Severe Menstrual Irregularities: Causes and Solutions

Irregular and heavy menstruation?

Hello Dr.
Lin, I would like to ask about my severe menstrual irregularities.
Since I started my period in sixth grade until now in my second year of graduate school, my menstrual cycle has never been regular (it often gets delayed for a long time).
There have been a few instances where the flow was very light, and when it is irregular, it can be delayed by several months, with at least a 10-day delay, and in some cases, it has been delayed for up to 4 months (it has been getting worse recently).
I went to a gynecologist and took medication to induce my period, but it did not come, so I received an injection to induce menstruation, which finally worked.
I have also had several ultrasounds at the gynecologist, and everything appeared normal; there were no signs of polycystic ovary syndrome or any other issues.
The gynecologist suggested I get blood tests for endocrine evaluation (including prolactin, thyroid hormones, growth hormone, adrenal cortex hormones, etc.), and the results came back normal as well.
So, I really don’t know what to do anymore.
The ultrasounds showed no problems, and the endocrine values were normal, but my menstrual cycle is still severely irregular, and this has been the case since I started menstruating.

Xiaqi, 10~19 year old female. Ask Date: 2018/11/28

Dr. Lin Manying reply Obstetrics and Gynecology

Dear Miss Hsia,
If the aforementioned examinations (ultrasound, hormone, endocrine tests, etc.) show normal results and your weight is within the normal range, and you do not have a history of chronic mental illness or night shift work, it is most likely that you are experiencing poor ovulation (anovulation or irregular ovulation).
It is recommended that you seek treatment from a gynecologist within 1 to 5 days after the onset of your menstrual period.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2018/11/28

More Info

Understanding severe menstrual irregularities can be a complex issue, particularly when the underlying causes are not immediately apparent. In your case, it seems that you have already taken significant steps by consulting with a gynecologist, undergoing ultrasounds, and having various hormonal blood tests, all of which returned normal results. This can be frustrating, especially when you have been experiencing irregularities since your first menstruation.

Menstrual irregularities can stem from a variety of factors, including hormonal imbalances, lifestyle factors, stress, and underlying medical conditions. Given that your hormonal tests have come back normal, it may be beneficial to explore other potential causes.

1. Hormonal Regulation: Even if your blood tests show normal levels of hormones, the regulation of these hormones can still be disrupted. Conditions such as hypothalamic amenorrhea, where the hypothalamus does not release the hormones necessary for ovulation, can lead to irregular periods. This can be influenced by factors such as stress, significant weight loss, or excessive exercise.

2. Lifestyle Factors: Stress and lifestyle choices can significantly impact menstrual cycles. High levels of stress can lead to hormonal fluctuations that disrupt the regularity of your cycle. Additionally, factors such as diet, exercise, and sleep patterns can also play a role. It may be helpful to evaluate your daily routine and consider stress management techniques, such as mindfulness, yoga, or counseling.

3. Polycystic Ovary Syndrome (PCOS): While you mentioned that you do not have PCOS, it is worth noting that this condition can sometimes be diagnosed based on symptoms rather than ultrasound findings alone. PCOS can cause irregular periods due to an imbalance in reproductive hormones. If you have symptoms such as weight gain, acne, or excessive hair growth, it may be worth discussing this possibility further with your healthcare provider.

4. Thyroid Function: Although your thyroid hormone levels may have been normal, thyroid dysfunction can sometimes be subtle. Conditions like hypothyroidism or hyperthyroidism can lead to menstrual irregularities. If there is any doubt, a more comprehensive evaluation of thyroid function, including TSH, T3, and T4 levels, might be warranted.

5. Other Medical Conditions: Other conditions such as endometriosis or uterine fibroids can also lead to irregular menstrual cycles. Even if these conditions were not identified in your ultrasounds, it may be worth discussing further evaluation or a second opinion with a specialist.

6. Age and Developmental Factors: Since you mentioned that these irregularities have been present since your first period, it is also important to consider that some individuals experience natural variations in their cycles as they transition from adolescence to adulthood. It is not uncommon for cycles to remain irregular for several years after menarche.

In summary, while you have already taken significant steps towards understanding your menstrual irregularities, it may be beneficial to continue exploring potential underlying causes. Consider discussing the possibility of lifestyle factors, hormonal regulation, and other medical conditions with your healthcare provider. Additionally, keeping a menstrual diary that tracks your cycle, symptoms, stress levels, and lifestyle factors can provide valuable insights that may help in diagnosing and managing your condition. If necessary, seeking a second opinion or consulting with a reproductive endocrinologist may also provide further clarity and options for treatment.

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