Irregular Menstruation: Causes, Treatments, and Fertility Impact

Menstrual irregularities

Hello Doctor, my menstrual cycle used to be 37 days, but in recent years, I often experience one or two months without a period.
When it does come, it lasts for about 20 days and I have to take medication to stop it.
From June to August this year, I visited a gynecologist for menstrual regulation due to heavy bleeding with clots.
However, three months after the treatment, I still did not have my period in September and October, so I went to see a traditional Chinese medicine practitioner.
My period started on November 25 and has not stopped since, with clots present.
I experienced a similar situation in February, where a urine test indicated that my ovarian function was not optimal.
I also did not have my period in March and April, and on May 16, my period came and I went to the gynecologist on June 6 to get a three-month prescription (progesterone and estrogen) for menstrual regulation.
I would like to ask: 1.
Should I go back to the doctor for medication to stop the bleeding, or should I let it stop on its own? 2.
Will this affect my ability to conceive in the future? 3.
I am overweight; will losing weight help improve this condition?

Zi, 20~29 year old female. Ask Date: 2017/12/18

Dr. Huang Jianzhong reply Obstetrics and Gynecology

My menstrual cycle occurs every 37 days, but in recent years, I often experience one or two months without a period.
When it does come, it lasts for about 20 days and only stops with medication.
From June to August this year, I consulted a gynecologist for menstrual regulation due to heavy bleeding with clots.
However, three months after the treatment, I still did not have my period in September and October, so I went to see a traditional Chinese medicine practitioner.
My period started on November 25 and has not stopped since, accompanied by clots.
I experienced a similar situation in February, where a urine test indicated that my ovarian function was not optimal.
I also missed my period in March and April, and on May 16, my period started and I went to the gynecologist on June 6 to get a three-month supply of medication (progesterone and estrogen) for menstrual regulation.

I would like to ask:
1.
Should I go back to the doctor to get medication to stop it, or should I let it stop on its own?
Answer: You should go back to the doctor to get medication.

2.
Will this affect my ability to conceive in the future?
Answer: Yes, it may affect your ability to conceive in the future.

3.
I am overweight; will losing weight improve this condition?
Answer: Yes, losing weight can improve this condition.

Reply Date: 2017/12/18

More Info

Irregular menstruation is a common issue that can significantly impact a woman's health and fertility. Understanding the causes, treatments, and potential effects on fertility is crucial for managing this condition effectively.

Causes of Irregular Menstruation
Irregular menstruation can stem from various factors, including hormonal imbalances, lifestyle changes, medical conditions, and stress. Common causes include:
1. Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) can lead to irregular cycles due to an imbalance in estrogen and progesterone levels.

2. Thyroid Disorders: Both hyperthyroidism and hypothyroidism can disrupt menstrual cycles.

3. Stress and Lifestyle Factors: High stress levels, significant weight changes, excessive exercise, or poor diet can affect the hypothalamus, which regulates the menstrual cycle.

4. Medications: Certain medications, including hormonal contraceptives and some psychiatric medications, can alter menstrual patterns.

5. Underlying Health Conditions: Conditions like endometriosis, fibroids, or pelvic inflammatory disease can also lead to irregular bleeding.

Treatments for Irregular Menstruation
The treatment for irregular menstruation often depends on the underlying cause. Here are some common approaches:
1. Hormonal Therapy: Birth control pills, hormone replacement therapy, or medications like progesterone can help regulate the menstrual cycle.

2. Lifestyle Modifications: Weight loss, a balanced diet, and regular exercise can improve hormonal balance, especially in overweight individuals.

3. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage heavy bleeding, while other medications may be prescribed to address specific conditions like PCOS or thyroid disorders.

4. Alternative Therapies: Some women find relief through acupuncture or herbal remedies, although these should be approached with caution and ideally discussed with a healthcare provider.

Impact on Fertility
Irregular menstruation can affect fertility, primarily because it may indicate anovulation (lack of ovulation). If ovulation does not occur, conception becomes challenging. However, many women with irregular cycles can still conceive, especially if they are able to identify their fertile window through methods such as tracking basal body temperature or using ovulation predictor kits.

Addressing Your Concerns
1. Medication Management: Given your history of prolonged menstruation and the presence of blood clots, it is advisable to consult your healthcare provider before making any decisions about stopping or continuing medication. They can assess your current situation and determine the best course of action, which may include adjusting your medication or exploring other treatment options.

2. Fertility Considerations: Irregular cycles can impact your fertility, but it is essential to work with your healthcare provider to monitor your ovulation and overall reproductive health. If you are considering pregnancy, they may recommend fertility assessments or treatments to enhance your chances of conception.

3. Weight Management: Being overweight can contribute to hormonal imbalances, which may exacerbate irregular menstruation. Losing weight through a combination of a healthy diet and regular exercise can help restore regular cycles and improve overall reproductive health. Even a modest weight loss of 5-10% can make a significant difference in menstrual regularity and fertility.

Conclusion
Irregular menstruation can be a complex issue influenced by various factors, and it is essential to approach it with a comprehensive understanding of its causes and treatments. Regular consultations with your healthcare provider can help you navigate this condition effectively, ensuring that you receive the appropriate care tailored to your specific needs. If you have concerns about your menstrual health or fertility, do not hesitate to seek professional advice to explore your options and develop a suitable management plan.

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