KAMPALA – Menstrual challenges are the leading causes of worries that every female at any age after puberty and menopause especially those in a productive age (child bearing ages [10 to 45 years]). Menstruation is the regular discharge of blood and mucosal tissue from the inner lining of the uterus through the vagina. The menstrual cycle is characterized by the rise and fall of hormones. Menstruation is triggered by falling progesterone hormone levels and is a sign that pregnancy has not occurred
These challenges affect activities of daily living such as studies, work and many more.
These menstrual challenges range from pre-(Before) menopausal, during menses (the time of menstruation)and post-menopausal (time after menopause, when a woman hasn’t experienced menstruation periods for over a year).
Menstrual disorders include: Dysmenorrhea referring to painful cramps during menstruation. Premenstrual syndrome referring to physical and psychological symptoms occurring prior to menstruation. Menorrhagia is heavy bleeding, including prolonged menstrual periods or excessive bleeding during a normal-length period.
Most women present at clinics with Irregular Periods Menstrual periods typically lasting four to seven days and occurring roughly every 28 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 row; Periods that last longer than seven days; Length of time between cycles varies by more than nine days. For example, one cycle is 28 days, the next is 37 days and the next is 29 days; Periods that are accompanied by severe pain; cramping, nausea or vomiting; Bleeding or spotting that happens between periods, after menopause or after sexual intercourse; Soaking through one or more tampons or sanitary pads in an hour and menstrual flow that’s much heavier or lighter than usual.
It should be noted that a period is still considered “regular” even if it varies slightly from cycle to cycle.
Menstrual cycle may not always be predictable and that may be OK. It’s normal to have slight variations in cycle length or have a menstrual period that seems slightly heavier or lighter in flow than your previous period. Menstrual irregularities are fairly common, and you don’t have to be able to predict your cycle to the exact day for it to be considered “normal.”
Lifestyle factors and irregular periods
Disruptions or changes in a woman’s daily routine can have an impact on your menstrual cycle. Some examples of lifestyle factors include:
- Stress.
- Gaining or losing a significant amount of weight.
- Viruses or other illnesses.
- Exercise routines that result in very low body fat (long-distance runners, dancers or gymnasts).
Medical conditions and irregular periods
Certain health conditions are associated with missed menstrual periods. They include:
- Endometriosis: Endometriosis occurs when endometrial tissue (a layer of the womb) grows outside of your uterus. The tissue often attaches itself to your ovaries or fallopian tubes. Endometriosis may cause abnormal bleeding, cramps or severe pain before and during your period.
- Pelvic inflammatory disease (PID): a bacterial infection that affects the female reproductive system. It’s typically caused by an untreated sexually transmitted infection (STI). Bacteria enter through vagina and spread to your uterus and upper genital tract. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods and pelvic pain.
- In polycystic ovary syndrome (PCOS): your ovaries make large amounts of androgens, which are a type of hormone that prevents or delays ovulation, causing irregular periods. People with PCOS may stop menstruating completely.
- Primary ovarian insufficiency: This condition occurs in women under age of 40 whose ovaries don’t function as they should, causing missed or irregular periods. It can occur during treatment for cancer, especially chemotherapy and radiation or if you have certain autoimmune (when the body cells fight each other unknowingly) conditions.
- Thyroid or pituitary gland disorders: Hypothyroidism (underactive thyroid), goiter/hyperthyroidism (overactive thyroid) and other thyroid or master pituitary gland disorders affect your hormones. This causes your period to be irregular.
- Bleeding disorders: You may experience heavy menstrual bleeding if you develop a bleeding or blood clotting disorder.
- Uterine cancer or ovarian cancer: Certain cancers can affect a person’s menstrual period. Changes may include bleeding that’s heavier than usual or missed periods.
Other causes of abnormal menstruation
Certain treatments like cancer treatments, complications of pregnancy or breastfeeding may also cause a period to be irregular.
Birth control pills: Most birth control pills contain a combination of hormones. The pills prevent pregnancy by keeping your ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. You may have irregular or missed periods for up to six months after discontinuing birth control pills.
Medications, such as steroids or anticoagulant drugs (blood thinners).
Miscarriage or and ectopic pregnancy (the fertilized egg implants outside your uterus). Surgery, scarring or blockages in your uterus, ovaries or fallopian tubes.
How are irregular periods diagnosed?
If you sense changes in your menstrual cycle, begin keeping records of when your periods begin and end. Note symptoms, the amount of flow or if you experience cramping, bleeding between periods or passing large clots. These are all helpful to share with your healthcare provider.
To diagnose irregular periods, your healthcare provider will ask you about your menstrual cycle and medical history. They’ll perform a physical examination, including a pelvic exam. They might also order certain tests, including:
- PAP smear: to check if you could be having cancer of the cervix
- Pelvic ultrasound: An ultrasound can detect irregular bleeding due to uterine fibroids, polyps or an ovarian cyst.
- Endometrial biopsy: Your provider removes a sample of tissue from the lining of your uterus. It can help diagnose endometriosis, hormonal imbalances or precancerous cells.
- Hysteroscopy: A procedure that allows your provider to look inside your uterus in order to diagnose and treat certain causes of abnormal bleeding.
How are irregular periods treated?
The treatment for irregular periods depends on the underlying cause.
It can be with medications such as hormones (hormonal therapy), Antibiotics in case the causes are infection-related, counter Pain killers if pain and cramps, medications shrink the size of uterine fibroids (Gonadotropin-releasing hormone agonists) and control heavy bleeding, but temporarily stop your menstrual period.
Medications are often the first treatment for irregular periods. If medication doesn’t help, your provider may recommend surgery.
When surgery is used:
There are surgical treatment options depending on the condition, age and whether you want to get pregnant in the future. Surgical treatments for irregular periods include:
- Removal of uterine fibroids, a cause of irregular bleeding(Myomectomy).
- Cutting off blood supply to your uterus in order to stop uterine fibroids (uterine artery embolization).
- Using heat, cold or different types of energy to destroy the tissue that lines your uterus so you bleed less during your period. You must have a form of birth control to have this procedure. If you still wish to get pregnant in the future, you shouldn’t have this procedure.
- Removal of excess endometrial tissue growing in your pelvis or abdomen (hysterectomy). A hysterectomy might be required as a last resort if your uterus has been severely damaged.
For all menstrual challenges visit a certified Health provider with a clear record of these irregular events so that the causes are identified for better treatment options.
The Author, Charlotte Angwena is a Registered Comprehensive Nurse, BSN(c) & RN, ICU at International Hospital Kampala (IHK).
