Irregular Menstrual Cycles: Causes and When to Seek Help

Irregular menstrual cycle?

Hello Dr.
Li: My menstrual cycle has always been regular, occurring approximately every 23 to 25 days, with a normal blood flow lasting about 5 days and no menstrual cramps.
However, the last two cycles have shown some unusual changes.
In the past two months, my menstrual flow suddenly increased significantly, accompanied by large blood clots, abdominal discomfort, and dizziness upon standing.
The duration of my period has also lengthened, with spotting occurring in the following days.
In my most recent cycle, it was only 18 days since the last one, starting with spotting for the first two days, and normal flow on the third day.
I would like to ask the doctor what might be the issue? Is it related to the uterus or hormones? When should I see a doctor, during my period or after it ends?

Gloria, 40~49 year old female. Ask Date: 2010/05/12

Dr. Li Guanghan reply Obstetrics and Gynecology

You have irregularities in your menstrual cycle, as well as abnormalities in menstrual flow and sensations.
It is advisable to come in for an examination, preferably after your period ends.
Thank you!

Reply Date: 2010/05/12

More Info

Irregular menstrual cycles can be concerning, especially when there are significant changes in flow, duration, and associated symptoms. Based on your description, it seems that you have experienced a notable shift from your previously regular menstrual cycle of 23 to 25 days to cycles that are now irregular, with increased bleeding and discomfort.
There are several potential causes for these changes in your menstrual cycle:
1. Hormonal Imbalances: The menstrual cycle is regulated by a complex interplay of hormones, including estrogen and progesterone. Any disruption in the hormonal balance can lead to irregularities in the cycle. Factors such as stress, significant weight changes, excessive exercise, or underlying health conditions can affect hormone levels.

2. Uterine Conditions: Conditions such as fibroids, polyps, or adenomyosis can lead to heavier menstrual bleeding and changes in cycle length. These conditions can cause the uterus to shed its lining more aggressively, resulting in larger blood clots and increased pain.

3. Thyroid Issues: Both hyperthyroidism and hypothyroidism can lead to menstrual irregularities. The thyroid gland plays a crucial role in regulating metabolism and hormonal balance, and any dysfunction can manifest in menstrual changes.

4. Polycystic Ovary Syndrome (PCOS): This condition is characterized by hormonal imbalances and can lead to irregular periods, heavier bleeding, and other symptoms such as weight gain and acne.

5. Other Medical Conditions: Conditions such as endometriosis, pelvic inflammatory disease, or even certain blood disorders can also lead to changes in menstrual patterns.

Given your symptoms of increased bleeding, the presence of blood clots, abdominal pain, and dizziness, it is essential to seek medical attention. These symptoms could indicate a more serious underlying issue that requires evaluation.

When to Seek Help
You should consider seeing a healthcare provider if you experience any of the following:
- Heavy Bleeding: Soaking through one or more pads or tampons every hour for several consecutive hours.

- Blood Clots: Passing large clots (larger than a quarter) consistently.

- Severe Pain: Experiencing significant abdominal pain or cramping that is not relieved by over-the-counter pain medications.

- Dizziness or Fainting: Feeling lightheaded or faint, especially if it occurs during your period.

- Changes in Cycle: Any significant changes in your menstrual cycle that are different from your normal pattern.

Timing of the Appointment
It is generally advisable to see a healthcare provider during your menstrual period if you are experiencing heavy bleeding or severe symptoms. This allows the provider to assess your condition while you are symptomatic. However, if your symptoms are manageable, you can also schedule an appointment after your period ends to discuss your concerns and undergo any necessary evaluations, such as blood tests or imaging studies.

In conclusion, while some variations in menstrual cycles can be normal, the changes you are experiencing warrant further investigation. A healthcare provider can help determine the underlying cause and recommend appropriate treatment options. It is essential to prioritize your health and seek medical advice to ensure that any potential issues are addressed promptly.

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