Menstrual irregularity is defined as bleeding outside normal menstruation. In a normal menstrual cycle, regular bleeding occurs for 3-7 days at intervals of 21-38 days. The amount of blood lost is between 30-40ml. This amount is considered normal. Irregular bleeding includes bleeding outside of menstrual days, spotting, bleeding after sexual intercourse, and postmenopausal bleeding. Amenorrhea (absence of menstruation) and menorrhagia (excessive bleeding) may also occur during the menstrual irregularity process. Bleeding that is not due to any organic cause such as a medical disease or pelvic pathology (myoma, cyst, polyp, etc.) is called dysfunctional bleeding.
Menstrual irregularity is a common problem. The rate of menstrual irregularity in women of productive age is between 9-30%. For regular menstrual cycles, the hypothalamus, pituitary and ovarian axis must function correctly and the anatomy of the uterus and vagina must be normal.
Causes of Menstrual Irregularity --
1- Endocrine Problems..(thyroid, diabetes, polycystic ovary syndrome, high prolactin etc.)
2- Systemic Diseases..(blood diseases, liver disease, obesity, medications used)
3- Gynecological Problems.. (pregnancy complications, myomas, uterine or cervical polyps, infections, cancer, trauma, intrauterine device)
Causes of Menstrual Irregularity According to Age Evaluation--
The age of onset of complaints is very important in patients with menstrual irregularities. Causes of abnormal bleeding before menarche (first menstrual period) include infection, malignancy, trauma, and sexual harassment and assault.
Menstrual irregularities in adolescence are mostly due to the inability to ovulate regularly as a result of the immature hypothalamic-pituitary axis. While the rate of menstrual irregularity is 85% in the first year after menarche, the rate in the first 4 years is around 56%. However, it should be evaluated whether there are hematological problems in patients with excessive bleeding in this age group.
In women of reproductive age, hormonal, systemic and gynecological reasons for menstrual irregularities should be taken into consideration. The possibility of pregnancy should first be ruled out in these patients. The most common cause of bleeding irregularity after pregnancy in this group is hormonal bleeding. Myoma, polyp, endometrial hyperplasia as you get older i and the carcinoma rate increases. The most common cause is myomas. Patients with bleeding disorders and hormonal disorders must be excluded in the differential diagnosis. Emotional and physical stress and significant body weight changes may disrupt hormonal balance and cause menstrual irregularity. All bleeding occurring in the postmenopausal period should be considered abnormal and investigated unless proven otherwise. It should not be forgotten that other gynecological problems such as infections, benign or malignant tumors and trauma may cause bleeding in this age group. It should also be kept in mind that irregular bleeding in the form of spotting may occur in patients receiving hormone replacement therapy due to menopause.
As a result; Women of all ages, from menarche to menopause, should consult their gynecologist in case of menstrual cycle disorders. Once the cause is determined, the treatment will be chosen according to the cause..
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