The menstrual cycle is the series of changes a woman's body goes through every month in preparation for an anticipated pregnancy. Cyclically, there is a release of of an egg by either ovary, — a process called ovulation. Simultaneously, the uterus gets prepared to accept a pregnancy, by way of hormonal changes.  If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is called a menstrual period.

What is normal menstrual cycle?

Every woman’s body is different, and therefore cycles and their lengths too might differ. In fact even in the same woman, there may be variations in the cycle length, due to various reasons such as hormonal influences, stress, etc. It may happen like clockwork in some , whereas in others there may be hit or miss or be unpredictable. On an average, a woman gets her period every 24 to 38 days. A period usually lasts about 2 to 8 days. For the first few years after menstruation begins, cycles may be long, but menstrual cycles tend to shorten and become more regular as you age.

Signs of Abnormal Periods

• Periods that occur less than 21 days or more than 35 days apart
• Missing three or more periods in a row
• Menstrual flow that is much heavier or lighter than usual
• Periods that last longer than seven days
• Periods that are accompanied by pain, cramping, nausea or vomiting
• Bleeding or spotting that happens between periods, after menopause or following sex

What are menstrual irregularities?

For most women, a normal menstrual cycle ranges from 21 to 35 days. However it has been seen that around 14% to 25% of women may have irregular menstrual cycles.

Ovulation may or may not occur (anovulatory) during the Irregular cycles

The most common menstrual irregularities include:

• Amenorrhea or absent menstrual periods: When a woman does not get her period by age 16, or when she stops getting her period for at least 3 months and is not pregnant.
• Oligomenorrhea or infrequent menstrual periods: Periods that occur more than 35 days apart.

• Menorrhagia or heavy menstrual periods: Also called excessive bleeding. Although anovulatory bleeding and menorrhagia are sometimes grouped together, they do not have the same cause and require different diagnostic testing.
• Prolonged menstrual bleeding: Bleeding that exceeds 8 days in duration on a regular basis.
• Dysmenorrhea: Painful periods that may include severe menstrual cramps.

Additional  irregularities in periods include:

• Polymenorrhea (pronounced pol-ee-men-uh-REE-uh): Frequent menstrual periods occurring less than 21 days apart
• Irregular menstrual periods with a cycle-to-cycle variation of more than 20 days
• Shortened menstrual bleeding of less than 2 days in duration
• Intermenstrual bleeding: Episodes of bleeding that occur between periods, also known as spotting

How to keep a Menstrual Record?

It is important to note down start of your menses, as Day 1 on a calendar, on a continuous basis, as well as the length or duration of bleeding in each cycle. This will be very useful to ascertain if you have irregular menstruation. The points to note will be:

• Start date,
• End date,
• Details such as very light, moderate, very heavy with clots,
• Of pads changed in a day,
• Degree of pain,
• If any pain killers were needed,
• If there was absence from work, etc.
• Also, u need to keep track of any intermittent bleeding at any time during the cycle, as well as any other behavioural or mood changes, breast pain, etc.

This record will be very useful to the doctor in case of any consultation for irregular periods.

What are the causes of irregular periods?

The causes for menstrual irregularities may be manifold. The most common ones are   

• Pregnancy – a missed period could be due to pregnancy. If you have had unprotected sexual intercourse after your previous period, it might be a good idea to go for a pregnancy test.
• Stress and lifestyle factors. Gaining or losing a significant amount of weight, dieting, changes in exercise routines, travel, illness, or other disruptions in a woman's daily routine can have an impact on her menstrual cycle.
• Birth control pills. Most birth control pills contain a combination of the hormones estrogen and progestin (some contain progestin alone). The pills prevent pregnancy by keeping the ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. Some women have irregular or missed periods for up to six months after discontinuing birth control pills. This is an important consideration when you are planning on conception and becoming pregnant. Women who take birth control pills that contain progestin only may have bleeding between periods.
• PCOS – Patients having polycystic ovary syndrome frequently face menstrual irregularities and delayed cycles. In PCOS, the ovaries produce large amounts of androgens or male hormones. Hormonal fluctuations also prevent the ovulation resulting in formation of cysts inside the ovaries.

• Anovulation- Mostly PCOS patients have anovulatory cycles , meaning ovulation doesn’t occur, and this may cause irregular bleeding. In normal physiology, ovulation is dependent on the presence of a functioning hypothalamic-pituitary-ovarian (HPO) axis and a chain of events unfolds, which is very sensitive to any fluctuations or physiological disturbances. This leads to an alteration of the hormonal milieu, causing anovulatory cycles.)

• Hormonal - primarily due to thyroid and prolactin hormone irregularities
• Lactation - In lactation women there can be delayed return of periods, called Lactational amenorrhoea. This is a temprorary condition induced by high amounts of the lactating hormone – prolactin. Once the women stops breast feeding, the menstrual cycles restarts.
• Perimenopausal – Menopause is a condition where the menstrual cycles stop completely. Women have a pool of eggs which keeps reducing every cycle. Gradually as they age this pool diminished until there is no egg left. This marks the onset of menopause. Periods tends to get irregular, or more or less frequent in the years leading to menopause.
• Uterine polyps or fibroids. Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumors that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumors are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.
• Endometriosis. The endometrial tissue that lines the uterus breaks down every month and is discharged with the menstrual flow. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs in the lower digestive tract and in the area between your rectum and uterus. Endometriosis may cause abnormal bleeding, cramps or pain before and during periods, and painful intercourse.
• Pelvic inflammatory disease.Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. Bacteria may enter the vagina via sexual contact and then spread to the uterus and upper genital tract. Bacteria might also enter the reproductive tract via gynaecologic procedures or through childbirth, miscarriage, or abortion. PID will have the following Symptoms : heavy vaginal discharge with an unpleasant odour, irregular periods, pain in the pelvic and lower abdominal areas, fever, nausea, vomiting, or diarrhea.
• Premature ovarian insufficiency. This condition occurs in women under age 40 who have depleted ovarian reserve and their ovaries stop normal function. The menstrual cycle stops and the women experience premature menopause. This can occur in patients who are being treated for cancer with chemotherapy and radiation, or if you have a family history of premature ovarian insufficiency or certain chromosomal abnormalities. If this condition occurs, see your physician.

How can you prevent Menstrual Irregularities?

A visit to your gynaecologist is mandatory whenever you notice irregularities in your menstrual cycle spanning over more than three months.

Treatment of the underlying disorder is very important. Careful investigation by way of blood tests, ultrasound and some other tests can help to arrive at a proper diagnosis and the Consultant can make a decision.

A change in lifestyle, modification of diet and stress reduction also plays a very vital role in correction of these disorders.

Being alert, aware and informed will help in early detection and correction of any underlying disorders.

For some women, use of birth control pills can help regulate menstrual cycles. Treatment for any underlying problems, such as an eating disorder, also might help. However, some menstrual irregularities can't be prevented.

In addition, consult your health care provider if:

• Your periods suddenly stop for more than 90 days — and you're not pregnant
• Your periods become erratic after having been regular
• You bleed for more than seven days
• You bleed more heavily than usual or soak through more than one pad or tampon every hour or two
• Your periods are less than 21 days or more than 35 days apart
• You bleed between periods
• You develop severe pain during your period
• You suddenly get a fever and feel sick after using tampons

If you have questions or concerns about your menstrual cycle, talk to me. I consult  at Care IVF and am also available on teleconsultation as well.

Ref: https://www.nichd.nih.gov/health/topics/menstruation/conditioninfo/irregularities#f4

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