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Abnormalities of Menses: Intermenstrual Bleeding and Irregular Menstrual Flow

Irregular menses

Today we'll be talking about something which has been requested to me ever since I started this platform. So yes, you guessed it right. We'll be talking about irregular periods, delayed periods, missed periods and everything around them.

In the last two posts about menses, we spoke about what is a period and what is a normal period. Now typically the duration of a menstrual cycle is anything between 22 to 35 days starting from the first day of the period till the first day of the next cycle. There is nothing called as 28 day cycle.

For someone, 22 days could be normal. For someone, 35 days could be normal. Typically, 5 to 7 days of variation is acceptable.

In case this variation, let's say its more than 8 days and this kind of irregularity is coming more than 2 or 3 times a year. This means that we now need to investigate and find out why the periods are becoming irregular. 

I know this may sound a little technical to you but for all of you who are having irregular periods, it is worthwhile to understand the entire game around the periods.

So the entire game actually is played by four hormones. The first one is FSH which is follicle stimulating hormone, the second is LH which is the luteinizing hormone, the third is the estrogen, the fourth is the progesterone. 

Normally in our brain, we have a gland called hypothalamus that produces a hormone called GnRH which then in turn stimulates a gland called pituitary that is also there in our brain to produce a hormone called FSH.

This hormone then acts on the ovary to develop the eggs in the ovary. Medically we call them follicles. As the follicles start developing, they start producing estrogen and the estrogen levels start rising in the blood.

When the estrogen level reaches a critical value, the pituitary senses it and releases another hormone called luteinizing hormone or LH which triggers the ovulation. I'm sure you all must have heard about those ovulation testing kits. Its by those kits actually we detect the level of LH in the body.

So that's the hormone which triggers the ovulation. Once the ovulation happens, the ruptured follicle is called corpus luteum and it produces progesterone. The estrogen initially which was secreted by the growing follicles makes the endometrium or the inner lining of the uterus thick and now the progesterone basically prepares it for the pregnancy.

In case the pregnancy happens meanwhile, the bed inside the uterus is nice and ready to receive the fertilised egg. While if the pregnancy does not happen, the levels of the estrogen and progesterone come down, this endometrium dies and it sheds off in form of a monthly period. 

Phases of menstrual cycle 

Typically the menstrual cycle has got two phases, the first phase is known as the pre ovulatory phase. It is also called as proliferative phase or it is also called as the follicular phase. The second phase which is the post ovulation phase is known as the post ovulatory phase or the luteal phase or the secretory phase.

Now the first phase of the menstrual cycle is variable which means because of lot of reasons, the eggs may develop very slowly or may take a very long time to develop increasing the length of the pre ovulatory phase. While the second phase of the menstrual cycle is fixed. So post ovulation is fixed which is 14 days.

The length of the menstrual cycle will actually depend upon the length of the preovulatory phase. Anything which disturbs the ovulation will disturb the cycle. So now you can understand in case the ovulation is happening late or it is irregular or it is not happening, this would have a bearing on the length of the menstrual cycle.

Causes of Delayed Period

Now let's discuss the causes of the delayed periods. All delayed or irregular periods are not always abnormal or sign of illness. There are certain physiological reasons for irregular periods which means there are natural reasons.

Natural or physiological causes of irregular periods 

There are certain phases in a woman's life where the periods will just go irregular. For example, in the beginning, the adolescent age or the teenage when the girl starts having her periods. So many times you know mothers come to me with their young daughters. So I just tell them this is absolutely normal. You don't have to worry about them and the periods would eventually become normal. 

The second thing is obviously pregnancy, when a woman is pregnant, obviously she does not get her period. 

The third thing is when she's feeding her baby, that's she's lactating. So when she's lactating, there's a hormone called prolactin which is secreted in her body to enhance milk production, the hormone actually suppresses the ovulation.

I'm sure you all probably would have heard from the senior ladies in the house saying till the time woman is feeding the child, the periods don't come. So this is perfectly normal. 

The fourth time when the periods naturally become irregular is when she's perimenopausal which means when the periods are about to stop, when she approaches menopause. This is the time when the ovulation becomes irregular. This is the time actually the number of eggs in the ovary are now less.

Pathological causes of irregular menstrual period 

Now let's talk about the pathological or the abnormal reasons of missing the period. Like I said earlier, any process which disturbs the ovulation or makes it irregular will make the periods irregular. 

So when a person comes to me with an irregular period, I like to take a detailed history. We talk about whether she's gained weight, whether she's undergoing any kind of stress.

The number one cause of irregular periods in this category is a thyroid problem. The second is hormone called prolactin. In some people, there is extra prolactin which is secreted because of probably some kind of malfunction in a pituitary gland in the brain.

Another most common cause these days what we see of irregular periods is PCOD which is polycystic ovarian disease. So I'm actually planning to do a series on PCOD as to what causes PCOD and what are the reasons. This is a situation wherein the ovary forms small cysts and they basically produce abnormal hormones which lead to irregular periods.

Another cause of irregular periods could be premature ovarian failure. This is a disturbing thing which is happening off late pretty commonly. In a normal person, the age of the menopause was supposed to be after 38 years.

But any menopause which happens before the age of 38 is supposed to be a premature menopause. These days we are seeing girls as young as probably 34 or 35 going into menopause. Then there could be certain lifestyle factors.

Lifestyle factors that causes irregular menstrual periods 

The most common cause in this category is  excessive weight gain or the obesity or the high BMI. Another reason of irregular periods could be any kind of physical or mental stress. 

By saying physical stress, I mean somebody has had some serious illness in the recent past, somebody has undergone a surgery. Any kind of excessive exercise also is not very good. Mental stress means somebody's exams are approaching, they are probably not very happy. Some people are losing job, financial stress, relationship stress or someone that's afflicted with serious calamity.

So I tell this to everyone, exercise should be moderate. You really do not have to go overboard. You must have heard people who are into high performance sports, you know, people who are marathon runners, they also experience irregular periods.

Medically, there could be certain medications if taken can cause disturbed periods. For example, certain medications which are taken for endometriosis, progesterone, cancer drugs, certain psychiatric medicines, these are also things which can disturb the periods.

How to treat irregular menstrual period 

Now let's talk about what can we do to tackle the problem of irregular periods. The first and foremost is get yourself investigated. Needless to say, diet plays a very, very important part.

What do you eat? How much do you eat? How do you eat? How do you cook? When do you eat? Everything is very important. So eat the food the way nature wanted us to eat. The food should be simple, freshly cooked, seasonal, local.

Avoid junk food, avoid packaged food, avoid refined food. Avoid plastics as much as possible. Plastic containers actually contain a compound which is known as xenoestrogen, which actually mimics the action of estrogen in the body.

Then yes, of course, be physically active. Remember, you don't have to torture yourself. You don't have to really hit the gym very hard or maybe lift weights.

You have to ingrain the physical activity in your lifestyle as much as possible. Of course, the exercise should be a happy exercise, which means that you must look forward to doing that exercise. It should be a sustainable exercise, which means even six months down the lane, even one year, two year down the lane, you should be seeing yourself doing that exercise.

Needless to say, you need to manage your stress. I know this is very easy to say that you should manage your stress. And people might tell you, do meditation, listen to music, go for walks.

But somehow I always feel that you must address the root cause of stress, whether it is the job or the relationship or the financial or whatever. Because unless and until that is done, the stress is going to come again and again. Very important, rather very, very important, the sleep hygiene.

Let me explain the effect of sleep hygiene, the periods actually happen because the hormones in our body are released according to the circadian rhythm. 

What is circadian rhythm? Is the day and night rhythm. So if you sleep, let's say at two o'clock in the middle of the night and get up at 10 o'clock in the morning, obviously the fore hypothalamus and pituitary are confused, what kind of hormones should they make now? 

Remember how sleep time is important, the adequacy of the sleep is important. The time when you sleep is also important. The quality of the sleep is also very, very important. Never compromise on that. 

Closing thought 

A woman is not supposed to be having irregular periods. If you're having irregular periods, your body is desperately trying to tell you something. So take out some time and listen to your body.

Nourish your body well. Look after your body well. Move your body well.

And yes, the things can be taken care of. So if you found this post helpful, please share it to your loved ones and follow Lafiyata to learn more.


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