The Health Implications of Pelvic Discomfort and Irregular Menstrual Cycles
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On average, the menstrual cycle spans approximately 28 days and usually persists for four to seven days. Examples of irregular periods include periods that occur fewer than 21 days or more than 35 days apart, missing three or more periods in a row, and menstrual flow that’s much heavier or lighter than usual.

What Are Irregular Periods?

Most women and individuals assigned female at birth (AFAB) typically experience menstrual periods that last for about four to seven days and occur approximately every 28 days. However, it’s important to note that normal menstrual cycles can vary, with an average cycle length of around 29 days.

Irregular periods, or irregular menstruation, refer to variations from this typical pattern. Various factors can contribute to irregular periods, including hormonal changes, stress, certain medical conditions, and medications.

Examples of Irregular Periods: Irregular menstruation can manifest in several ways:

  1. Cycle Duration: Menstrual cycles shorter than 21 days or longer than 35 days in duration are considered irregular.
  2. Missed Periods: If you miss three or more consecutive periods, this is classed as irregular menstruation.
  3. Flow Abnormalities: Irregularities in the amount of menstrual bleeding can occur, with some periods being much heavier or lighter than what is typical for an individual.
  4. Extended Menstruation: Menstrual cycles that extend beyond seven days can be considered irregular.
  5. Cycle Variability: Significant variations in the length of time between cycles, for example, one cycle being 28 days, the next 37 days, and the following 29 days, are considered irregular.
  6. Severe Symptoms: When severe pain, intense cramping, nausea, or vomiting accompany menstruation, it is also categorised as irregular.
  7. Bleeding Between Periods: Any bleeding or spotting that occurs between periods, after menopause, or following sexual intercourse is considered irregular.
  8. Excessive Bleeding: If you need to change a tampon or sanitary pad every hour due to heavy bleeding, this is another form of irregular menstruation.

Firstly, understand that some degree of variability in menstrual cycles is normal and minor changes in cycle length or flow from one period to the next are not typically cause for concern.

Conditions Related to Irregular Menstruation:

Several medical conditions are associated with irregular menstruation:

  1. Amenorrhea: This condition refers to the absence of periods. If a period is absent for 90 days or more, it’s considered abnormal unless they are pregnant, breastfeeding, or experiencing menopause (usually occurring between the ages of 45 and 55). If menstruation does not commence by the age of 15 or 16 years or within three years of breast development, healthcare professionals may also diagnose it as amenorrhea.
  2. Oligomenorrhea: Oligomenorrhea occurs when periods are infrequent, with cycles exceeding 35 days or an individual having only six to eight periods per year.
  3. Dysmenorrhea: This term describes painful periods and severe menstrual cramps. Some level of discomfort during menstruation is considered normal, but dysmenorrhea indicates more severe pain.
  4. Abnormal Uterine Bleeding: Abnormal uterine bleeding encompasses any bleeding occurring between regular monthly periods, prolonged bleeding, or extremely heavy menstrual flow.

Various factors can cause irregular periods, often associated with underlying health conditions. It’s essential for individuals experiencing significant menstrual irregularities to seek medical evaluation and guidance to determine the underlying cause and appropriate management.

What is the cause of my irregular periods?

The reasons behind irregular periods are diverse, encompassing factors from stress to underlying medical conditions. There are numerous potential causes for irregular menstrual cycles, including benign and more serious issues. Consult with a healthcare professional to accurately identify the cause of your irregular periods. 

Here are some potential medical conditions that can lead to irregular periods:

1. Endometriosis: Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. This condition can cause abnormal bleeding, severe cramps, and pain before and during menstruation.

2. Pelvic Inflammatory Disease (PID): PID is an infection that affects the female reproductive system, often resulting from untreated sexually transmitted infections (STIs). Symptoms include irregular periods, heavy vaginal discharge with an unpleasant odour, and pelvic pain.

3. Polycystic Ovary Syndrome (PCOS): PCOS is characterised by high levels of androgens (male hormones) that disrupt ovulation, leading to irregular periods or even cessation of menstruation.

4. Primary Ovarian Insufficiency (POI): POI occurs in individuals under 40 whose ovaries don’t function properly, resulting in missed or irregular periods. It can be caused by factors such as chemotherapy, radiation, or autoimmune conditions.

5. Thyroid or Pituitary Disorders: Conditions like hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid), and disorders affecting the pituitary gland, can disrupt hormone levels and lead to irregular periods.

6. Bleeding Disorders: Disorders affecting blood clotting or bleeding can lead to heavy menstrual bleeding and irregular periods.

7. Uterine or Ovarian Cancer: Certain cancers can affect menstrual patterns, causing heavier-than-usual bleeding or missed periods.

Private gynaecologists can help determine the underlying cause of your irregular periods and recommend appropriate treatments or interventions based on your condition.

Lifestyle factors and irregular periods

Lifestyle factors can impact on the regularity of your menstrual cycle. These changes or disruptions in your daily routine may include:

  1. Stress: High-stress levels can disrupt your hormonal balance and lead to irregular periods.
  2. Fluctuations in Weight: Significant weight gain or weight loss can affect your menstrual cycle.
  3. Intensive Exercise: Engaging in rigorous exercise routines, such as long-distance running, dancing, or gymnastics, can lower your body fat percentage and impact your menstrual cycle.
  4. Illnesses and Infections: Viral or other illnesses can temporarily disrupt your menstrual cycle.

Other factors include:

  1. Birth Control Pills: Many birth control pills contain a combination of hormones that prevent pregnancy by inhibiting ovulation. Starting or stopping birth control pills can lead to irregular or missed periods for up to six months.
  2. Medications: Certain medications, such as steroids or anticoagulant drugs (blood thinners), can affect your menstrual cycle.
  3. Pregnancy Complications: Miscarriage or an ectopic pregnancy (when the fertilized egg implants outside the uterus) can result in irregular bleeding.
  4. Surgical Interventions: Surgery, scarring, or blockages in your uterus, ovaries, or fallopian tubes can disrupt your menstrual cycle.

How are irregular periods diagnosed?

If you notice changes in your menstrual cycle, it is important to keep a record of when your periods begin and end. Document any associated symptoms, the flow, and whether you experience cramping, bleeding between periods, or passing large clots. This information will be valuable to share with your healthcare provider.

Your healthcare provider will inquire about your menstrual cycle and medical history to diagnose irregular periods. They will conduct a physical examination, which may include a pelvic exam. Additionally, they might recommend specific tests, such as:

  1. Pelvic ultrasound: This imaging test can identify irregular bleeding caused by uterine fibroids, polyps, or ovarian cysts.
  2. Endometrial biopsy: During this procedure, a small tissue sample is taken from the lining of your uterus. It helps diagnose conditions like endometriosis, hormonal imbalances, or precancerous changes.
  3. Hysteroscopy: This procedure enables your healthcare provider to examine the inside of your uterus, helping to diagnose and treat causes of abnormal bleeding.

How are irregular periods treated?

The treatment for irregular periods varies depending on the underlying cause. Here are some treatment options:

Medications are often the initial approach to managing irregular periods. Your healthcare provider may recommend surgical options if medication does not offer relief. 

  1. Hormonal birth control: Hormonal birth control methods can effectively manage irregular or heavy bleeding caused by conditions like PCOS, uterine fibroids, or endometriosis. They also regulate your menstrual cycle, making it more predictable. These options include combined hormonal birth control pills containing oestrogen and progestin, and progestin-only birth control methods. These can be administered as pills, a vaginal ring, injections, or an intrauterine device (IUD).
  2. Tranexamic acid: This medication is prescribed to control heavy menstrual bleeding. You typically take one tablet at the onset of your period to reduce bleeding.
  3. Pain relievers: Over-the-counter pain relievers such as ibuprofen or acetaminophen can offer relief from mild to moderate pain and cramps associated with irregular periods.
  4. Hormone therapy: Hormone therapy may be helpful if irregular periods are linked to perimenopause. It can also help manage other menopausal symptoms like hot flashes and vaginal dryness. However, discuss the associated risks with your healthcare provider.
  5. Antibiotics: In cases where irregular bleeding is due to an infection, doctors often prescribe antibiotics as part of the treatment plan.
  6. Gonadotropin-releasing hormone agonists: These medications reduce the size of uterine fibroids and control heavy bleeding. They temporarily halt your menstrual periods during treatment.

Surgery for irregular periods

Surgical interventions can be considered as treatment options for irregular menstrual periods depending on factors such as your medical condition, age, and future pregnancy plans. 

Surgical treatments for addressing irregular periods encompass the following:

  1. Endometrial Ablation: Endometrial ablation is a medical procedure that employs heat, cold, or various energy sources to eliminate the tissue lining the uterus, thus reducing menstrual bleeding. Note that this procedure requires birth control, and we don’t recommend it if you intend to become pregnant in the future.
  2. Myomectomy: This surgical procedure removes uterine fibroids, which can cause irregular menstrual bleeding.
  3. Uterine Artery Embolization: Uterine artery embolization is a procedure that involves cutting off the blood supply to the uterus to stop uterine fibroids from causing irregular bleeding.
  4. Hysterectomy: In severe cases, surgery might be necessary to remove excess endometrial tissue growing in the pelvis or abdomen. A hysterectomy could be considered a last alternative if your uterus has sustained significant damage.

To reduce the risk of experiencing irregular periods, consider the following self-care recommendations:

  1. Maintain a Healthy Lifestyle: Engage in moderate exercise and consume a nutritious diet. If you aim to lose weight, do so gradually instead of resorting to extreme diets with severe calorie restrictions.
  2. Adequate Rest: Ensure you get sufficient rest and sleep to support your well-being.
  3. Stress Management: Practice stress reduction techniques and relaxation methods to mitigate the impact of stress on your menstrual cycle.
  4. Manage Exercise Intensity: If you have intense or prolonged exercise routines, consider moderating them, as excessive exercise can sometimes contribute to irregular periods.
  5. Contraception: If applicable, use birth control pills or other contraceptive methods as prescribed by your healthcare provider.
  6. Hygiene Practices: Change tampons or sanitary pads every four to six hours to prevent toxic shock syndrome and reduce the risk of infections.
  7. Regular Check-ups: Schedule regular check-ups with your gynaecologist and primary care provider to monitor your reproductive health.

Consult a healthcare provider if you experience any of the following symptoms related to irregular periods:

  • Severe pain (cramping) during menstruation or between periods.
  • Abnormally heavy bleeding, characterised by saturating a sanitary pad or tampon every hour for two to three hours, or passing large clots (larger than a quarter).
  • Foul-smelling vaginal discharge.
  • Menstrual periods last longer than seven days.
  • Vaginal bleeding or spotting between periods or after reaching menopause.
  • Irregular periods deviating from your typical menstrual cycle.
  • Nausea or vomiting during menstruation.
  • Symptoms suggestive of toxic shock syndrome (TSS) include fever, vomiting, diarrhoea, fainting or dizziness.
  • If you suspect you might be pregnant, seek guidance from your healthcare provider.

Mahantesh Karoshi
Mahantesh Karoshi

I'm a Consultant Obstetrician & Gynaecologist and Women's Health Expert. I believe in educating my patients to contribute to achieving the best possible clinical and holistic outcomes. By taking this approach, I enable and empower my patients whilst addressing their issues and concerns. I run a private practice with an extremely high standard of professionalism. My patients are directly involved in their care and management in all stages. My approach to my patient's problems is built on dedication and passion, drawing on analytical thinking and my on-time honored reading, teaching medical professionals nationally and internationally.