Heavy periods Possible causes

What is the menstrual cycle and what is its norm?

The menstrual cycle is a cyclic change in a woman’s reproductive system that occurs under the influence of the sex hormones estrogen and progesterone. In the first half of the cycle, preparations are made for possible conception. In the second half, if conception does not take place, the body prepares to reject the unfertilized egg. Then comes menstruation. Menstruation refers to repeated uterine bleeding that lasts several days. During this period, along with menstrual blood, an unfertilized egg, endometrial particles and mucous secretions of the cervix leave the body.

Reference! The endometrium is the inner mucous membrane of the cervix. At the end of each menstrual cycle, it is renewed: the old one is rejected and comes out during menstruation, and young cells take its place.

The duration of the cycle can vary, but normally it is from 21 to 35 days.

Reference! In adolescents, the menstrual cycle has not yet become established, so the norm is a duration of 21 to 45 days. And some women have a very long, genetically determined menstrual cycle. In their particular case, it is considered the norm. As a rule, in this case, other women in the family also have a long cycle.

On average, menstruation lasts 3–5 days. The normal duration is 2 to 7 days. On average, between 40 and 100 ml of blood are released during menstruation.

The beginning of the cycle is considered the first day of menstruation, the end is the day preceding the next menstruation. The cycle is divided into 2 phases:

1. Follicular - an egg matures in one of the ovarian follicles.
2. Luteal - the follicle turns into the corpus luteum, which synthesizes progesterone, which is necessary to prepare the body for a possible pregnancy; if fertilization of the egg does not occur, the corpus luteum is destroyed.

Between these two phases, in the middle of the cycle (for example, if its duration is 28 days, then on 14), ovulation occurs. A mature egg leaves the follicle and is ready for fertilization.

Birth control pills

If you are taking hormonal birth control pills, it is possible that your menstrual cycle will be significantly different from normal. Very often, the duration of cycles when taking birth control pills increases significantly. Some pills do not have this effect. Menstruation occurs as usual, but most often it is lighter and shorter. It is also worth noting that in very rare cases the pill may not prevent pregnancy, especially if it is missed. However, even if you took the pills accurately and correctly, if your period is late and you are worried about it, you can take a pregnancy test to calm down.

Nowadays you can find a fairly large number of different birth control pills on sale. Some of them may differ significantly in their effects on the body. In addition, it is worth noting that each individual woman can react differently to the same pills.

Also, keep in mind that when you stop using birth control pills, you may not have a normal menstrual cycle right away. For most women, the recovery period takes from one to two months, and sometimes this period can last up to six months. Only then will you be able to conceive a child again. Accordingly, during the recovery period you may also have an irregular cycle, and this must be taken into account if you have a delay.

What is considered a menstrual disorder?

• Delay of menstruation by more than 10 days.
• Shortening the cycle by 5-7 days.
• Increase or decrease in the volume of menstrual flow.
• Accompanying menstruation with deterioration of well-being and/or severe pain.
• Discharge of blood outside of menstruation (minor bleeding during ovulation is part of the norm).
• Complete cessation of menstruation before menopause.
• Uterine bleeding during menopause.

Reference! In order for a change in a cycle to be called a violation, it must be repeated over several cycles. Situational, that is, single changes (increasing or shortening the cycle by 5-7 days) are not violations and are considered a type of norm.

Examinations for delayed menstruation

To find out the reasons for the delay in menstruation, the following studies are prescribed:

1. Examination for sexually transmitted diseases (gonorrhea, chlamydia, trichomoniasis, mycoplasmosis, ureaplasmosis, etc.).
2. Ultrasound of the pelvic organs, thyroid gland and adrenal glands. This study is carried out to exclude pregnancy, tumors, gynecological and endocrine diseases.
3. Examination of the pituitary gland (radiography, magnetic resonance imaging, computed tomography, electroencephalography). Diseases of the pituitary gland are quite often the cause of delayed menstruation.
4. Hormonal studies. The levels of estrogen, progesterone, FSH, LH, PRL are determined, as well as thyroid and adrenal hormones.
5. Curettage of the inner layer of the uterus and its further histological examination. Curettage is performed from the cavity and canal of the cervix.

NMC classification

Violations are classified:

• By duration.
• Cyclicality.
• The amount of blood released.
• Impact on well-being.

The following disorders are distinguished by cyclicity:

• Opsomenorea – infrequent periods, the menstrual cycle is longer than 35 days.
• Proyomenorrhea – frequent periods, menstrual cycle less than 21 days.
• Spaniomenorea – very rare menstruation, no more than 4 times a year.
• Amenorrhea is the complete absence of menstruation for six months or more.

According to duration, failures are divided into 2 types:

• Oligomenorrhea – periods are too short, less than 2 days.
• Polymenorrhea is an excessively long menstruation, from 8 to 12 days.

Based on the amount of blood released, there are:

• Hypomenorrhea – very scanty periods.
• Hypermenorrhea – heavy menstrual bleeding.

Based on their effect on well-being, NMCs were previously divided into several types:

• Algomenorrhea – deterioration of the general condition (nausea, headache, vomiting, etc.).
• Dysmenorrhea – pain in the lower abdomen without deterioration in overall health.
• Algodismenorrhea – pain in the lower abdomen combined with poor condition.

Nowadays, all of the above disorders are called dysmenorrhea. There is also a condition known as PMS - premenstrual syndrome. It is expressed by irritability, mood swings, depression, anxiety, swelling, headaches, and discomfort in the mammary glands.

Reference! PMS occurs in 20-25% of women. In 5% it is severe.

Hemorrhagic metropathy is also a menstrual disorder. This is abnormal uterine bleeding that is not caused by the usual causes for abnormal uterine bleeding (gynecological diseases, systemic pathologies, pregnancy or its complications, hormonal disorders, medications, etc.). It occurs due to the fact that in the second phase of the menstrual cycle the follicle does not transform into the corpus luteum. Then it reverses or degenerates into a cyst. Without progesterone, which the corpus luteum is supposed to produce, the old endometrium remains in place and becomes filled with blood. Later, it is still rejected, but not completely. In the absence of the corpus luteum, excess estrogen secretion occurs, under the influence of which the endometrium grows. Due to malnutrition, degenerative processes occur in it with tissue death, accompanied by bleeding. Most often, abnormal uterine bleeding develops in adolescents (20%) of cases and in women over 45 years of age (50% of cases).

Causes of NMC

In most cases, disorders occur due to hormonal changes. Failure can be caused by an imbalance not only of female sex hormones, but also of other hormones. The functioning of the hormonal system can be influenced by many factors. They can be roughly divided into three categories:

• Pathological.
• Medication.
• External (physiological).

Pathological factors include :

• Ovarian diseases, recovery period after ovarian surgery.
• Disruption of the hypothalamic-pituitary system.
• Endometrial pathologies: endometriosis, polyps.
• Oncological diseases of the female reproductive system.
• Diseases of the liver, kidneys.
• Chronic inflammatory processes in the uterus.
• Pathologies of the nervous system.
• Severe infectious diseases.
• Consequences of a poorly performed abortion.

Reference! NMCs can also occur due to a malfunction of the blood coagulation system.

List of medications that can affect the menstrual cycle:

• Hormonal contraceptives.
• Anticonvulsants.
• Anticoagulants (blood thinning medications).
• Glucocorticosteroids.
• Tranquilizers.
• Antidepressants.
• Preparations of Dilantin and Digitalis.

Reference! Menstrual irregularities can occur in women who have an intrauterine device installed.

External (physiological) factors include:

• Frequent stress.
• Abrupt climate change.
• Poor nutrition or change in diet.
• Lack of sleep.
• Lack of fresh air.

Stress and physical activity

The most common causes of missed periods, besides pregnancy, are various nervous tensions, stress, and the like. Difficult work environment, exams, family problems - all this can cause a delay. A woman’s body perceives stress as a difficult life situation in which a woman should not give birth yet. It is worth taking care of changing the situation: contact a family psychologist, change jobs, or learn to relate to the situation more simply, and the like. Keep in mind that overwork and lack of sleep are also very stressful for the body.

Excessive exercise also does not contribute to the regularity of the menstrual cycle. It is known that professional athletes often experience problems with delayed periods and even with childbearing. The same problems plague women who take on physically demanding jobs. It's better left to men.

But don’t think that moderate exercise or morning jogging can affect the situation. An active lifestyle has never bothered anyone. We are talking specifically about excessive loads under which the body works for wear and tear.

Features of menstrual cycle disorders in women of different ages

In adolescence, menstrual irregularities are observed in many patients. The cycle is established within several years after the onset of the first menstruation. During this period, “jumps” are possible - the amount of discharge, the length of cycles and menstruation, etc. may differ. If the cycle is established, and after this, disturbances occur again, you need to consult a doctor.

Reference! The age at which teenage girls begin menstruation depends on many factors. In women of the European race, the first menstruation is most often observed at 12-13 years of age. However, the onset of menstruation at 10-11 or 15 years old can also be a type of norm. If a girl reaches 14 years of age and has not yet had her period, it is recommended to consult a doctor.

In women 20-40 years old, the cycle is usually predictable and stable. It may change when changing hormonal contraceptives. In other cases, menstrual irregularities may be caused by gynecological and systemic diseases.

After 40 years, hormonal changes begin - the body prepares for menopause. The ovaries produce less and less estrogen. This can cause menstrual irregularities:

• Irregularity of menstruation.
• Scarcity or abundance of discharge.
• Cycle reductions.

Also common causes of NMC at this age are fibroids, cysts, and disruptions of the endocrine system.

If a woman has not entered menopause at age 50, she will continue to have periods, but the intervals between them will become longer and longer.

Reference! In some patients, at 50-55 years of age, the menstrual cycle is still stable. This is not a deviation, but since the body produces a large amount of female sex hormones, you should be especially careful about disease prevention and regularly visit a mammologist and gynecologist.

Is treatment necessary?

To find out why the discharge occurs frequently, you should go to the clinic and undergo an examination. If a woman keeps a menstrual calendar, it is better to take it to the appointment, so the doctor can see changes in the cycle.

Frequent periods are not a disease, but the body’s reaction to problems in it. To identify diseases, you need:

• gynecological examination;
• general blood analysis;
• vaginal smear;
• blood test for hormones (if necessary).

The gynecologist can refer you for additional consultation to other specialists - mammologist, endocrinologist.

Treatment tactics depend on the cause. For inflammatory diseases, antibacterial drugs and vitamins are prescribed; for endometriosis, fibroids, and cysts, hormonal therapy is required.

If premature periods were sporadic and come on time in subsequent cycles, the failure may have been caused by stress or lack of sleep. Rest, sleep patterns, and sedatives will restore the body’s functioning.

We recommend reading the article about the reasons for short periods. From it you will learn about the causes of short menstruation in adolescents, during pregnancy, in women after childbirth, at the onset of menopause, as well as the need to consult a doctor.

Why do I have pink discharge a week before my period? Read here.