Irregular menstruation is noted during periods of hormonal adjustment, observed in ovarian and progesterone insufficiency, some endocrine diseases and mental disorders. It is possible to both decrease and increase the cycle duration with its constant fluctuations. The cause of the violation is determined on the basis of complaints, general and gynecological examination data, results of instrumental and laboratory tests. Treatment in most cases consists in hormone replacement therapy. Sometimes operations are required.
Causes of irregular periods
Physiological causes
Short-term cycle failures are determined by irrational nutrition (lack of nutrients, excess caffeine), too strict diets. Irregular menstruation during 1-3 cycles can be observed with intensive sports, a sharp change in climate. After correcting the diet or the level of physical activity, adapting to new climatic conditions, the cycle normalizes. If this does not happen, it is necessary to undergo an examination to determine the cause of the pathology.
Hormonal restructuring
Irregular periods are considered the norm for 1-2 years from the moment of menarche. In case of fluctuations that continue after the specified period, it is recommended to have an examination by a pediatric gynecologist. Changes in the duration of the cycle are also detected during premenopause. There is an irregularity, a tendency to lengthen the intervals between menstruation, a shortening of the duration of bleeding.
Prolonged use of oral contraceptives leads to a decrease in the production of own estrogen. After the cancellation of birth control pills, menstruation may be absent, then irregular meager bleeding occurs. Normally, recovery takes several months. If irregular menstruation persists for a year or more, you need to visit a specialist.
Psychological reasons
The cause of the symptom is often acute psychotrauma and prolonged stressful situations. This is due to increased production of the stress hormones adrenaline and cortisol and, as a result, a drop in estrogen levels. Another possible etiofactor is anorexia nervosa. With a decrease in body mass index, menstruation first becomes irregular, and after a decrease in BMI to 18-19 and below, they disappear due to a lack of adipose tissue and poor nutrition.
Ovarian insufficiency
At an early stage, ovarian insufficiency is characterized by infertility, there are no other symptoms. Clinical manifestation is manifested by progressive menstrual cycle disorders and signs of estrogen deficiency. Menstruation occurs less frequently, becomes irregular, and then stops completely. Pathology occurs in three forms: gonadal dysgenesis, ovarian depletion syndrome and resistant ovarian syndrome. Etiological factors are:
- Genetic disorders: Shereshevsky-Turner syndrome, X-trisomy, galactosemia.
- Immune-related diseases: rheumatoid arthritis, Hashimoto’s thyroiditis, autoimmune hemolytic anemia, thrombocytopenic purpura, some variants of myasthenia gravis.
- Extragenital diseases: sarcoidosis, diabetes mellitus, a number of infections (mumps, rubella, flu).
- Gynecological pathologies: chronic nonspecific adnexitis and oophoritis, genital tuberculosis, condition after removal of appendages due to tumors, cysts, tubal pregnancy.
- Other reasons: nicotine addiction, chemotherapy, exposure to ionizing radiation.
Progesterone deficiency
The most noticeable manifestation of progesterone deficiency is considered to be cycle disorders: soreness, lengthening or shortening of duration, irregularity, change in the amount of discharge. Infertility, pregnancy complications, edema, anemia are possible against the background of heavy menstruation. The main reasons are:
- Hereditary predisposition: mutations affecting the functioning of the ovaries and hypothalamic-pituitary system.
- Ovarian damage: polycystic disease, neoplasms, traumatic injuries.
- Extragenital pathologies: diabetes mellitus, kidney diseases (pyelonephritis, CRF).
- Lifestyle: obesity, alcoholism, too intense physical activity.
Endocrine diseases
Irregular menstruation can be caused by disorders of the adrenal glands, thyroid gland, pituitary gland. They are observed in the following diseases:
- Hypothyroidism. On the part of the reproductive system, dysfunctional bleeding, irregular or rare menstruation, amenorrhea, increased likelihood of miscarriage or infertility are possible. There is puffiness of the face, bradycardia, muscle pain, dry skin, hair loss, apathy, chilliness. Cognitive decline, insomnia, increased fatigue, and a tendency to depression are revealed.
- Itsenko-Cushing’s disease. Menstrual disorders sometimes reach the severity of amenorrhea, combined with hirsutism, typical distribution of adipose tissue (on the neck and upper torso), moon-shaped face, striae, osteoporosis. Tachycardia, increased blood pressure, gastritis, steroid ulcers of the upper gastrointestinal tract, diabetes mellitus, secondary kidney damage, neurological disorders are possible.
- Addison’s disease. Irregular periods are complemented by a bronze hue and uneven pigmentation of the skin. There is a decrease in body weight, a decrease in sexual desire, severe asthenia, orthostatic hypotension, fainting. Dyspeptic phenomena, a tendency to eat salty food are characteristic.
- Tumors of the adrenal glands. With glucosteromas, the Itsenko-Cushing syndrome is formed. Typical obesity, striae, increased fatigue, muscle weakness, virilization are revealed. In girls with an estrogen-producing corticosteroma, early menarche, irregular menstruation, and vaginal bleeding are detected. Adult women have no symptoms. With androsteromas, on the contrary, the level of androgens increases, which is manifested by virile syndrome and a decrease in menstruation.
- Adrenogenital syndrome. In patients with the classical form, the body develops according to the male type, there are no monthly periods. In the non-classical type, there is a late onset of menarche, irregular cycles, weakly expressed secondary sexual characteristics, oily skin.
Diagnostics
Diagnostic measures are carried out by an obstetrician-gynecologist. If extragenital causes of hormonal imbalance are suspected, patients are referred to a gynecologist-endocrinologist. In case of somatic diseases, it is necessary to consult a rheumatologist, a nephrologist, and other specialists. The survey clarifies the time of the onset of menarche, the peculiarities of sexual development in puberty, gynecological history, the presence of pathologies of other organs and systems. Additional examination includes such measures as:
- Gynecological examination. It provides for examination in mirrors, bimanual palpation of the uterus and other procedures. The technique allows you to detect developmental anomalies and acquired disorders. The scope of diagnostic manipulation is determined by the nature of the detected changes. A mandatory element is the sampling of smears for the study of microflora.
- Ultrasonography. Ultrasound of the pelvis is informative in assessing the size and configuration of the internal genitalia, identifying tumor processes, inflammation, malformations and other pathologies. Patients with progesterone insufficiency require repeated procedures in different phases of the cycle. With hypothyroidism, ultrasound of the thyroid gland is recommended, with signs of Addison’s disease and tumors of the appropriate localization – ultrasound of the adrenal glands.
- Radiation methods. With hypothyroidism, thyroid scintigraphy can be prescribed, with Cushing’s disease and Addison’s disease (to exclude the secondary nature of the disease) – radiography of the Turkish saddle, CT and MRI of the brain, with adrenal neoplasia – MRI or CT of these organs.
- Other techniques. To exclude a number of gynecological pathologies, hysteroscopy and colposcopy are performed. In case of progesterone insufficiency, an aspiration biopsy of the endometrium is performed. Women with ovarian insufficiency undergo diagnostic laparoscopy to confirm the characteristic changes and biopsy sampling. According to the indications, patients undergo densitometry to exclude osteoporosis.
- Laboratory tests. The list of laboratory tests depends on the nature of the disease. It may be necessary to determine the level of thyroid hormones, gonadotropins, estrogens, progesterone. Violations of biochemical parameters are typical for Cushing’s disease: an increase in the level of cholesterol, globulins, chlorine and sodium, a decrease in the concentration of albumins, phosphates and potassium. In some cases, stimulation tests are carried out.
Treatment
Conservative therapy
Management tactics are chosen depending on the causes of the symptom:
- Mental disorders. If a violation occurs against the background of acute and chronic stress, it is necessary to create a favorable psychological environment, normalize the daily routine, psychotherapy, sometimes taking psychotropic drugs. Treatment of anorexia nervosa is a difficult task, often requires hospitalization. It is produced using diet therapy, psychotherapy, sex hormones, neuroleptics, H1-histamine blockers.
- Ovarian insufficiency. Ovulation stimulation is usually ineffective. In the absence of a desire to have a child, patients are prescribed hormone replacement therapy. In the presence of reproductive plans, IVF with a donor egg is indicated against the background of preliminary estrogen-progestogenic stimulation and subsequent hormonal support until the 15th week of pregnancy.
- Progesterone deficiency. Progesterone preparations are recommended. The treatment plan is made individually, taking into account age, the causes of pathology, hormonal background in different phases of the cycle, the nature of menstrual disorders, etc. It is necessary to treat the underlying disease and secondary disorders, correct the regime, eliminate stress, normalize the emotional state using sedatives.
- Endocrine pathologies. Therapeutic tactics are determined taking into account the type of disease. Substitution therapy is carried out using synthetic analogues of thyroid hormones, mineralocorticoids, glucocorticoids. Hypercorticism requires means to suppress the secretion of ACTH, blockers of the production of steroid hormones.
- In some adrenal tumors, chemotherapy is effective. Patients who have undergone an adrenalectomy are shown to take hormonal drugs for life.
Surgical treatment
Women perform the following surgical interventions:
- Ovarian insufficiency: bilateral oophorectomy in the presence of a Y chromosome for the prevention of germinogenic malignant tumors of the ovaries.
- Progesterone insufficiency: drilling or wedge-shaped resection in polycystic.
- Adrenal tumors: open or laparoscopic adrenalectomy for benign neoplasms, extended and combined operations for malignant neoplasia.
- Cushing’s disease: bilateral adrenalectomy with severe course, transcranial or transnasal removal of the tumor with pituitary adenoma.
