Menstrual Irregularities: Management and Treatment Options

The menstrual cycle—a natural process that occurs in the female reproductive system—typically lasting about 28 days. However, it is still normal for a cycle to range in length from 24 days to about 35 days.

Menstrual irregularities are not unusual experiences among women. A study in Malaysia discovered that abnormal cycle length (longer than 35 days, between 14 and 20 days, or irregular pattern) affected 37.2% of adolescent girls, where the majority (74.6%) had premenstrual syndrome, and 69.4% had dysmenorrhea.

Menstrual irregularities can be concerning, but there are effective management and treatment options available.

What Are the Classifications for Menstrual Irregularities?

The terminology for describing menstrual abnormalities has evolved over time. Previously, the terms menorrhagia, metrorrhagia, polymenorrhea, hypermenorrhea, oligomenorrhea, and dysfunctional uterine bleeding were used.

However, newer terms have been adopted to provide a more standardised and precise classification of menstrual irregularities.

Abnormalities in frequency

Abnormalities in frequency are defined as:

Frequent: Bleeding period at intervals <24 days
Infrequent: Bleeding period at intervals >38 days
Absent: Primary amenorrhea (absence of menarche by age 15) or secondary amenorrhea (absence of spontaneous menstrual bleeding for 6 months in a patient who previously had menstrual bleeding).

Irregular bleeding

Depending on the patient’s age, irregular bleeding is defined as:

Cycle length variance >9 days for ages 18 to 25
Cycle length variance >7 days for ages 26 to 41
Cycle length variance >9 days for ages 42 to 45

Prolonged menstrual bleeding

Menstrual bleeding that consistently lasts longer than 8 days.

What Are the Causes of Menstrual Irregularities?

Menstrual irregularities are common and can be caused by a variety of factors, including:

During puberty, the period may be irregular for the first 2 years.
The beginning of menopause (between the ages of 45 and 55).
Hormonal imbalances.
Underlying health conditions such as polycystic ovary syndrome (PCOS), endometriosis, thyroid disorders, and uterine fibroids.
Certain medications like steroids and anticoagulant medicines (blood thinners) can influence menstruation and make them irregular, longer, and occasionally heavier. Usually, this occurs with prolonged usage of these drugs.
Lifestyle factors like stress, extreme exercise, significant weight loss.

Medical conditions that cause menstrual irregularities

Several medical conditions causing irregular menstruation include:

Polycystic ovary syndrome (PCOS): PCOS is a hormonal issue that affects women during their reproductive years. It is a condition that can lead to infrequent or lengthy periods. The ovaries produce high concentrations of androgens, male sex hormones that are typically present at modest levels.

Endometriosis: Endometriosis occurs when endometrial tissue grows outside the uterus. This condition causes period pain that stops you from carrying out daily activities, pain during or after sex, pelvic pain and may make it difficult to conceive.

Hypothyroidism and hyperthyroidism: Hypothyroidism happens when the thyroid gland does not produce enough hormones. Hyperthyroidism occurs when the thyroid gland overproduces thyroid hormones.

Uterine or ovarian cancer: Sometimes, menstrual irregularities can signify a more serious underlying condition, such as cervical or uterine cancer. Uterine cancer occurs when abnormal cells form and expand uncontrollably in the uterus. Ovarian cancer is the uncontrolled proliferation of cells in the ovaries.

Lifestyle factors that cause menstrual irregularities

Stress: The menstrual cycle is significantly impacted by cortisol, a stress hormone. Cortisol can cause irregular, mild, or absent periods depending on how the body handles stress.
Extreme exercise: Extreme exercise can cause hormonal changes that lead to shedding of the uterus’ endometrium. This results in dark or bright red blood that is lighter in flow than regular periods. Missing periods due to extreme exercise is called exercise-induced amenorrhea.
Significant weight loss: Hypothalamic amenorrhea occurs when the hypothalamus decreases or halts the release of gonadotropin-releasing hormone (GnRH), a hormone crucial for regulating the menstrual cycle. This condition is often linked to factors such as low body weight (typically defined as being 10% below the ideal weight), a low body fat percentage, eating disorders like anorexia nervosa or bulimia nervosa, emotional stress, intense physical exercise, and certain medical conditions or illnesses.

How Are Menstrual Irregularities Diagnosed?

Your healthcare practitioner will enquire about your medical history and conduct a physical examination to diagnose menstrual irregularities. Some tests may also be needed, such as:

Pregnancy test for women whose menstrual periods have stopped.
Blood tests to measure hormone levels, such as oestrogen, progesterone, follicle-stimulating hormone (FSH), luteinising hormone (LH), thyroid hormones, and prolactin.
Hysteroscopy enables the doctor to examine the uterus using a tiny camera to identify and address specific sources of irregular bleeding.
Endometrial biopsy to obtain a tissue sample from the lining of the uterus for further examination.
An MRI (magnetic resonance imaging) scan, particularly when there is a suspicion of hypothalamic or pituitary gland abnormalities in the brain.

What Are the Treatments for Menstrual Irregularities?

The treatment options will depend on the underlying cause. They include:

Lifestyle changes
The following are some lifestyle tips that may help regulate your periods:
- Engage in moderate exercise and a balanced diet. Instead of using restrictive diets that significantly reduce food and calorie consumption, try losing weight gradually.
- A good night’s sleep is essential.
- Practice relaxation and stress-reduction methods.
- Reduce the number of extended or strenuous workouts.
- Follow the directions on any contraceptive tablets or devices.
- Change tampons or sanitary napkins every 4 to 6 hours to prevent toxic shock syndrome and infections.
- Consult a gynaecologist and primary care physician for regular examinations.
Hormonal therapy
This could include birth control pills, intrauterine device (IUD), hormonal patches, vaginal rings, or progesterone therapy. These medications can help regulate menstrual bleeding, reduce pain, and restore hormonal balance.
Medications
Depending on the underlying cause of menstrual irregularities, medications may be prescribed to address specific conditions or symptoms. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate menstrual pain, while medications such as metformin may be used to manage insulin resistance in PCOS.
Surgical Interventions
In some cases, surgical interventions may be necessary to treat underlying structural issues that are causing menstrual irregularities. For example, surgical removal of uterine fibroids or treatment of endometriosis lesions may be recommended.

When Should Irregular Periods Be a Concern?

It is recommended to consult your doctor as soon as you notice a cause of concern with your periods, such as:

Prolonged severe cramping before, during, or after a period.
Unusual heavy bleeding or passing huge clots.
Foul-smelling vaginal discharge.
A period lasting longer than 7 days consistently.
Vaginal bleeding or spotting before or after menopause.
Periods start to become irregular after having regular menstrual cycles.

Make an Appointment at Pantai Hospitals

Menstrual irregularities can occur due to a variety of reasons. It is important to pay attention to any sudden changes in your menstrual cycle that may cause discomfort during your period.

If you notice any changes or symptoms, discuss them with your doctor. They can help determine the underlying cause and provide appropriate treatment if necessary.

Get in touch with us to book an appointment with our team of gynaecologists today, or find out more about our Obstetrics and Gynaecology Services at your nearest Pantai Hospital.

Pantai Hospitals have been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.