IRREGULAR PERIODS

This article by Dr Neha Gupta is intended to detail some reasons, diagnosis and management of irregular periods. Dr Neha Gupta is a leading gynecologist and Obstetrician in NOIDA. She works as a senior consultant in Fortis hospital NOIDA. She also has her clinic at The Gyne clinic, Sector 29, NOIDA.

To understand what are irregular periods one needs to know about normal periods. Periods are normal monthly shedding of tissue along with blood from the inner lining of uterus. Uterus is the organ in women which carries the pregnancy. Periods usually start around 11years to 16years of age. First period occurring in an adolescent girl is called as Menarche. Periods are a sign of good health. They provide the female with ability to reproduce. First day of bleeding of periods is considered as first day of cycle. Every month one egg is released from the ovary around mid- cycle (14^th day in a 28day cycle) and picked up by the fallopian tube of that side. The egg waits for male partner’s sperm to come and fertilize it. If this doesn’t happen then the egg is shed along with the inner lining (which is prepared to attach the fertilized egg for implantation) by the end of cycle. These changes in the menstrual cycle are controlled by the hormones released from hypothalamus, pituitary and ovaries.

Normal periods are defined by few characteristics depending on frequency, Duration, Regularity and flow.

Normal Periods- Frequency 28 days- duration <8 days- Regularity shortest to longest cycle variation <7-9 days- Flow Menstrual blood loss 35 ml

Common causes of Irregular Periods

• Hormonal imbalance
  • Thyroid disorders
  • Soon after periods start first time at puberty( up till 2yrs)
  • Approaching menopause ( permanent natural cessation of periods )
  • PCOS or Polycystic ovarian syndrome
• Polyps- soft tissue fleshy growth arising from inside of uterine cavity (endometrium)
• Cancers of genital tract – vulva, vagina, cervix, uterus, ovaries
• Pregnancy complications- miscarriage, ectopic etc.
• Breast feeding
• Stress
• Extreme weight change
• Over exercising
• Irregular hormonal pill intake/ contraceptives
• Certain medications like some anti-depressants etc.

History & examination

• A. Detailed history taking and physical examination should be done.
•  a. Medical history should include: Age of the patient, patterns of abnormal uterine bleeding, severity, associated pain, family history and use of medication.
• b. General and physical examination: Pallor, edema, neck glands, thyroid, and systemic examination, and pelvic examination (per speculum, Pap smear, and bimanual examination) are included.

Investigations

Laboratory investigations:

• Complete hemogram
  •  Thyroid function test
  • Coagulation profile
  • Urine pregnancy test

• Imaging studies:
  • Ultrasonography (Transvaginal),
  •  Saline infusion sonography (SIS)
  • Magnetic resonance imaging (MRI): adenomyosis
• Histological confirmation of pathology by
  • Endometrial Biopsy or
  • Diagnostic Hysteroscopy

Management

• Depend on pathology
• Women with AUB with >45 years endometrial biopsy (D?C or hysteroscopy directed biopsy)
• Adoloscent girls need exclusion of bleeding disorders
•  
•  
• Menstrual calendar x 3 cycles
• Weight loss
• Exercise
• Diet
• Sleep
• De stress
• Correction of anemia
• Pain killers
• Medicine sto control bleeding – Tranexamic acid
• Cycle control= COC
• Progesterone therapy- oral, IUS
• Some-times surgery is needed – esp. for structural causes like Polyp, Adenomyosis, Leiomyoma(fibroid) and Malignancy
  • CONSERVATIVE SURGERY
  • HYSTERECTOMY
    • ABDOMINAL/VAGINAL/LAPAROSCOPIC