Menstrual irregularity, which many women may regard as normal or ignore, can be a sign of very serious diseases. Having regular periods, on the other hand, is an indicator that many systems in a woman’s body are working correctly. For this reason menstrual irregularity, which may be seen as a simple complaint, can be a problem that needs to be taken into account.
WHAT ARE ITS SIGNS AND MOST COMMON CAUSES?
Although it is considered normal for periods to be irregular in the first years, if this situation still continues after a few years it certainly requires follow-up. When defining menstrual irregularity, women generally think of the interval between two periods being longer than expected, but an interval shorter than 21 days also points to irregularity. In short, menstrual cycle intervals shorter than 21 days and longer than 35 days are accepted as a sign of irregularity. In addition, the amount of menstrual bleeding and bleeding lasting less than 2 days or more than 10 days should also be taken as a sign of irregularity.
So what can menstrual irregularity be due to? The most common causes are stress, hormonal imbalances, the use of medication, sudden excessive weight loss or weight gain, doing too much exercise and a very low body mass index (weight lagging behind height). In addition, thyroid disease (goitre), liver diseases, diabetes, and depression due to medication or clinical depression can also cause menstrual irregularity. Irregularity, which can at the same time be a sign of gynaecological cancers such as cancer of the uterus and the cervix, can also be caused by polycystic ovary syndrome (PCOS), which is very common (it is seen in 1 in every 10 women!), and by endometriosis (the chocolate cyst).
HOW ARE DIAGNOSIS AND TREATMENT CARRIED OUT?
First of all, women who complain of irregular menstrual bleeding must certainly be assessed by a gynaecology specialist. During the examination, the factors that could cause the bleeding are reviewed one by one and the vagina, the cervix, the uterus and the ovaries are assessed.
With ultrasound it is investigated whether there is a tumour of the uterus or the ovaries. With the same method the thickness of the inner lining of the uterus and whether it is regular are measured. Polyps or fibroids forming in the inner lining of the uterus can also cause abnormal bleeding and pain. If the patient with abnormal vaginal bleeding is over the age of 40 and no obvious cause of the bleeding has been found, a biopsy of the inner lining of the uterus needs to be taken. In this way the structure of the inner lining of the uterus is assessed pathologically and cancer of the uterus is investigated.
If the cause of the bleeding originates from the reproductive organs, in other words if it is not a hormonal imbalance, treatment is directed at the cause. For example, if the bleeding is due to a fibroid, the fibroids are removed by surgery. If it is due to abnormal hormone release from the thyroid gland (goitre), the adrenal gland or the pituitary gland, the menstrual irregularity is corrected only by resolving these situations.
One of the important situations that should come to mind is premature ovarian insufficiency (what our people call early menopause). If, along with menstrual irregularity, there are hot flushes, distress, sweating, inability to sleep and irritability, premature loss of ovarian function should come to mind even if the woman is very young.
If as a result of all these investigations no disease that could cause the bleeding is found, the menstrual irregularity is due to a hormonal imbalance. In this situation an attempt is made to regulate the bleeding with medicines that regulate the cycle. In this treatment, pills containing progesterone or contraceptive pills are mostly used. If the cause is weight, the weight is brought back to normal.