DR TARIQ JAGNARINE
MD, FAMILY MEDICINE/ENDOCRINOLOGY
A period, or menstruation, is the part of the menstrual cycle in which the endometrium, which is the lining of the uterus, is shed. This appears as bleeding from the womb that is released through the vagina. The normal length of a woman’s menstrual cycle is 28 days, but this varies between individuals.
Periods usually start during puberty, between the ages of 10 to 16 years, and they continue until menopause, when a woman is 45 to 55-years old. Most women have between 11 and 13 menstrual periods each year. Bleeding usually lasts around 5 days, but this too can vary, from 2 to 7 days.
Irregular menstruation is when the length of the cycle is more than 35 days, or if the duration varies. When menstruation first starts, it can take up to 2 years to establish a regular cycle. After puberty, most women’s menstruation is regular. The length of time between each period is similar. However, for some women, the time between periods and the amount of blood shed vary considerably. This is known as irregular menstruation.
The main symptom of irregular menstruation is when the cycle is longer than 35 days, or if it varies in length. If there are changes in blood flow, or if clots appear that are more than 2.5 centimetres in diameter, this is also considered irregular.
In a South Korean study published in PloS One in March 2019, over 14 per cent of 4709 adult women ages 19 to 54 reported having irregular menstruation. In another, occupational status was found to have an effect: Service, manual overnight shift and sales workers, and unemployed women had higher risks of developing irregular menstrual cycles.
CAUSES
Many things can cause irregular periods. Changes in the body’s level of the hormones estrogen and progesterone can disrupt the normal pattern of a period. This is one of the main reasons why young girls going through puberty and women approaching menopause commonly have irregular periods.
Other common causes of irregular periods include:
* Having an intrauterine device (IUD) as a contraceptive
* Changing birth control pills or using certain medications
* Too much exercise
* Polycystic ovary syndrome (PCOS) is a condition in which a number of small, fluid-filled sacs known as cysts develop in the ovaries
* Cervical or uterine cancer, or cancer of the womb, may, in rare cases, cause bleeding between periods or during sexual intercourse
* Endometriosis is a condition in which cells that are normally found inside the uterus, called endometrial cells, grow outside it. In other words, the lining of the inside of the uterus is found outside of it
* Pelvic inflammatory disease (PID) is an infection of the female reproductive system. Among women, it is the most common and serious complication of sexually transmitted infections (STIs), apart from AIDS
* Pregnancy or breastfeeding
* Stress
* Overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism)
* Thickening of or polyps on the uterine lining
* Uterine fibroids
A less common cause is severe scarring (adhesions) of the lining of the uterus, a condition that doctors call Asherman syndrome.
TREATMENT
Most cases of irregular cycle do not require treatment unless it is affecting the person or the cause is due to an underlying medical condition that is affecting the menstrual cycle.
Polycystic ovary syndrome (PCOS) and hypothyroidism are two common causes of irregular periods in women. In general, the goal of treatment is to restore the balance of hormones in the body. In the case of PCOS, it is recommended to use birth control pills or other hormones to trigger a period. If the cause is due to hypothyroidism (underactive thyroid), then treatment is needed using thyroid hormones replacement.
Changing birth control. Experiencing irregular periods after 3 months of hormonal birth control; then it is recommended to try another type of birth control. Some women develop irregular periods when using Nexplanon, Depo-Provera, or an IUD.
Lifestyle changes. Some women have changes in their period because they exercise too much. Adapt workouts that are less intense, or exercise less often.
If stress is the problem, stress management is important and possibly also talking with a counsellor may be helpful.
Extreme changes in weight can affect periods. Weight gain can make it harder for women to ovulate, so weight loss could help with better cycles. However, extreme, sudden weight loss can also lead to infrequent or irregular periods.
Hormone therapy (HT). An irregular menstrual cycle is often due to a lack of or imbalance in certain hormones in the body. Often, birth control pills (oral contraceptives) containing the hormones estrogen and progesterone are prescribed to help control irregular periods. A hormone medication called progestin can also help trigger periods in women who do not get them.
Surgery. Sometimes, scarring or structural problems in the uterus (womb) or fallopian tubes may lead to irregular periods. Surgery is then recommended to correct any structural problems or birth defects, particularly in persons desirous of conceiving.
HOME REMEDIES
Maintaining a healthful lifestyle can help reduce the risk of some of the causes of irregular periods.
This includes:
* Exercising regularly to maintain a healthy weight and reduce stress
* Following a healthful diet
* Some herbal remedies, such as black cohosh, chaste berry, liquorice root, ginger, cinnamon, apple cider vinegar and turmeric are all said to help, but research has not confirmed their effectiveness, and they may have adverse effects
* Practice yoga
* Maintain a healthy weight
* Regular exercise
* Get your daily dose of vitamins
A study published in 2015 linked low levels of vitamin D to irregular periods and suggested that taking vitamin D may help regulate menstruation.
WHEN TO SEEK MEDICAL ATTENTION
Seek medical advice once having had regular, monthly periods and the pattern changes. Or if any of the following symptoms occur:
* Miss three or more periods a year
* Period more often than every 21 days
* Period less often than every 35 days
* Bleeding more heavily than usual during periods
* Bleed for more than 7 days
* Having more pain than usual during a period
COMPLICATIONS
Irregular periods can sometimes indicate a health problem, and some of these can lead to further problems, such as fertility issues, anxiety, stress, social issues and even affect employment.
When asking how long your period lasts, it is easy for women to want a definitive answer. However, each woman is different and she will have her own normal. Tracking each unique cycle each month will help to detect trends and patterns, picking up any changes as soon as they happen. In the cases of any sudden changes in a cycle that may not be stress-related, especially alongside other new symptoms, seek medical attention as soon as possible. The first step to being healthy is thinking healthily.
