Irregular/Abnormal Periods

Most women have menstrual periods that last four to seven days. A woman's period usually occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days.

Examples of menstrual problems include:

Periods that occur less than 21 days or more than 35 days apart or missing three or more periods in a row
Menstrual flow that is much heavier or lighter than usual or periods that last longer than seven days
Periods that are accompanied by pain, cramping, nausea, or vomiting
Bleeding or spotting that happens between periods, after menopause, or following sex

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Examples of abnormal menstruation include the following

Amenorrhea is a condition in which a woman's periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven't started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.

Oligomenorrhea refers to periods that occur infrequently.
Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.
Abnormal uterine bleeding may apply to a variety of menstrual irregularities, including: a heavier menstrual flow; a period that lasts longer than seven days; or bleeding or spotting between periods, after sex, or after menopause.

What causes abnormal menstruation?

A comprehensive series of blood tests will be offered at around 12-15 weeks. We arrange a detailed ultrasound nuchal translucency scan at 12-13 weeks, combined with blood tests, which make the screening more accurate and also (anomaly scan) at around 20 weeks when the growth of the baby is usually such that a careful examination of the development of all the crucial organs can be made.

There are many causes of abnormal periods, ranging from stress to more serious underlying medical conditions:

Stress and lifestyle factors

Birth control pills

Uterine polyps or fibroids

Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumours that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumours are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.

Contraceptives

Thyroid disorder

Pelvic inflammatory disease

Polycystic ovary syndrome

In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. These can often been seen on ultrasound. The hormonal changes can prevent eggs from maturing, and so ovulation may not take place consistently. This leads to abnormal levels of hormones causing the irregular thickening of the lining of womb, which leads to irregular periods.

Premature ovarian insufficiency

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Other causes of abnormal menstruation include:

Uterine cancer or cervical cancer
Medications, such as steroids or anticoagulant drugs (blood thinners)
Medical conditions, such as bleeding disorders, an under- or overactive thyroid gland, or pituitary disorders that affect hormonal balance

How is abnormal menstruation diagnosed?

If any aspect of your menstrual cycle has changed, you should keep an accurate record of when your period begins and ends, including the amount of flow and whether you pass large blood clots. Keep track of any other symptoms, such as bleeding between periods and menstrual cramps or pain.

I prefer the following investigations

A plan for the birth/delivery will be discussed in more detail. We will talk about the signs to watch out associated with spontaneous labour in addition to the pros and cons of induction of labour and Caesarean Section if required. Once in labour, Mr Raza aim to provide continuity wherever possible.

The pregnancy-related changes do not end with delivery hence the care for all the delivered mothers. Mr Raza will provide full postnatal care until 6 weeks after delivery. This helps with deal with issues as mastitis, irregular bleeding and pelvic pain.

At Chelsea Well Women we offer several types of packages.

Early pregnancy, which is from the positive pregnancy test to week 12.
A full pregnancy care package, which includes care starting from 12 weeks all the way to delivery and postnatal care.
Cesarean section package.

How is abnormal menstruation treated?

The treatment of abnormal menstruation depends on the underlying cause. I carry out all the investigations and then will look into the best possibilities to treat the problem.

Following are the few treatment options which I may consider.

Regulation of the menstrual cycle

Pain control

Uterine fibroids

These can be treated medically and/or surgically. Initially, most fibroids that are causing mild symptoms can be treated with over-the-counter pain relievers. If fibroids do not respond to medication, there are a variety of surgical options that can remove them or lessen their size and symptoms. The type of procedure will depend on the size, type, and location of the fibroids. A myomectomy is the simple removal of a fibroid. In severe cases where the fibroids are large or cause heavy bleeding or pain, a hysterectomy might be necessary. During a hysterectomy, the fibroids are removed along with the uterus. Other options include uterine artery embolization, which cuts off the blood supply to the active fibroid tissue.

Endometriosis

Although there is no cure for endometriosis, over-the-counter or prescription pain relievers may help to lessen the discomfort. Hormone treatments such as birth control pills may help prevent overgrowth of uterine tissue and reduce the amount of blood loss during periods. In more severe cases, a gonadotropin-releasing hormone agonist or progestin may be used to temporarily stop menstrual periods. In severe cases, surgery may be necessary to remove excess endometrial tissue growing in the pelvis or abdomen. A hysterectomy might be required as a last resort if the uterus has been severely damaged.

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How can the risk of abnormal menstruation be reduced?

Here are some recommendations for self-care:

Try to maintain a healthy lifestyle by exercising moderately and eating low-fat foods. If you have to lose weight, do so gradually instead of turning to diets that drastically limit your calorie and food intake.
Make sure you get enough rest.
Practice stress reduction and relaxation techniques.
If you are an athlete, cut back on prolonged or intense exercise routines. Excessive sports activities can cause irregular periods.
Use birth control pills or other contraceptive methods as directed.
Change your tampons or sanitary napkins approximately every 4 to 6 hours to avoid toxic shock syndrome and prevent infections.

Irregular/Abnormal Periods

Examples of abnormal menstruation include the following

What causes abnormal menstruation?

Other causes of abnormal menstruation include:

How is abnormal menstruation diagnosed?

I prefer the following investigations

How is abnormal menstruation treated?

How can the risk of abnormal menstruation be reduced?

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