Just as most aspects of health change with age in a person, so does the menstrual cycle. Neither the volume nor the length or regularity may remain the same as you age from menarche to menopause. But what’s important is to know about alarming menstrual cycle changes.
Dr Sonal Singhal, MD Obstetrician and Gynaecologist – Senior Consultant, Motherhood Hospital, Gurugram, says every woman has her own cycle length, duration and flow, which she can consider as normal. But changes in that patern warrant her to approach her healthcare provider.
Some sudden changes in menstrual cycle that you should note as you grow up, can be summarised according to a woman’s age group.
Girls usually hit puberty when they turn 11 or 12 years of age. But if periods start before the age of 10 years, it is known as precocious puberty. “It can be constitutional or secondary to any tumour, meningitis or hypothyroidism,” says Dr Singhal.
Wheras if menarche or first period is delayed beyond 16 years of age, its causes can be imperforate hymen, absent uterus, hormonal imbalance, chromosomal abnormalities, Polycystic Ovary Disease (PCOD), thyroid dysfunction or malnutrition. All these conditions need proper evaluation and treatment by the gynaecologist or endocrinologist.
Excessive bleeding at the time of adolescence is called pubertal menorrhagia. This can be due to immature hypothalamic-pituitary-ovarian (HPO) axis, bleeding disorders, hypothyroidism or ovarian tumours. It can lead to severe anaemia and should raise alarm bells to approach your doctor.
A normal menstrual cycle is considered as lasting for 3 to 5 days, at intervals of 25 to 35 days and average flow with no or some pain.
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“Any deviation from this patern, like delayed periods, very frequent cycle, heavy flow or severely painful periods – all these changes at any age make it
important that a patient consults their gynaecologist,” adds Dr Singhal.
During reproductive cycles, frequent period cycles or intermenstrual bleeding are also a cause for worry. They can be due to hormonal imbalance, uterine or cervical polyps, fibroids, contraceptive pill usage, vaginal/uterine or cervical infections, uterine or cervical cancers, ovarian tumours and not to forget pregnancy and related complications. An ectopic pregnancy or abortion can lead to this scenario.
Delayed periods can be due to pregnancy, PCOD, hyperprolactinemia, and use of some medicines, etc. After proper evaluation, your doctor may advise lifestyle modifications such as diet, exercise or medicines to regularize the cycles.
Menorrhagia or very heavy menstrual bleeding can again be due to hormonal imbalance like PCOD or hypothyroidism, fibroids, infection, post-delivery malignancies, and of course a spontaneous miscarriage, can present as very heavy flow with clots. In such situations, one should immediately consult their gynaecologist as it is easily correctable with medications, DNC, hysteroscopic or
laparoscopic polyp or fibroid removal, putting in a hormone releasing IUCD hysterectomy, explains Dr Singhal.
The perimenopause stage is a transition from reproductive years to menopause. Irregular periods, early, late or heavy flow is common. One should get malignancy ruled out before treating it as a hormonal issue.
When a lady of menopausal age has no menses for a period of at least 1 year, it is considered as menopause. Any vaginal bleeding after menopause is called post-menopausal bleeding. It may be heavy or very light. But whenever this happens, it needs thorough evaluation to rule out malignancy, followed by treatment or follow up from a professional.
The list for abnormalities in menstrual cycles is long and exhaustive, but we have summarised the most commonly encountered conditions which mandate a visit to your doctor. Further investigations would decide the treatment.