hair growth
• new acne
• nipple discharge

Keep track of your menstrual cycles, including 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 gynecological appointment.

Avoid products that contain aspirin because they may increase bleeding.

If you have abnormal menstrual periods, your doctor will probably begin with a pelvic examination. They will request your medical history. You should list all the medications and supplements you’re taking.

Depending on your specific symptoms, diagnostic testing may include:

Pap smear

This test checks for various infections or cancerous cells in the cervix.

Blood tests

Blood tests will be used to check for anemia, blood-clotting problems, and thyroid function.

Pelvic ultrasound

A pelvic ultrasound will produce images of your uterus, ovaries, and pelvis.

Endometrial biopsy

If your doctor wants to evaluate possible issues with your uterus, they may order an endometrial biopsy. During this procedure, a sample of your uterine tissue is taken so it can be analyzed.

They may also use a diagnostic hysteroscopy to view the inside of your uterus. For a hysteroscopy, your doctor will use a lighted tube to view the uterus and remove the polyp.

Sonohysterogram

A sonohysterogram is an ultrasound that involves injecting fluid into your uterus to help make an image of your uterine cavity. Your doctor will then be able to look for polyps or fibroids.

Pregnancy test

Your doctor may request a pregnancy test.

Treatment will depend on:

• your overall health
• the reason for your menstrual abnormalities
• your reproductive history and future plans

Your doctor will also need to address any underlying medical conditions, such as thyroid dysfunction.

Treatments may include the following.

Medication

Possible medication treatments your doctor may suggest include:

• Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or naproxen, can reduce mild blood loss.
• Iron supplements can treat anemia.
• Hormone replacement injections can treat hormonal imbalances.
• Oral contraceptives can regulate your cycle and shorten periods.

You can work with your doctor to find alternatives if your irregularities are due to medications you’re already taking.

Medical procedures

D&C

Dilation and curettage, also known as D&C, is a procedure in which your 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.

Surgery

Surgery is the most common treatment for cancerous tumors. It’s also an option to treat fibroids, but it’s not always necessary. Removal of polyps can be done using a hysteroscopy.

Endometrial ablation

Endometrial ablation is a procedure used in women who haven’t had any success with medications being used to control heavy bleeding and related symptoms. This procedure involves your doctor destroying the uterine lining, leaving little or no menstrual flow.

Endometrial resection

Endometrial resection removes the uterine lining. This procedure significantly decreases your chances of a future pregnancy. If you’re planning to have children, you may want to discuss and consider other treatment options.

Hysterectomy

A hysterectomy is the surgical removal of the uterus and cervix. Your doctor may also remove your ovaries, if necessary. This results in premature menopause.

This procedure may be the preferred treatment if you have cancer or fibroids. It can also treat endometriosis that hasn’t responded to other less invasive treatment methods.

Having a hysterectomy removes your ability to bear children.

Heavy blood flow isn’t 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 the following symptoms:

• headaches
• dizziness
• shortness of breath
• rapid heart rate

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