Our bodies function on a set rhythm, orchestrated by the complex interplay of hormones. In women, this hormonal harmony is fundamental to the reproductive system, especially the menstrual cycle.

The process starts in the ovaries, where hormones trigger the thickening and enrichment of the endometrial layer in the uterus.

This prepares the womb for potential pregnancy every 28 days on average. If no conception occurs, this layer sheds itself to start anew, resulting in the release of blood, known as menstruation.

A menstrual cycle begins on the first day of bleeding and ends at the onset of the next period. Typically, a woman experiences a menstrual cycle ranging between 21 to 35 days. Deviations from this pattern, like intermittent or excessive bleeding, denote menstrual irregularities.

Irregular menstruation can stem from various causes. Inter-menstrual bleeding may occur due to a hormonal dip during ovulation, causing the endometrial layer to lose hormonal support and leading to spotting.

If a patient finds this bleeding unsettling, they should consult a physician immediately. If irregularities are hormone-related, causing severe and painful periods, medical help is essential.

Several conditions may induce menstrual irregularities:

1. Adenomyosis: Overgrowth of the endometrial tissue
2. Ovulation issues
3. Presence of fibroids, polyps, or cysts
4. Usage of hormonal medications
5. Estrogen or other hormonal disorders
6. Infections
7. Malignant growths in the uterus or ovaries

Regular menstrual bleeding typically lasts between 2 to 7 days. The duration from the start of one period to the beginning of the next should ideally be between 21 to 35 days.

Deviations from these parameters qualify as menstrual irregularities. However, such irregularities during puberty or menopausal transitions due to hormonal adjustments are considered normal.

The main symptoms of menstrual irregularity include cycle durations shorter than 21 days or longer than 35 days, periods lasting less than 2 days or more than 7 days, severe bleeding, abdominal pain or cramping, vomiting, constant fatigue, dizziness, anemia, frequent periods or long intervals without menstruation.

When consulted for menstrual irregularity, your doctor will inquire about your medical history followed by a gynecological examination. Ultrasonographic investigations may be performed to visualize the uterus, ovaries, and surrounding structures.

Subsequently, blood tests may be ordered to analyze estrogen, FSH, LH, AMH levels, and other imaging techniques like MRI may be used. Tissue samples may be taken if a growth or thickening of the uterine lining is suspected.

Treatment for menstrual irregularity depends on the underlying cause. If hormonal imbalance is identified, hormone-regulating medications are prescribed. In the presence of organic issues like polyps, hysteroscopy is performed for internal examination, and pathological areas are excised.

For fibroids causing heavy bleeding, treatment varies from removing the fibroids alone to, rarely, total hysterectomy. Adolescents with excessive bleeding may be screened for coagulation disorders and then treated accordingly to restore regular menstruation.

Early or late-onset of menstruation during puberty should be evaluated and treated as per the situation.