A balanced menstrual cycle is crucial for women’s reproductive health. The menstrual cycle indicates the physiological as well as pathological changes occurring in the body. To understand the balanced and regular menstrual cycle, one should know the normal cycle length, amount of bleeding in each cycle and frequency at which the cycles are occurring.
A normal menstruation is the complex phenomenon, which involves the uterus, ovaries and the endocrine system. The hypothalamic gland releases GnRH (gonadotropin-releasing hormones) which stimulates the pituitary gland to produce LH (luteinizing hormones) and FSH (follicle stimulating hormone) to stimulate the ovaries, which release estrogen and progesterone. The endometrial lining of uterus prepares itself for the implantation of fertilized ovum. If the oocyte (an egg released from the ovary) is not fertilized, with male sperm, it is shed along with the endometrial lining in the form of menstrual blood flow.
Interval Between Healthy Cycles:
The length of a normal menstrual cycle is between 21 to 35 days. If the woman is having long cycles (oligomenorhea) or frequent cycles (polymenorrhea), both conditions are abnormal and show abnormality either in hormonal system or in anatomical structure of reproductive system.
Polymenorrhea is a dysfunctional bleeding, in which bleeding occurs earlier than 21 days. Although the bleeding is regular in amount, but the cycles become too short.
Causes of Frequent Periods:
The causes of frequent periods are as follows:
- Hormonal irregularities
- Thyroid dysfunction
- Liver disorder
- Hemorrhagic disorders, excessive bleeding at puberty may be the first manifestation of idiopathic thrombocytopenic purpura
- Uterine Tuberculosis
- Cervical polyps
- Uterine fibroids
- Malignancies of cervix, uterus, ovary, sarcoma
- Sexually transmitted diseases
- Endometriosis and pelvic diseases
- Adrenal dysfunction
- Excessive exercise or poor nutrition
Various drugs also cause frequent menstruation such as anticoagulants, corticosteroids, hormone replacement and oral contraceptive pills.
What Investigations are Essential?
If the condition persists, an expert medical advice should be taken to treat the condition. Your doctor would advise different investigations, in order to make an appropriate diagnosis.
Transvaginal ultrasonography or hysterography is useful in the diagnosis of frequent uterine bleeding, to see the pelvic pathology. A diagnostic curettage of endometrium is also done to evaluate the risk of endometrial cancer. Hormonal essays are done to see the levels of FSH, LH, Serum Progesterone, prolactin, TSH (Thyroid stimulating hormone) or fasting insulin level to rule out ovarian and pituitary dysfunction as well as Polycystic ovaries. Evaluation of liver function test, platelet count and hemoglobin are also important.
If there is no uterine pathology, medical treatment is preferred over surgical options as a primary treatment.
Acute management: In acute dysfunctional bleeding, estrogen is a drug of choice. It can be given as an emergency measure. Ten mg a day in four divided doses can stop bleeding in 24 hours.
OCPs containing 35 micrograms or less of ethinyl estradiol, can be taken as four tablets per day. Taken for one week after bleeding stops.
Long-term management of frequent cycles: Combination OCPs are best for the long-term management. These are taken as one tablet per day for 21 days.
Progestins are indicated for the anovulatory women. Ten mg daily medroxyprogesterone therapy should be taken for 10 days each month.
NSAIDs (non-steroidal anti-inflammatory drugs) can reduce bleeding in women having normal ovarian functions. Other drugs helpful in controlling abnormal bleeding are danazol, GnRH agonists, Progesterone releasing IUD, tranexamic acid, para-aminomethybenzoic acid.
Surgical options for the treatment of frequent uterine bleeding include hysteroscopy for the removal of cervical polyps and fibroids, endometrial Nd:YAG laser ablation and hysterectomy (removal of uterus). A wide variety of ablative techniques has been used.
These techniques include: Nd:YAG laser ablation, electrosurgery, heated saline, cryotherapy and microwave.
Frequent periods can cause infertility and several other health issues. Therefore, it must be taken seriously to rule out the underlying pathologies, so that a prompt action can be taken to treat the condition.