What is considered normal
- The duration of the cycle from the first day of one menstruation to the first day of the next - from 21 to 35 days
- Duration of menstruation - from 2 to 7 days
- The volume of blood loss is approximately up to 80 ml per menstruation; practical guideline: the gasket is changed no more than once every 2–3 hours
- Fluctuations in cycle duration within a few days from month to month are acceptable
- In the first year or two after the start of menstruation and during perimenopause, the cycle may be irregular - this is physiological
- Moderate discomfort on the first day is acceptable, but severe pain is not normal.
Полезный практический ориентир по объёму: если приходится менять прокладку или тампон чаще чем раз в два часа, если менструация длится дольше недели или в выделениях крупные сгустки, кровопотеря избыточна — даже если «так было всегда».
Types of violations
- Amenorrhea - absence of menstruation for three months or more
- Oligomenorrhea - infrequent menstruation, cycle longer than 35 days
- Polymenorrhea - frequent menstruation, cycle shorter than 21 days
- Menorrhagia - heavy and prolonged menstruation
- Metrorrhagia - bleeding between periods
- Dysmenorrhea - painful menstruation
- Intermenstrual spotting
- Postmenopausal bleeding - any bleeding after menopause
- Bloody discharge after sexual intercourse
Reasons
- Pregnancy, including ectopic, is excluded first of all
- PCOS is the most common cause of irregular periods
- Thyroid diseases: both hypothyroidism and hyperthyroidism
- Elevated prolactin, including with pituitary adenoma
- Sudden changes in body weight, strict diets, eating disorders
- Intense physical activity and professional sports
- Chronic stress, lack of sleep, jet lag
- Uterine fibroids, especially submucosal fibroids
- Polyps of the endometrium and cervical canal
- Endometrial hyperplasia
- Adenomyosis
- Chronic endometritis
- Intrauterine device
- Bleeding disorders
- Taking hormonal drugs, anticoagulants, some antidepressants
- Perimenopause
- Oncological diseases of the uterus and cervix
Survey
- Pregnancy test or hCG - the first step in case of delay
- A diary of the menstrual cycle for several months is very helpful for the doctor
- Gynecologist examination and smear
- Ultrasound of the pelvic organs, preferably at a certain phase of the cycle
- Complete blood count and ferritin - assessment of anemia with heavy menstruation
- TSH and thyroid hormones
- Prolactin
- FSH, LH, estradiol, AMG
- Testosterone and androgen assessment in irregular cycles and hair growth
- Glucose, insulin for suspected PCOS
- Coagulogram for heavy menstruation from youth
- Pipelle biopsy of the endometrium for bleeding, especially after 40 years
- Hysteroscopy for suspected polyp, node, synechiae
- PAP test for spotting after intercourse
The cycle journal is the most underrated tool. Three to four months of records of the duration, severity, and associated symptoms often provide the physician with more information than several tests.
Treatment
- Treatment is aimed at the cause, and not at “normalizing the cycle” itself
- Correction of thyroid function and prolactin levels
- Normalization of body weight with its deficiency or excess
- Combined hormonal contraceptives for cycle regulation
- Progesterone preparations in courses
- Intrauterine hormonal system - very effective for heavy menstruation
- Tranexamic acid to reduce blood loss
- Non-steroidal anti-inflammatory drugs - reduce both pain and blood loss
- Iron supplements for anemia are a must
- Hysteroscopic removal of polyps and submucosal nodes
- Endometrial ablation for heavy bleeding in women not planning pregnancy
- Surgical treatment of fibroids when indicated
- Emergency bleeding control in case of massive blood loss
When to contact immediately
- The gasket gets wet more often than an hour for several hours in a row
- Bleeding is accompanied by weakness, dizziness, darkening of the eyes
- Any bleeding after menopause
- Bleeding during confirmed or possible pregnancy
- Bleeding with lower abdominal pain and fever
- Delayed menstruation with pain and positive pregnancy test
Where to get examined in Tashkent
An ultrasound, hormonal laboratory and, in case of bleeding, the ability to perform an endometrial biopsy and hysteroscopy are required.
In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
Before your visit, keep a cycle diary for at least two to three months: dates, duration, abundance, pain, additional symptoms. This simple action significantly speeds up the diagnosis. Clinic contacts are below.
