Dear Doctor, I have irregular menses. My periods come every two weeks and the flow is heavy and lasts for over a week. I have never gone for check-up but I am starting to worry if this could be a medical condition that needs urgent attention. Kate Dear Kate, What is your age? For how long have you been having irregular periods? The duration and flow pattern of menstrual periods depends on the changing balance of hormones estrogen and progesterone, and also genetic factors. Normally during puberty, when menses start, they may be irregular for 4 to 6 months, following which a regular pattern sets in. This is the time taken for the hormonal equilibrium to be set. Menses become irregular around menopause as well. For months or even 1 to 2 years, menses become irregular and then stop altogether in middle aged women. The flow and duration of menses is also influenced by genetic makeup of an individual. Stress, anxiety, recent weight loss or weight gain can affect the hormonal balance governing menstruation, resulting in irregular menses with or without heavy flow. Heavy bleeding may be due to miscarriage during early pregnancy. It may occur as early as a pregnancy occurs, when it has not been tested. Other hormonal disorders like that of pituitary, thyroid gland, adrenal glands, can cause irregular periods as a manifestation in women. Prolonged use of steroids can affect the hormonal balance altering normal menstrual cycle. Simple measurement of blood levels of these various hormones can help identify any abnormality present. Treatment done will help menses to revert to being regular and normal. Blood thinning drugs like aspirin can cause heavy bleeding from any site, including menstrual bleeding as a side effect. One can have irregular menses and a heavy flow due to diseases of the uterus. Any infection or inflammation of the inner lining of the uterus alters the balance of hormones resulting in change in duration and pattern of flow of menstrual cycles. There would be associated pain in lower abdomen with or without fever, nausea, vomiting. Any such existing infection can be detected by blood test like full blood count and a pelvic ultrasound. Treatment is by suitable antibiotic and anti-inflammatory drugs. Sinister diseases like cancer of the uterus, either primary or spreading from cervix or ovary, may alter the menstrual cycles and cause heavy flow. Diagnosis is made by physical examination, pelvic ultrasound and other imaging techniques like C.T. scan. Treatment is by surgery, chemotherapy or radiotherapy, depending on stage of cancer and whether it has spread to adjoining parts or not. If the heavy and frequent menses is a recent phenomenon, it can be ignored. Try to be stress free and take a nutritious diet. However if it has been there for long time persistently, if there is severe associated pain, fever among other symptoms, it is advisable to get investigations done to know the cause and get it treated. Dr. Rachna Pande E-mail-rachna212002@yahoo.co.uk Dr. Rachna Pande is a specialist in internal medicine.
