Irregular Period Bleeding

Irregular period bleeding is most often defined as spotting or bleeding between periods or having periods that do not follow a normal 21-35 day cycle. However, excessively heavy periods or a cessation of periods in pre-menopausal women are often classified as irregular periods.

What causes irregular period bleeding?

The most common causes of spotting or bleeding between periods are:

  • IUD’s -Intrauterine devices frequently cause spotting, and bleeding can be amplified if slippage or an infection occurs.
  • Fluctuation in hormones – Changes in hormone levels can occur naturally or as a result of oral contraceptives or hormone replacement drugs. Very young (under 12) women and those who are in menopause are also susceptible.
  • Infections – Chlamydia and pelvic inflammatory disease are the most common bacterial infections that cause irregular period bleeding.
  • Ovulation – Many women experience spotting during ovulation, some every month.
  • An under-active thyroid.
  • Stress.

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  • Spotty bleeding between periods and heavy bleeding during and between periods can be caused by other conditions, some potentially serious.
  • Endometriosis – This is a condition where the lining of the womb, instead of being shed during the period, reattaches itself where it doesn’t belong. Normally it is accompanied by pelvic pain and severe cramps.
  • Ectopic pregnancy – This occurs when the fertilized egg becomes lodged in the fallopian tube and begins to grow.
  • Polyps or benign tumors – These are non-cancerous growths that can appear in the lining of the uterus or in the cervix.
  • Cancer and precancerous conditions – It is rare that changes in periods are a symptom of ovarian, cervical, or uterine cancer, but it is possible.
  • What factors should I consider when deciding whether to seek medical care for irregular period bleeding?
  • The age of the patient – Post-menopausal women or those who have just begun to menstruate should be evaluated, particularly if the bleeding is heavy.
  • Is the bleeding on a regular cycle or is it random? Some women experience a second period at regular intervals between their normal ones. This often coincides with ovulation.

Some Questions That Often Arise About Irregular Period Bleeding:

  • Does exercise ease or worsen the bleeding?
  • If you take birth control pills, have you recently missed or delayed a dose?
  • How severe is the bleeding? If you are soaking a sanitary pad thoroughly in less than fifteen minutes and this persists for more than an hour, seek immediate care.
  • Is there any fever or severe pain?
  • Has your stress level increased?
  • Are you pregnant, or do you think you might be pregnant?
  • Have you recently had an abortion, a miscarriage, or a surgical procedure?
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What about skipped or cessation of periods?

What is the age of the patient? In the years leading up to menopause, many women find their periods unpredictable. Instead of monthly, they may occur every two or three months. They may be extremely light, with minimal flow occurring over a very short period. They may also be heavier than normal.

Is there any chance that a pregnancy might have occurred? Early pre-natal care is essential to the health of the child and mother, so if it is possible that conception has occurred, medical care should be sought promptly.

Has the patient ever had an abnormal pap smear? Since cervical cancer may on occasion present as an alteration in the menstrual cycle, an abnormal Pap smear result makes it more important for the patient to see her physician.

Is the patient exercising strenuously? Many athletes report that periods are skipped or even stopped during heavy training cycles. This can also happen when women first start an intensive exercise program.

What kind of stress levels are being exerted on the patient? Stress, whether physical or psychological, can alter menstrual cycles.

Is the patient on a severe diet? Lack of calories and nutrients can cause periods to cease. This was observed in women in concentration camps during World War II and has also been found to be common in those with anorexia.

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What treatments are available for irregular period bleeding?

Depending on the cause and the severity of the condition, there are many tools at the physician’s disposal. These may include:

  • Hormone therapy – Birth control pills and hormone drugs can often control the situation.
  • Bed rest – Especially in cases of heavy bleeding where no cause can be determined, bed rest is often the only treatment prescribed.
  • Medications to control thyroid levels or help with stress.
  • Dilation and curettage – This procedure, also called a D & C, can serve as a diagnostic tool as well as helping the bleeding problems.
  • Hysterectomy – Few women require such drastic action to control irregular bleeding problems, although the procedure was widely used a few decades ago. This is a physician’s option of last resort, and every other means will be attempted first.