Menstrual Problems (Irregular Periods) | (حیض کے مسائل بے قاعدہ ماہواری)

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Menstrual Problems (Irregular Periods)

Menstruation problems or irregular periods could occur in various forms. It is a common condition in women worldwide as well as in Pakistan and Indian Sub-Continent.

Menstruation (also called periods or menses) is defined as the monthly bleeding that occurs in women after reaching puberty until menopause. Normally, periods continue for about 3-5 days and blood loss during periods is around 30 – 40 ml. The inner lining of the uterus is also peeled-off and discharged along with the menses blood.

Menstrual cycle is the time from the start of one periods to the start of next period. Typically, menstrual cycle is of around 28 days, however a few days earlier or later is considered as normal. During the menstrual cycle, various changes take place in the body due to the release of hormones. Every month, this cycle is repeated.

During the menstrual cycle estrogen hormone level increases. Estrogen is helpful in making bones healthy and strong. Additionally, estrogen hormone prepares the women for pregnancy.

Some of the menstrual problems are enlisted below:

Absence of Menstrual Cycle (Amenorrhea) - Many women suffer with this condition that causes complete absence of menstrual cycle. It could be primary or secondary. Normal age of having periods is around 10-17 years, if a girl is not capable of menstruating by the age of 17 or beyond that, then she is said to have primary absence of menstruation (amenorrhea). Secondary absence of menstrual cycle (amenorrhea) occurs when there is interruption of regular period for at least more than three months.

Painful Period (Dysmenorrhea) – It is defined as having painful period. This is a common complain of most menstruating women of Pakistan.

Bleeding Other Than Normal Menstrual Cycle (Abnormal uterine bleeding) - Abnormal period is bleeding in between two periods (intermenstrual bleeding) or any bleeding other than normal menstrual cycle.

Heavy Menstrual Bleeding (Menorrhagia) - It is defined as heavy menstrual cycle, which could be either primary or secondary. Primary heavy menstrual bleeding (menorrhagia) has no organic pathology but secondary heavy menstrual bleeding (menorrhagia) has some underlying organic pathology like a harmless (benign) tumor in the uterus, which is known as fibroid. Fibroids occur in various women of child bearing, worldwide and Pakistan as well. Heavy bleeding could also be due to anemia (iron deficiency). Because of this reason, these patients frequently visit clinics with this complain.
Decreased or Less Menstruation (Oligomenorrhea) - It refers to decreased menstruation.

Beginning and Stopping of Menstruation (Menarche and Menopause) - Menarche marks the time when a girl menstruates for the first time ever in her life while menopause is referred to the time when finally her menstrual cycle comes to an end, either spontaneously or gradually.

Signs and symptoms of menstrual irregularities are as follows:

  • During heavy menstrual bleeding, excessive blood loss could cause problems in daily routine because of usage of various sanitary towels and other symptoms related to increased menstruation.
  • Women could appear with unusual paleness (pallor) which could be because of anemia, which is defined as deficiency of red blood cells in the blood. This is due to excessive blood loss
  • Bloating (distension of the stomach)
  • Feeling tiredness and lethargy
  • Nausea and vomiting
  • Loss of hunger or appetite
  • Increased abdominal pain or cramps in dysmenorrhea (painful menstruation)
  • Pain in back and limbs
  • Mood swings
  • Migraine
  • Irritability
  • Soaking of bed sheets and passage of blood clots 

Patients’ complete medical history should be considered for diagnosis that includes: current menstrual cycle; frequency, nature of periods and any abnormal intermenstrual bleeding.

Menstrual problems could be because of no specific cause but usually there is some significant underlying pathology associated to it.  Irregularities could either occur after puberty or just before menopause.

Some of the causes or risk factors are as follows:

  • Major cause of menstrual irregularities is hormonal imbalance, it could be present in a girl from birth or could be acquired by her during her developmental process.
  • In some patients, lifestyle could be a key reason of disturbing a normal menstrual cycle for instance excessive weight loss, weigh gain, strenuous exercise or even stress.
  • Usage of birth control medicines or devices (contraceptives) also leads to disturbance in period. Some women take combined oral contraceptive pills, some take injections or beneath the skin (intradermal) implants/devices, some of them directly go for placing a device in their uterus or birth canal which prevents them from getting pregnant. This is termed as intrauterine system of protection and it could be either hormonal or chemical. These maneuvers cause hormonal imbalance, eventually leading to disturbed cycle. They release certain hormones which are the main source of disturbing the whole cycle. A woman may experience absence of menstrual cycle, painful periods or heavy periods.
  • Gynecological problems like early abortion (miscarriage) or any gynecological surgery could also lead to menstrual problems.
  • Various diseases are a source of irregular menstrual cycle like polycystic ovarian syndrome (PCOS), in which small cysts appear in the ovaries as the name suggests.  In PCOS, there is no period at all or very less amount of period (oligomenorrhea), along with no ovulation (anovulation). Apart from PCOS, thyroid problems could also cause menstrual irregularity.
  • Always rule out pregnancy when having interrupted menstrual cycle because pregnancy is the major cause of secondary amenorrhea.  If there is pain along with interruption of menstruation, then there is a possibility of missed abortion or even ectopic pregnancy (that is pregnancy outside normal uterine cavity).
  • Dysmenorrhea or pain during period could also be caused by disease such as endometriosis.

Usually diagnosis is made on both clinical assessment and complete history of the patient.
However, certain baseline tests could prove beneficial as well:

  • CBC (Complete blood count) - Done for ruling out anemia due to heavy menstrual bleeding
  • Clotting profile
  • Blood grouping
  • Pregnancy test
  • Urine D/R

Treatment of irregular menstruation cycle is not always important or required.

For instance, hormonal changes are normal when a girl reaches her puberty or when she is about to have menopause, therefore nothing should be done to stop this normal phenomenon.

However, one should definitely see her general physician if she faces one of these problems:

  • Constant spotting
  • Abnormal uterine bleeding
  • Heavy bleeding between periods or after having sex.
  • Heavy bleeding causing frequent changing of tampons or sanitary towels.
  • Increased frequency or duration of periods.
  • Passage of increased blood clots.
  • Abdominal cramps
  • Severe backache or pressure symptoms (Increased urinary frequency or urgency).

Women facing these problems should first of all, change their lifestyle.  Lifestyle modification is the initial step in combating this issue. They should take proper diet and some exercise will also prove beneficial.
Birth controlling (Contraceptive) method should be revised; if the cause is any intrauterine hormonal contraceptive system then it should be removed. If it is because of any medicines, then they should be changed after the advice of doctor.

If a woman is complaining of increased pain during menstrual cycle then she should be prescribed with over the counter pain killers (analgesics) and request for doctor’s consultation.

Patient going through any sort of problem regarding her period should tell her doctor about what she is going through so that proper treatment is initiated.

  • Lifestyle modification.
  • Exercise
  • Healthy diet
  • Wise selection of birth controlling or contraceptive methods
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