Abnormal and irregular periods

Shabnam has been concerned for the past 2 months. She is 41 years old and has always had very regular periods. Surprisingly, in the past two months she has had irregular bleeding. She called her mother this morning for advice. Should she go and see a gynaecologist? Is this something to be worried about?

Women usually settle into a specific pattern of periods by the time they are in their early 20’s. They are accustomed to that pattern and get very concerned if there is any change. It is normal for a period to last from 1- 7 days. Counting from the first day of one period to the first day of the next period, an average cycle lasts about 28 days, but it can be longer or shorter. If the cycle is longer than 35 days or shorter than 21 days, it is considered abnormal.

When the menstrual period is not regular, when bleeding lasts longer than normal, is heavier than normal, or when bleeding patterns change, it is called abnormal bleeding. Bleeding between periods, bleeding after intercourse, or spotting anytime in the menstrual cycle is also abnormal. This requires a checkup with a gynaecologist because abnormal bleeding has a number of causes.

Causes

During puberty, and for the first few years after a girl begins to have periods (around 9–16 years of age), it is common to have irregular cycles because the system is still immature. This usually settles down without intervention.

Between the ages of 35 and 45, it is very common to have changes in the pattern of periods. This happens because in some cycles, the normal process of ovulation gets missed. Closer to menopause, which is commonly around the age of 50, it is normal to skip periods or for the bleeding to become lighter or heavier.

Uterine fibroids and polyps, both of which are non-cancerous growths in the uterus, can cause irregular bleeding. Certain types of cancers, such as cancer of the uterus, cervix, or vagina can also be first suspected because of abnormal bleeding. Medical conditions like thyroid hormone imbalance can also occasionally cause irregular bleeding. Very rarely, in young girls, abnormal bleeding can be caused by disorders in their blood clotting mechanisms.