My Periods Are Irregular, How Important Is This Situation? What Could Be The Reason?
Menstrual irregularity is when a woman, who should normally menstruate every 21-35 days, has periods at frequent or long intervals. Occasionally, intermenstrual bleeding may occur, and this situation can also be considered as menstrual irregularity. A normal menstrual cycle occurs every 21-35 days and lasts at least 2 and at most 10 days. Its intensity or daily amount is not standard because some women may change pads frequently. However, we can say that menstruation is heavy in a woman who has to use diapers during her periods.
In a woman with menstrual irregularity, it must be questioned whether there is accompanying pain during menstruation, pain during intercourse, anemia, or medication use.
The first point we emphasize in a woman presenting with a complaint of menstrual irregularity is the age of the woman. If the woman’s age is under 20, hormonal reasons, polycystic ovary syndrome, endometriosis, thyroid gland diseases, and uterine anomalies may be the cause. After examination and ultrasonography are performed in these women, blood tests and sometimes advanced imaging tests such as MRI may be requested.
The type of examination and ultrasonography method are performed either vaginally or abdominally depending on whether she is married. If the woman’s age is between 20-40, the underlying cause may again be hormonal reasons, polycystic ovary syndrome, endometriosis, myoma, adenomyosis, endometrial hyperplasia, endometrial polyp, thyroid gland diseases, and—though not frequently—genital organ cancers. Again, in these women, advanced imaging methods such as blood tests and MRI can be used when deemed necessary after gynecological examination, smear screening test, and ultrasonographic evaluation.
When the woman’s age is over 40, it is necessary to exclude genital organ cancers. It will definitely be appropriate to perform a gynecological examination, ultrasonography, and frequently a biopsy by evaluating the inner cavity of the uterus with a piece taken from the uterus or an endoscopic procedure we call hysteroscopy. Again, in this age group, thyroid gland problems should be ruled out, and it should also be considered that there may be irregular bleeding due to hormonal changes caused by the menopausal transition period.
However, our priority should be to exclude genital organ cancers. Any evaluation of vaginal bleeding after menopause must be aimed at revealing whether it is cancer.
What Are the Treatment Methods for Women with Menstrual Irregularity?
If the cause of menstrual irregularity is hormonal disorder, it is generally possible to treat it with medication. Menstruation becomes regular with drugs to be used in thyroid gland diseases. However, in this case, hormonal follow-up is important, and blood tests should be performed periodically. Again, in polycystic ovary syndrome, which is a hormonal disease, periods may be irregular; in these patients, periods get into a rhythm by using drugs containing metformin, weight loss, exercise, lifestyle changes, and occasionally birth control pills. If the cause of menstrual irregularity is myoma, endometriosis, polyp, or adenomyosis, surgery may be required. In recent years, we have been performing these surgeries endoscopically, namely with laparoscopy and hysteroscopy. In patients where no problem is detected in tests and examinations, the type of irregularity can be tried to be learned by suggesting they keep a period diary.
In summary, menstrual irregularity is a common condition in women. Its causes vary greatly from person to person. First of all, examination, ultrasonography, and blood tests aimed at learning the cause should be performed without neglect, a treatment plan should be determined according to the results, and then it will be appropriate to continue treatment follow-up at appropriate intervals for at least 6-12 months.
