Menstrual Cycle Disorders

A normal menstrual cycle lasts between 21 and 35 days, with an average of 28 days. In a 28-day cycle, ovulation occurs on day 14, but if the cycle is longer, ovulation happens accordingly later. If pregnancy does not occur within two weeks after ovulation, the next cycle begins.

During the first two days of menstruation, blood flow is heavier and bright red. As the days progress, the discharge may appear pink, brown, or black. Women typically lose between 30 to 72 ml of blood per period.

• 1 in 3 womenmay experience temporary irregularities in their cycle, which are usually not a cause for concern.
• If pregnancy is ruled outand the irregularity persists for more than 2–3 months, a gynecological consultation is recommended.

Medical evaluation is especially important if:

• Bleeding occurs between periodsor after sexual intercourse.
• Menstrual flow changes significantly in duration or intensity.

Types of Menstrual Disorders

• Intermenstrual bleeding– Spotting or bleeding before or after the period.
• Very short (<20 days) or very long (>35 days) cycles.
• Prolonged menstruation– Lasting more than 7 days.
• Irregular cycle frequency and duration.
• Excessive blood lossduring menstruation.
• Delayed menarche (first period not occurring by age 18).
• Severe menstrual pain (dysmenorrhea).
• Intense Premenstrual Syndrome (PMS)– Mood swings, joint/muscle pain, headaches, bloating, cramps, breast tenderness, stress, anxiety, insomnia, fatigue, acne.

Causes of Menstrual Disorders

1. Hormonal & Metabolic Causes

• Pregnancy
• Stress– One of the most common
• Extreme dieting or exercise– Common in athletes or rapid weight loss.
• Polycystic Ovary Syndrome (PCOS)– Leads to irregular ovulation and increased testosterone levels.
• Thyroid disorders & diabetes– Affect hormone balance.
• Pituitary gland issues– High prolactin levels can disrupt menstruation.
• Premature ovarian insufficiency– Ovarian function declines before age 40.

2. Gynecological Conditions

• Uterine polyps or fibroids– Usually benign but can cause heavy bleeding.
• Endometriosis– Can lead to pain and irregular bleeding.
• Ovarian cysts– May disrupt hormone balance.
• Gynecological cancers– In rare cases, abnormal bleeding may indicate cervical or uterine cancer.

3. Age-Related Factors

• Adolescence– Menstrual cycles take time to regulate.
• Perimenopause– Cycles become irregular for several years before menopause.

Diagnosis of Menstrual Irregularities

• Medical history & gynecological exam.
• Transvaginal ultrasound– Evaluates uterus & ovaries.
• Hormonal blood tests– Includes estrogen, progesterone, thyroid hormones, insulin, and prolactin levels.
• Colposcopy– If abnormal bleeding occurs.
• Smear test (Thin Prep)– Screens for cervical abnormalities.
• Vaginal cultures– Detect infections.

Treatment for Menstrual Irregularities

• Treatment depends on the underlying cause.
• Options range from lifestyle changesto short-term or long-term medication
• Hormonal therapy (birth control pills)may be prescribed for cycle regulation.
• In some cases, surgical interventionmay be required for polyps, fibroids, or ovarian cysts.