Irregular Periods

Numerous factors can contribute to Irregular periods, also known as oligomenorrhea. In most cases, it can result from an imbalance in hormonal levels. The three primary hormones that control the menstrual cycle are oestrogen, progesterone, and follicle-stimulating hormone. The rise and fall of these hormones throughout each cycle can lead to irregular periods.

Usually, when a menstrual cycle extends the normal range of 21-35 days, it is considered irregular.

A normal menstrual cycle ranges from 21 to 35 days. Irregular periods are when someone gets their periods before or after this set of range.

Symptoms of irregular periods are:-

1. Menstrual flow is heavier or lighter than usual.
2. Periods last longer than seven days.
3. Bleeding or spotting happens in between periods

Females may experience irregular, missed, or late periods for various reasons, from stress to more serious medical concerns. Some causes of irregular periods may include:

1. Hormonal imbalance: Changes in the hormone level can cause irregular menstrual cycles. Any alteration in the level of these hormones can cause irregular periods. The three main hormones that are responsible for the regulation of the menstrual cycle are:-
   1. Oestrogen 
   2. Progesterone
   3. Follicle-stimulating hormone(FSH)
2. Puberty: During puberty, the body goes through several changes that can contribute to the irregularity of the periods.
3. Stress and anxiety: Extreme mental stress can cause irregular periods.
4. Pregnancy and breastfeeding: Missing your periods might signify pregnancy. During breastfeeding, ovulation is suppressed, and hence it causes irregular periods.
5. Extreme weight loss and weight gain: Major changes in the body can disrupt the usual cycle.
6. Start of menopause: Menopause usually occurs between the age of 45-55. During this, a woman has irregular or no period at all.
7. Starting or stopping birth control: hormonal birth controls disrupt the expected level of the hormones, leading to irregular periods.

Underlying health issues:

Sometimes Irregular periods may indicate an underlying disease which may include any of the following:-

1. Polycystic ovary syndrome (PCOS): It is a condition where small fluid-filled cysts develop in the ovaries. It causes an increase in the level of testosterone hormone that, in turn, delays the period.
2. Eating disorders: Eating disorders like anorexia nervosa, bulimia nervosa, and binge eating may cause irregular or absent periods. When the body does not get enough nutrition, the cycle is disturbed and hence causes irregularity.
3. Endometriosis: In this condition, cells that usually grow inside the uterus start to grow outside. These cells are responsible for making the uterine line, and when they grow somewhere else, it results in heavy periods.
4. Thyroid disease: The thyroid is responsible for producing hormones that affect our body's essential functions. 

The irregular periods can be avoided by following a few simple steps. They are as follows:-

1. Maintaining a healthy lifestyle: Eating nutritious food and exercising regularly. When the body is healthy, it functions normally, resulting in regular periods.
2. Getting enough rest: Not taking at least seven hours of sleep every day and sleeping for less than 6 hours can alter your body functions and can lead to irregular periods.
3. Avoid taking stress: Stress and anxiety can also cause irregular periods. Practising some stress-relieving activities like meditation can help maintain a regular menstrual cycle.
4. Avoid intense workouts: For athletic women, avoiding intense and prolonged workouts can prevent irregular periods. 
5. Using contraceptive pills carefully: It is recommended to take pills as directed and under the doctor's supervision. 

If any unusual changes are noticed in a female's menstrual cycle, consultation with a doctor may help with the proper diagnosis. The doctors will perform some of the following diagnostic tests to gauge the reason for irregular periods:-

1. Blood test to check anaemia.
2. Vaginal cultures for possible infections.
3. Pelvic ultrasound exam to check the uterine fibroids, polyps, or an ovarian cyst
4. Endometrial biopsy for the diagnosis of endometriosis, hormonal imbalance, or cancer-causing cells.  
5. Endometriosis and other conditions are diagnosed by a procedure called laparoscopy.
6. Diagnostic Hysteroscopy: A hysteroscopy can be used to help diagnosis cases where a woman’s symptoms suggest that there may be a problem with heavy or irregular periods.

The treatment of abnormal menstruation depends on the underlying cause. The treatment options for irregular periods may include the following:

Treatment for Irregular periods without surgery

1. Regulation of the cycle: Oestrogen and progesterone are prescribed to control heavy bleeding. These hormones can also help in regulating the menstrual cycle.
2. Pain control: Period cramps can be relieved by medications, such as ibuprofen or acetaminophen. The heating pad can also be a great choice.
3. Uterine fibroids: These conditions are either treated medically or surgically. Progestin injections and low doses of birth control can relieve heavy bleeding. The drugs reduce the production of oestrogen and this, in turn, stops menstruation for a while.

Treatment for Irregular periods with surgery

1. Uterine fibroids: Myomectomy and hysterectomy are the surgical methods by which fibroids are removed from the uterus. 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.
2. Endometriosis: There is no cure for this condition, but a few pain relievers are given to the patient. Hormone treatments are a part of the procedure along with some surgical options that are opted to remove the excess endometrial tissue. Hysterectomy is possibly the last resort if the uterus is severely damaged. A five-year contraceptive intrauterine device (IUD) has been approved to help lessen bleeding and can be as effective as surgical procedures such as endometrial ablation. This is inserted in the doctor’s office with minimal discomfort and also offers contraception. It uses heat or electrocautery to destroy the uterus lining and is usually only used when other therapies have been tried and failed. This is because scars from the procedure can make monitoring the uterus more difficult if bleeding persists in the future.

The irregular menstrual cycle is not harmful but if it persists for a long time, then it can lead to other severe conditions. The complications can be as follows:

1. Iron deficiency: Our blood has iron, and if someone has frequent and heavy periods, then they can lose enough blood to cause an iron deficiency.
2. Infertility: Another reason behind irregular periods can be anovulation. In this situation, the body doesn’t release an egg, and the person might have difficulty in getting pregnant.
3. Osteoporosis: The process of ovulation is a source of estrogen hormone. The estrogen hormone keeps our bones strong. If someone doesn’t ovulate, they can be at a higher risk for osteoporosis.
4. Cardiovascular disease: Lack of estrogen can also lead to cardiovascular diseases.
5. Endometrial hyperplasia: This is a condition where the uterus lining gets unusually thick, and it can cause endometrial cancer.

It is not advised to ignore any symptoms of irregular periods. The patient should consult a doctor if she is facing any of the following symptoms:-

1. Severe cramps during the period.
2. Unusual heavy bleeding (every two or three hours).
3. Foul-smelling vaginal discharge.
4. Nausea and vomiting during periods.
5. Shock syndromes such as fever over 102 degrees, vomiting, diarrhoea, fainting, and dizziness