Irregular Menstruation

 In Abnormal Bleeding

Probably the most common problem I see in practice is Irregular Menstruation.  The human menstrual cycle usually lasts 28 days.  Therefore, bleeding should occur once every 28 days.  But every woman, at some point in her life, will have cycles that come too frequently, not frequently enough, or not at all.  A common cause of irregular bleeding in reproductive-age women is pregnancy – something which can easily be tested at home before ever calling the doctor.  But what if that test is negative, or you (how shall I put this tactfully) “have reached a stage of life and a maturity level such that pregnancy is no longer a primary concern”?

There are many other potential causes of bleeding, ranging from an entirely benign hormone imbalance to pre-cancerous or cancerous conditions.  (Fortunately, the former is much more common.)   The evaluation of irregular or absent bleeding will depend very much on your age and medical condition.  And the urgency with which medical care is sought will depend on several factors.  For example, if bleeding amounts are minimal, you are 25 years old, and a home pregnancy test is negative, it is reasonable to wait up to a few months before seeking medical care (to see if the problem resolves itself).  However, a 65-year-old who has been menopausal for 10 years and is now bleeding heavily should be evaluated as soon as possible.  Tests may include ultrasound, blood tests, and/or biopsies, again depending on your age and medical history.

So, what can be done about it?  Like most medical conditions, the treatment depends on the cause.  In early pregnancy, a small amount of bleeding is often managed with simple observation (also known as “tincture of time”), using ultrasounds for reassurance.  Medical conditions causing bleeding, such as thyroid disorders, are usually managed with medications (was that too obvious to mention?).  Pre-cancerous conditions (or cancer) are often treated with surgery.  Many cases of hormone imbalance are treated with (*surprise!*) hormones (such as birth control pills).  For many, bioidentical hormone therapy can be considered for management of bleeding.

I discussed Endometrial Ablation procedures in a previous post – these are great options for women through with child-bearing who have irregular bleeding.  (As an added plus, the permanent birth control methods discussed here can be done at the same time.  Talk about convenience!)

An important point to make is that irregular bleeding is NEVER considered “normal”.  It may very well be “expected” (i.e., it is an extremely common side effect seen in the first few months of taking birth control pills) – but no matter what your age, unless you’ve been told by your physician to expect the amount of bleeding you are having, irregular menstrual cycles always warrant an evaluation.

So, if your cycles aren’t once a month, let your doctor find out why!  Only then can you find out what options are available to you.

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