Menstrual Irregularity

Menstrual irregularity is defined as bleeding other than normal menstruation. In the normal menstrual cycle (menstrual cycle), regular bleeding occurs for 3-7 days at intervals of 21-35 days. The amount of blood lost is between 30-40ml. This amount is considered normal. Irregular bleeding includes bleeding other than menstrual days, spotting, postmenopausal (post-menopausal) bleeding that occurs after sexual intercourse. Amenorrhea (menstruation) and menorrhagia (excessive bleeding) may also occur during menstrual irregularity. Irregular haemorrhages that are not linked to any organic cause such as a medical illness or pelvic pathology (myoma, cyst, polyp, etc.) are called dysfunctional (hormonal) bleeding.

Menstrual irregularities are common problems. The rate of menstrual irregularities in women of childbearing age is between 9-30%. For regular menstrual cycles, the hypothalamus, pituitary and ovarian axis (the connection between the brain and the ovary) should work properly, and the anatomy of the uterus (uterus) and vagina should be normal.

Causes of Menstrual Irregularity

  1. Endocrine Problems (thyroid, diabetes, polycystic ovary syndrome, prolactin height etc.)
  2. Systemic Diseases blood diseases, liver disease, obesity, drugs used
  3. Gynaecological Problems pregnancy complications, fibroids, uterine or cervical polyps, infections, cancer, trauma, intrauterine device

Causes of Menstrual Irregularity by Age

The age of onset of complaints is very important in patients with menstrual irregularities. Causes of abnormal bleeding before menarche (first menstruation) include infection, malignancy, trauma, and sexual harassment and assault.

Menstrual irregularities in the adolescent period are mostly due to inability to spawn regularly as a result of the immature hypothalamic-pituitary axis. While the rate of menstrual irregularity in the first year after menarche is 85%, the rate in the first 4 years is around 56%. However, whether there are haematological problems in patients who bleed a lot in this age group should be absolutely evaluated.

In women of childbearing age, hormonal, systemic and gynaecological causes should be considered in menstrual irregularity. The possibility of pregnancy should be ruled out in these patients. Hormonal bleeding is the most common cause of bleeding irregularity in this group after pregnancy. As the age progresses, the rate of fibroids, polyp, endometrial hyperplasia (thickening of the tissue inside the uterus) and carcinoma increases. The most common cause is fibroids. Patients with bleeding disorders and hormonal disorders should be excluded in the differential diagnosis. Emotional and physical stress and marked body weight changes can disrupt hormonal balance, causing menstrual irregularity.

All bleeding during the postmenopausal period should be evaluated and investigated abnormally, unless proven otherwise. It should be remembered that infections in this age group can cause bleeding in other gynaecological problems such as benign or malignant tumours and trauma. In addition, it should be remembered that patients who receive hormone replacement therapy due to menopause may have irregular bleeding in the spotting style.

As a result, Women of all ages, from menarche to menopause, should consult absolute gynaecologists in menstrual cycle disorders (menstrual irregularity). After determining the cause, the treatment will be chosen according to the cause and the problem will be resolved in a short time.

Op. Sibel Malkoç, MD

Gynecology and Obstetrics Specialist

Dr. Sibel Malkoç attended many domestic and international training seminars and congresses during 25 years of specialised physician service.

Pregnancy follow-up, urinary incontinence surgery and laser treatments, genital aesthetic surgery and laser applications and vaginismus treatment are of special interest.

It serves its patients especially in surgical and laser-assisted Vagina aesthetics.

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