Irregular Menstrual Cycles

Why do I have irregular cycles?  How can we treat irregular cycles?

There’s a long list of possibilities causing the menstrual cycles to vary from the usual 28 to 35 days periods and lasting 4 to 7 days that most women usually experience.

Of course once we rule out pregnancy, a gynecology exam can help us zero in on the cause and develop a treatment plan.

A change in hormone levels from stress, weight gain or illness or other disruptions in a woman’s routine can affect the menstrual cycle.  If the thyroid or other glands are not functioning properly, one sign may be problems of the menstrual cycle.

Polyps or dangling growths in the lining of the uterus  and fibroids, also known as leiomyoma are knots or growths of the muscle layer of the uterus may cause heavy bleeding and bleeding between cycles.  These growths are usually benign.

Endometriosis or adenomyosis can occur when the lining tissue of the uterus starts to growth outside the uterus or into the wall of the uterus.  These may cause abnormal bleeding as well as pain during the cycles and painful intercourse.

Other causes include polycystic ovary syndrome which can be seen on ultrasound, pelvic infections caused when bacteria enters the genital tract usually during sexual intercourse, bleeding disorders such as Von Willebrand’s disease,  and cervical or upper uterine cancer.

A history of use of medication such as blood thinners, skipped or late birth control pills would give us the answer also.

Pelvic examination may help us determine if there are fibroids of the uterus or any large ovarian cysts.   A Pelvic ultrasound will locate abnormalities of the thickness of the lining of the uterus or polycystic ovaries.  The Pap test will help us determine if there is pre-cancer or cancer of the cervix.  A complete blood count, blood sugar, thyroid hormone test, or other hormone tests may be very helpful.

Hysteroscopy, scoping the inside of the uterus with a directed biopsy tells us if there are polyps, pre-cancer or uterine cancer. The polyps can be removed and sometimes fibroids can also be scrapped away.  Young women may not need this step to determine the cause of the abnormal bleeding.

If all the results so far are normal or unremarkable, a daily pill of estrogen and progestin or progestin only may be all that’s needed to return the cycles to a regular and short interval.

Laparoscopy, a surgery to look inside the pelvis may be required if the cycles remain irregular to locate and treat endometriosis.

Fibroids can be treated with surgery to remove them, or a procedure to block their blood supply, or in some cases with anti-estrogen medications.

Menopause or premature ovarian failure, when the ovaries stop working, may lead to absent or very infrequent cycles.