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1.

CASE
A 28 year old nulliparous woman presents for evaluation of irregular
menstrual cycles for the past year. Her periods come only every 2 or 3
months and she has gone as long as 4 months without a period. Currently,
she gives a last menstrual period of 11 weeks ago. She says she had
menarche at age 13 years and that her cycles have been mostly regular,
usually occurring every 30 days, but she would miss a cycle several times
a year. She has never been on hormonal contraception. She does not
smoke, does not drink alcohol, and does not exercise. She is sexually
active with single partner and uses condoms for contraception. On review
of systems, she reports a 30 1b weight gain in the past 18 month, but
otherwise has felt fine. On examination, she is noted to be obese, with a
body mass index of 30. Her vital signs are otherwise normal. She has fine
hair growth on her face and a velvety thickening of the skin on her neck.
Her general physical examination is normal. A pelvic examination reveals
normal external genitalia, no vaginal or cervical discharge, no cervical
motion tendernees, and no uterine or adnexal masses.

2. KEYWORD
1.
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3.
4.
5.
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A 28 year
The last menstrual period of 11 weeks ago
Menarche at age 13 years
Her cycle have been mostly regular
Does not smoke, does not drink alcohol, and does not execise.
Body mass index of 30
Fine hair growth on her face
General examination is normal
No vaginal or cervical discharge

3. THEORY

Irregular cycles or irregular periods is an abnormal variation in length of


menstrual cycles in a female. A textbook period happens every 24-29
days, but in truth what is regular covers a wide range. Cycles
between 23-35 days are very common. A woman may get her period
only one to four times a year. Or she might have periods that occur 2-3
times in a month and involve spotting or extremely heavy flow.
Alternatively, she may have heavy episodes of bleeding every 2-3
months. Irregular periods are simply what is irregular for you.

4. ANALYSIS
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4.1 Clinical Approach


Menstruation irregularly cycles

4.2 Definition
Irregular cycles or irregular periods is an abnormal variation in length of
menstrual cycles in a female. A textbook period happens every 24-29
days, but in truth what is regular covers a wide range. Cycles between
23-35 days are very common. A woman may get her period only one to
four times a year. Or she might have periods that occur 2-3 times in a
month and involve spotting or extremely heavy flow. Alternatively, she may
have heavy episodes of bleeding every 2-3 months. Irregular periods are
simply what is irregular for you.
For the most part, we dont worry at the clinic about a missed period or two
over the course of a year. More variation than that may indicate to us the
beginning of perimenopause or a disruption of the natural chain of
hormonal events that controls menstruation.

4.3 Etiology

While menstruation is orchestrated by many hormones, progesterone and


estrogen are the primary hormones responsible for irregular periods :
-

Estrogen
Estrogen is responsible for thickening the uterine lining before
ovulation

Progesterone
Progesterone is responsible for trigerring the sed of the uterine
contens after ovulation when fertilization hasnt occurred

Other causes of irregular periods :


Health Condition
- Eating disorders
- Polycystic ovarian syndrome
- Uterine abnormalities ( fibroids,
-

cysts,

polyps,

and

endometriosis)
Irritable bowel syndrome
Tuberculosis
Liver disease
Diabetes
Cancer
Anemia
Thyroid dysfunction

Lifestyle Triggers
- Significant weight gain / loss
- Over exercise
- Poor nutrition
- Smoking
- Drug use
- Caffeine
- Excessive alcohol use
- Medication use
- Breastfedding
- Increased stress
When we are stressed, regardless of the source (danger, personal
relationships, work, environment) our adrenal glands are designed to
secrete the hormone cortisol (read more in our articles in our Adrenal
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Health section). Cortisol has a direct impact on the sex hormones


estrogen, progesterone, and DHEA. Eating disorders, dieting, drug use,
and reliance on stimulants like caffeine and alcohol are also interpreted by
the body as kinds of stress. Poor nutrition seems to physically change the
proteins in the brain so they can no longer send the proper signals for
normal ovulation.

4.4 Patofisiology
Estrogen and progesterone disorder

Disturbed body chemical processes

deficit vit B6

impaired serotonin production

menstruation irregularly cycles

4.5 Period Irregular


A normal menstrual cycle lasts 28 days, plus or minus seven days.
Menstrual bleeding is considered irregular if it occurs more frequently than
every 21 days or lasts longer than 8 days. Missed, early, or late periods
are also considered signs of an irregular cycle.
To determine whether your menstruation schedule is irregular, count from
the last day of your previous period and stop counting on the first day of

your next. Repeat this for three months. If the number of days between
stopping and starting your period is significantly different each month, you
have an irregular cycle.

4.6 Signs And Symptoms


The primary sign of menstruation is bleeding from the vagina.
Additional symptoms include :

Food cravings

Mood swings and irritability

Headache and fatigue


Irregular periods are often one of the first signs that a woman is

approaching menopause. Though the exact symptoms of irregular


periods vary depending on a woman's unique cycle, most women will
experience irregular periods for three to ten years before periods stop
completely. In fact, only 10% of women reach menopause without any
irregular periods.
As

menopause

approaches,

women's

hormones

become

imbalanced, and because the menstrual cycle is entirely dependent


upon hormones, irregular periods often occur. Keep reading to learn
more about irregular periods and their symptoms, common causes, and
treatment options.
Irregular periods are essentially characterized by what is irregular
for each individual woman. However, there are specific symptoms that can
help determine if irregular periods are occurring.

4.7 Common Symptoms

Infrequent/too frequent periods

Abnormal duration of bleeding

Changes in blood flow

Blood clots

Missed periods

Painful cramping

4.8 Clasification
Other types of conditions that can be referred to by "irregular
menstruation" include:

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Metrorrhagia, which generally refers to vaginal bleeding that


occurs between the expected menstrual periods.[4] The distinction
between irregular cycle lengths and metrorrhagia is not always
clear, and may depend on whether the bleeding is regarded as
marking the menstrual period (favoring the term "irregular cycles")
or being separate from it (favoring the term "metrorrhagia").

Oligomenorrhea generally refers to infrequent menstruation, [3]


More strictly, it is menstrual periods occurring at intervals of greater
than 35 days, with only four to nine periods in a year. [3] Also,
menstrual

periods

should

have

been

regularly

established

previously before the development of infrequent flow.[3] and often


(but not always) involves irregular intervals. In contrast to "irregular
cycles", the interval between one cycle and the next may still be
consistent, but can still be regarded as "irregular" compared to the
cycle length of a female without oligomenorrhea. Still, females with
oligomenorrhea often have irregular cycles as well.

Polymenorrhea is the medical term for cycles with intervals of 21


days or fewer. This can be regarded as the opposite of
oligomenorrhea.

4.9 Complications
For most women, an irregular period is nothing to be worried about; the
majority of women will eventually develop a regular cycle with regular
periods. Sometimes though, underlying complications can be the cause of

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these period problems. If you are noticing particularly irregular periods, or


have gone a year or more with missed periods, see your health care
professional. If you experience extreme cramping, heavy period bleeding,
dizziness, nausea, or fainting you should also visit with your health care
provider.

4.10 Medical treatment


Treatment of irregular periods depends on the cause and your desire to
have children in the future. Irregular periods can be caused by many
different things. Changes in your body's level of the hormones estrogen
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and progesterone can disrupt the normal pattern of your period. That's
why young girls going through puberty and women approaching
menopause commonly have irregular periods.
Other common causes of irregular periods include:

Having an intrauterine device (IUD)

Changing birth control pills or using certain medications

Excessive exercise

Polycystic ovary disease (PCOS)

Pregnancy or breastfeeding

Severe scarring (adhesions) of the lining of the uterus, a condition


known as Asherman syndrome

Stress

Overactive thyroid or hyperthyroidism

Thickening of or polyps on the uterine lining

Uterine fibroids

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4.11 How Are Irregular Periods Treated?


Usually, no treatment is needed for irregular periods caused by puberty
and menopause unless they are excessive or bothersome. It is also
normal for your period to stop when you are pregnant.
Treatments for irregular periods due to other causes may include:

Correcting or treating underlying disease

Changing your type of birth control

Lifestyle changes, including weight loss

Hormone therapy

Surgery

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4.12 Prevention and Treatment of Irregular Periods

If stress is a possible culprit in your irregular cycle, try stress


management techniques, such as meditation, yoga, tai chi,
visualization, and biofeedback. Avoid over-exercising and try not to
diet excessively, as doing so can interfere with your menstrual
cycle.

Oral contraceptive pills may be prescribed to get your period back


on track. But if youd rather travel the natural treatment road,
consider black cohosh. This medicinal herb is sometimes used for
menstrual

irregularities and

premenstrual

syndrome,

though

rigorous scientific studies havent verified these properties. Black


cohash should not be used if you have any symptoms of or a past
history of liver disease.

You may have heard that completely darkening your room at night
will help regulate menstrual cycles but whether it really works is
unknown.

A couple of irregular periods per year are usually nothing to worry


about. Any more than that, and you should see a doctor to be sure
an ovulation problem or health condition isnt the cause. However,
you might want to rule out pregnancy first. If youve had sexual
relations in the past month, take a home pregnancy test first,
advises Autry. If the test is negative, then you can explore other

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options and talk to your doctor about how to get your menstrual
cycle back on track.

5.

Conclusion

If you are overweight, weight loss may be all the treatment you need. A
small amount of weight loss is likely to help balance your hormones
and start up your menstrual cycle and ovulation.

Eat a balanced diet that includes lots of fruits, vegetables, whole

grains, and low-fat dairy products.


Get regular exercise to help you control or lose weight and feel

better.
If you smoke, consider quitting. Women who smoke have higher

levels of androgens than women who don't smoke.


For more information, see Home Treatment.
Hormone therapy
If weight loss alone doesn't start ovulation (or if you don't need to
lose weight), your doctor may have you try a medicine such

as metformin orclomiphene to help you start to ovulate.


If you aren't planning a pregnancy, you can also use hormone
therapy to help control your ovary hormones. To correct menstrual
cycle problems, birth control hormones keep your endometrial

lining from building up for too long. This can prevent uterine cancer.
Hormone therapy also can help with male-type hair growth and
acne. Birth control pills, patches, or vaginal rings are prescribed for
hormone therapy. Androgen-lowering spironolactone (Aldactone) is

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often used with combined hormonal birth control. This helps with
hair loss, acne, and male-pattern hair growth on the face and body

(hirsutism).
You can use other methods to treat acne and remove excess hair.
For more information, see Home Treatment.

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