Menstrual Disorders
What are menstrual irregularities?
Your menstrual cycle is counted from the first day of your period to the first day of the next. Many women have menstrual cycles that last between 21 and 35 days. The length of period bleeds also vary from 2 – 7 days. Menstrual cycles become less regular as you near menopause.
You should have regular periods unless you are:
Pregnant or breastfeeding
Postmenopausal
Have a medical condition that causes your periods to stop
It is thought that up to a quarter of women experience irregular menstrual cycles. This means they may have:
Heavy periods (menorrhagia) is when you have excessive bleeding during your period
Bleeding or spotting between periods (intermenstrual bleeding)
Infrequent periods (oligomenorrhea) – periods that occur more than 35 days apart
Irregular periods when your cycles vary from period to period, typically with a variation of more than 20 days difference
Delays the return of menstruation
What are heavy periods?
Heavy periods are periods which have excessive bleeding which interfere with woman’s physical, emotional and social wellbeing.
Bleeding may be considered as being excessive if you are changing pads every hour or passing moderate-sized blood clots.
How do I know if my periods are heavy?
Symptoms of heavy periods are:
Bleeding through one or more pads or tampons every 1-2 hours
You have menstrual blood costs larger than a 20c piece (smaller clots are normal to pass)
Signs of anemia (low iron) – dizziness, lightheadedness, weakness, tiredness, chest pain or trouble breathing
Long periods
What tests would I need if I have heavy periods?
You will need to see us for a complete assessment including a detailed history examination. You may need some or all of the following tests:
Blood tests
Pregnancy test
Ultrasound of your pelvis
Cervical screening test
Iron studies
How is heavy bleeding treated?
Your heavy bleeding may be treated with hormonal birth control or medication to lessen the bleeding. If you also have strong pain you may be prescribed pain medication. In rare cases you may require surgery to treat the cause of the bleeding.
What treatment would I be offered?
There are different treatment options that could be recommended. This depends on your age, desire to have children in the future, severity of bleeding, and the cause of heavy periods. The different options of treatment could be:
Hormonal tablets
Endometrial ablation (destroying the lining of the uterus)
Mirena IUD
Hysterectomy
What are the causes of heavy bleeding?
Some causes of heavy bleeding are:
Thyroid problems
Uterine fibroids
Uterine polyps
Certain medications
There may be a link between chronic fatigue syndrome and heavy periods
Obesity and excess oestrogen
Ovulation problems and uterine lining problems that cause hormone imbalances or uterine lining build up
Pregnancy problems (miscarriage or ectopic pregnancy)
Bleeding disorders (hemophilia)
What is intermenstrual bleeding?
Unusual or abnormal bleeding is any bleeding that happens when you do not have your period, including:
Spotting or bleeding at any time during your menstrual cycle other than your period. Bleeding after sex, more than once
What are the common causes of intermenstrual bleeding?
Midcycle bleeding can occur at the time of ovulation
Infections like chlamydia
Oral contraceptive pills
Cervical or endometrial polyp
Cancer of the cervix or lining of the uterus
Anticoagulant medications
What should I do if I have intermenstrual bleeding?
Your doctor will check for causes of irregular bleeding. Many of these are easy to treat and do not indicate a serious underlying problem. Hormonal birth control may be prescribed.
Any vaginal bleeding after menopause can be a sign of a serious health problem.
What tests will I be offered for IMB?
Testing for infection
Pregnancy test
Ultrasound of the pelvis
Cervical screening test
What are infrequent periods?
Infrequent periods are periods that occur at different times with long lengths between them. If you are missing periods for three months in a row, or have not had your first period by 15, this is called amenorrhea. You may have a hormonal imbalance (not enough oestrogen). This can have serious health effects.
What causes infrequent periods?
Infrequent periods may be caused by:
Stress
Eating disorders, especially anorexia nervosa
Serious health problems like tumors in the brain
Hormonal problems such as PCOS
Pregnancy and breastfeeding
Gaining or losing too much weight
Your periods should start again once these problems are treated.
What are irregular periods?
If your cycle is shorter or longer than average you are considered to have irregular periods. That is:
If your next period is less than 24 days from the start of your last period
If your next period is more than 38 days from the start of your last period
Your cycle length varies by more than 20 days from month to month
What causes irregular periods?
Irregular periods are normal for teenage girls and tend to become more regular after a few years. Perimenopausal women (women nearing and entering menopause) have periods that become more irregular over time until they eventually stop.
Irregular periods can be caused by:
Eating disorders
Thyroid problems (hyperthyroidism or overactive thyroid)
High level of prolactin in the blood
Primary ovarian insufficiency (POI) when the ovaries stop working normally before 40. This is not early menopause as you may still have periods and can get pregnant
Certain medications (e.g. anxiety or anti-epileptic drugs)
PCOS
Pelvic inflammatory disease (PID)
Stress
Uncontrolled diabetes (both Type 1 and Type 2)
Obesity
What is PCOS?
Polycystic ovary syndrome (PCOS) is a complex hormonal condition that can cause menstrual cycle disruptions, skin and hair changes and cysts on the ovaries. Simply having polycystic ovaries on an ultrasound does not mean that you have PCOS. PCOS can occur at any point in your reproductive lives – from puberty to menopause.
Who gets PCOS?
PCOS affects between 12-21% of South African women of reproductive age. However, it is estimated that up to 70% of women with PCOS are undiagnosed.
The causes of PCOS are not yet well understood. It is thought:
There is a genetic component – yet to be identified
That insulin resistance may be a risk factor
The excess of insulin in the blood (hyperinsulinemia) is thought to then cause the other problems of PCOS.
What are the symptoms of PCOS?
PCOS can present differently in each woman. Common symptoms include:
absent or irregular periods
acne
difficulties falling pregnant and infertility
excess facial and/or body hair
excess weight and obesity
insulin resistance and diabetes
thinning of hair or baldness
How can I get tested for PCOS?
There is no definitive PCOS test and it takes many women years to receive a diagnosis. Some tests that may be conducted include:
Test of hormone levels – Blood tests to check hormones like –
- testosterone
- sex hormone-binding globulin
- thyroid hormones and
- prolactin
Tests to see how your body handles glucose
- blood cholesterol and glucose levels
- 2-hour glucose tolerance test
Ultrasound of the ovaries
Transvaginal or internal ultrasound that is used to examine the uterus and ovaries
For a PCOS diagnosis to be made, you must have 2 of the following: