Irregular periods are observed during periods of hormonal changes, are observed with ovarian and progesterone insufficiency, some endocrine diseases and mental disorders. It is possible to both decrease and increase the duration of the cycle with its constant fluctuations. The cause of the violation is determined on the basis of complaints, data from a general and gynecological examination, and the results of instrumental and laboratory studies. Treatment in most cases is hormone replacement therapy. Sometimes surgery is required.
Why do irregular periods occur?
Physiological causes
Short-term cycle failures are determined by poor nutrition (lack of nutrients, excess caffeine), too rigid diets. Irregular periods for 1-3 cycles can be observed with intensive sports, a sharp change in climate. After adjusting the diet or 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 adjustment
Irregular periods are considered normal for 1-2 years after menarche. With fluctuations that continue after the specified period, an examination by a pediatric gynecologist is recommended. Changes in cycle length are also detected during premenopause. Irregularity, a tendency to lengthening the intervals between menstruation, a shortening of the duration of bleeding are noted.
Long-term use of oral contraceptives leads to a decrease in the production of one's own estrogen. After the abolition of birth control pills, menstruation may be absent, then irregular bleeding occurs. Normally, recovery takes several months. If irregular periods persist 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 etiological factor is anorexia nervosa. With a decrease in body mass index, periods first become irregular, and after a decrease in BMI to 18-19 and below, they disappear due to a lack of adipose tissue and poor nutrition.
irregular periods
ovarian failure
At an early stage, ovarian failure is characterized by infertility, other symptoms are absent. The clinical manifestation is manifested by progressive menstrual disorders and signs of estrogen deficiency. Periods occur less frequently, become irregular, and then stop completely. Pathology occurs in three forms: gonadal dysgenesis, ovarian wasting syndrome and resistant ovary syndrome. Etiological factors are:
- Genetic disorders: Shereshevsky-Turner syndrome, X-trisomy, galactosemia.
- Immune-mediated 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, influenza).
- Gynecological pathologies: chronic nonspecific adnexitis and oophoritis, genital tuberculosis, condition after removal of appendages due to tumors, cysts, tubal pregnancy.
- Other causes: nicotine addiction, chemotherapy, exposure to ionizing radiation.
progesterone deficiency
The most noticeable manifestation of progesterone deficiency are cycle disorders: soreness, lengthening or shortening of the duration, irregularity, change in the amount of discharge. Possible infertility, complications of pregnancy, swelling, anemia against the background of heavy periods. The main reasons are:
- Hereditary predisposition: mutations that affect the functioning of the ovaries and the hypothalamic-pituitary system.
- Ovarian lesions: polycystic, neoplasms, traumatic injuries.
- Extragenital pathologies: diabetes mellitus, kidney disease (pyelonephritis, chronic renal failure).
- Lifestyle: obesity, alcoholism, too intense physical activity.
Endocrine diseases
Irregular periods can be caused by disorders of the adrenal glands, thyroid gland, pituitary gland. Observed in the following diseases:
- Hypothyroidism. On the part of the reproductive system, dysfunctional bleeding, irregular or rare periods, amenorrhea, increased likelihood of miscarriage or infertility are possible. Puffiness of the face, bradycardia, muscle pain, dry skin, hair loss, apathy, chilliness are noted. Decreased cognitive abilities, insomnia, increased fatigue, and a tendency to depression are detected.
- Itsenko-Cushing's disease. Menstrual disorders sometimes reach the severity of amenorrhea, combined with hirsutism, a typical distribution of adipose tissue (on the neck and upper body), moon-shaped face, striae, osteoporosis. Possible tachycardia, increased blood pressure, gastritis, steroid ulcers of the upper gastrointestinal tract, diabetes mellitus, secondary kidney damage, neurological disorders.
- Addison's disease. Irregular periods are complemented by a bronze tint and uneven skin pigmentation. A decrease in body weight, a decrease in sexual desire, severe asthenia, orthostatic hypotension, fainting are found. Characterized by dyspeptic symptoms, a tendency to eat salty foods.
- Tumors of the adrenal glands. With glucosteroma, Itsenko-Cushing's syndrome is formed. Typical obesity, striae, increased fatigue, muscle weakness, virilization are revealed. In girls with estrogen-producing corticosteroma, early menarche, irregular menstruation, and vaginal bleeding are determined. Adult women have no symptoms. With androsteroma, on the contrary, the level of androgens increases, which is manifested by a viril syndrome and a decrease in menstruation.
- adrenogenital syndrome. In patients with a classical form, the body develops according to the male pattern, menstruation is absent. In the non-classical type, there is a late onset of menarche, irregular cycles, mild secondary sexual characteristics, and 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, nephrologist, and other specialists. As part of the survey, the time of the onset of menarche, the characteristics of sexual development in puberty, the gynecological history, and the presence of pathologies in other organs and systems are specified. Additional testing includes activities such as:
- Gynecological examination. Provides examination in the mirrors, bimanual palpation of the uterus and other procedures. The technique allows to detect developmental anomalies and acquired disorders. The volume of diagnostic manipulation is determined by the nature of the identified changes. A mandatory element is the collection of smears for the study of microflora.
- Ultrasonography. Ultrasound of the small pelvis is informative in assessing the size and configuration of the internal genital organs, identifying tumor processes, inflammation, malformations and other pathologies. Patients with progesterone deficiency require repeated procedures in different phases of the cycle. In case of hypothyroidism, ultrasound of the thyroid gland is recommended, with signs of Addison's disease and tumors of the corresponding localization - ultrasound of the adrenal glands.
- Beam 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. With progesterone deficiency, endometrial aspiration biopsy is performed. In women with ovarian failure, a diagnostic laparoscopy is performed to confirm characteristic changes and take a biopsy. According to 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, gonadotropic hormones, estrogen, progesterone. For Cushing's disease, violations of biochemical parameters are typical: 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 performed.
Gynecologist's consultation
Treatment
Conservative therapy
The tactics of management are chosen depending on the reasons for the development 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 regimen, psychotherapy, and sometimes take psychotropic drugs. Treatment of anorexia nervosa is not an easy task, often requiring hospitalization. It is produced using diet therapy, psychotherapy, sex hormones, neuroleptics, H1-histamine blockers.
- ovarian insufficiency. Stimulation of ovulation is usually ineffective. In the absence of a desire to have a child, patients are prescribed hormone replacement therapy. If there are reproductive plans, IVF with a donor egg is indicated against the background of preliminary estrogen-gestagenic stimulation and subsequent hormonal support up to the 15th week of pregnancy.
- progesterone deficiency. Progesterone preparations are recommended. The treatment plan is drawn up individually, taking into account age, the causes of pathology, hormonal levels 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 regimen, eliminate stress, and 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. With hypercortisolism, agents are required to suppress the secretion of ACTH, blockers of the production of steroid hormones.
Chemotherapy is effective for some tumors of the adrenal glands. Patients who have undergone adrenalectomy are shown to take hormonal drugs for life.
Surgery
Women perform the following surgeries:
- Ovarian insufficiency: bilateral oophorectomy in the presence of a Y chromosome for the prevention of germ cell malignant tumors of the ovaries.
- Progesterone deficiency: drilling or wedge resection for polycystic disease.
- Tumors of the adrenal glands: open or laparoscopic adrenalectomy for benign neoplasms, extended and combined operations for malignant neoplasia.
- Cushing's disease: bilateral adrenalectomy in severe cases, transcranial or transnasal removal of the tumor in pituitary adenoma.