Why Does Menstrual Irregularity Occur, and How Is It Treated?

What is Menstrual Irregularity?

The female reproductive system is primarily regulated by hormones secreted by the ovaries. Approximately every 28 days, under the influence of these hormones, the endometrial layer lining the inner surface of the uterus thickens and becomes rich in blood vessels in preparation for a potential pregnancy. If pregnancy does not occur, it is shed at the end of that period to prepare for the next cycle.

Because the endometrium is a richly vascularized tissue, shedding it for renewal causes some bleeding. This bleeding is referred to as menstruation or menstrual bleeding.

The menstrual cycle is calculated from the first day of bleeding to the beginning of the next menstrual bleeding. Normally, each woman experiences a menstrual cycle lasting between 21 and 35 days. If there are irregularities in this pattern, such as intermenstrual bleeding or excessive bleeding, this condition is considered menstrual irregularity.

Causes of Menstrual Irregularity

Menstrual irregularity can develop due to various reasons. The primary cause of intermenstrual bleeding may be a drop in hormones during ovulation. As a result of this drop, the endometrial tissue lining the uterus loses hormonal support and can lead to spotting-like bleeding. If patients begin to feel uncomfortable with this intermenstrual bleeding, it is recommended to see a doctor as soon as possible.

If menstrual irregularity is due to hormonal reasons, and if a person’s menstrual bleeding is severe and painful, they should seek medical help regarding this condition.

Some conditions that can cause menstrual irregularity and irregular bleeding include:

  • Adenomyosis (thickening of the endometrial tissue)
  • Lack of ovulation or ovulation-related issues
  • Fibroids, polyps, or cysts
  • Use of hormonal medications
  • Estrogen-related or other hormonal disorders
  • Infectious conditions
  • Malignant masses in the uterus and ovaries

Symptoms of Menstrual Irregularity

It is generally accepted that menstrual bleeding lasts between 2 to 7 days. Additionally, the interval between the beginning of one period and the beginning of the next is expected to be between 21 to 35 days.

Menstrual cycles that fall outside of these ranges are considered menstrual irregularities. However, irregularities in menstrual cycles can also be normal during adolescence when menstruation begins and during the perimenopausal period when hormonal adjustments occur.

Once these conditions are assessed, any irregularities deemed abnormal can be treated and regulated.

The Main Symptoms of Menstrual Irregularity

  • Having menstrual cycles (the time between the beginning of one period and the beginning of the next) shorter than 21 days or longer than 35 days
  • Menstruation lasting less than 2 days or more than 7 days
  • Heavy bleeding
  • Pain, cramps, or vomiting
  • Persistent fatigue
  • Dizziness
  • Anemia
  • Providing some symptoms such as frequent menstruation or not having menstruation for a long time.

Diagnosis Methods for Menstrual Irregularity

When you consult your doctor with complaints of menstrual irregularity, your doctor will first inquire about your medical history, and then perform a gynecological examination. During the gynecological examination, ultrasonographic examinations may be performed to obtain images of the uterus, ovaries, and surrounding structures.

Following the examination, to clarify the diagnosis, some blood tests such as estrogen, FSH, LH, AMH may be requested. In addition, imaging techniques such as MRI may be used. If menstrual irregularity is thought to be due to a mass or thickening of the endometrial tissue, samples may be taken for examination.

Treatment of Menstrual Irregularity

Menstrual irregularity is not a disease in itself; it usually emerges as a significant symptom of other conditions. Therefore, the treatment of menstrual irregularities primarily involves addressing or regulating the medical condition causing it.

If menstrual irregularity is determined to be due to hormonal imbalance, the treatment involves prescribing hormone-regulating medications to the individual.

If there is an underlying organic condition such as a polyp, the uterine cavity is examined with a tool called hysteroscopy, and if necessary, pathological areas are removed.

Among other causes of bleeding are fibroids. Fibroids are benign tumors located within the uterus and they often do not cause any symptoms. However, in some patients, they can cause bleeding by exerting pressure on the inner lining of the uterus.

Fibroids causing severe bleeding are treated according to the patient’s age and whether they have children, either by removing the fibroids alone or, rarely, by removing the entire uterus.

In adolescents with excessive bleeding, all conditions that could cause this bleeding, including coagulation disorders, are investigated. Then, the bleeding is brought under control, and menstrual regularizing treatments are administered to ensure the patient’s periods become regular. The onset of menstruation at very early or late ages during adolescence should be investigated and treated accordingly.

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