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Interrupted Menstrual Cycle

By Bjarne Lühr Hansen PhD, MD and Philipp Skafte-Holm MD, Mentor Institute

Most women experience that their menstruations vary in strength and are not regular every time. It is normal and should not give rise to worry or closer examination. However, some interruptions in the menstrual cycle can be signs of infection or cancer. Women with spotting and older women, who after menopause have new bleedings, should therefore quickly seek a doctor. All women with lasting troublesome bleedings can go to a doctor and receive treatment for their interruption of their menstrual cycle.

Interrupted menstrual cycle is divided into regular but heavy bleedings (menorrhagia) and completely irregular bleedings (metrorrhagia).

Heavy bleedings (menorrhagia). In the case of menorrhagia, the interval between the bleedings is regular but the bleedings are lengthy and heavy. Menorrhagia is common and appears with 20% of women in the age of 30 to 50 years. With the majority of the women, there is no explanation for the heavy bleedings. Fibroids in the uterus and non-hormonal intrauterine devices (IUD) can lead to menorrhagia.

Irregular bleedings (metrorrhagia). In the case of metrorrhagia, the interval between menstruations is entirely irregular or the woman has spotting between regular bleedings. Metrorrhagia is common and seen with 20% of women in the age of 15-20 years. The most common causes are hormonal disturbances, use of birth control, infections and pregnancy. Hormonal disturbances are seen with the very young and not yet fully developed women or with older women nearing menopause. Using birth control or hormones during menopause can cause metrorrhagia as a side effect. Another more rare but serious cause of metrorrhagia is abdominal cancer.

What can you do?

It would be advantageous to have a form to keep track of your bleedings, where you write the date and the strength of your bleedings and note possible spottings. This makes it easier for the doctor to find the cause of your interrupted menstrual cycle.

What can your doctor do?

Heavy bleedings (menorrhagia). If you suffer from very heavy but regular bleedings it is okay to wait and see for a few months. If you have pain or develop symptoms of low haemoglobin percentage (tiredness, headache, tinnitus, dizziness and reduced physical strength) you should contact your doctor as soon as possible.

Your general practitioner asks about the strength and duration of your bleeding, takes blood samples and performs a gynaecological examination. If you general practitioner finds everything to be normal, the general practitioner may choose to administer hormonal treatment to reduce the strength of your bleedings. Hormonal treatment is either given as tablets or as a hormonal intrauterine device.

Irregular bleedings (metrorrhagia). Very young women with irregular bleedings and who has not yet had their sexual debut do not need to seek doctor. They must wait for their hormones to adjust so that the bleedings become regular.

All women who begin taking contraceptive pills will have irregular bleedings the first months. This is a side effect of the contraceptive pill that disappears again. There, wait and see for 3 to 4 months before contacting the doctor.

All women with spotting (small bleeding in between menstruations) or contact bleeding (bleeding after intercourse) should seek a doctor as soon as possible, since spotting can be sign of infection or cancer.

Practically all women have irregular bleedings when they approach menopause. This happens because the production of sex hormones becomes increasingly insufficient and in the end it stops. In the case of prolonged troublesome irregular bleedings, women in menopause should seek a doctor.

All women who has entered menopause with the end of menstruation and who has bleeding anew should contact a doctor immediately, since this can be sign of cancer.

Your general practitioner asks about your bleedings, takes a blood sample and performs a gynaecological examination. During the examinations the doctor looks for signs of infection, pregnancy and cancer.

If the doctor finds an infection, it will be treated with antibiotics. With women who have an intrauterine device (IUD), the doctor may choose to remove the IUD. With women who take the contraceptive pill, the doctor may choose to change to another contraceptive pill.

What can a specialist doctor do?

Heavy bleedings (menorrhagia). If you general practitioner finds any abnormal conditions during the gynaecological examination or if you bleedings continue to be heavy despite treatment the doctor refers you to a gynaecologist.

The gynaecologist can perform an ultrasound scan and look for abnormal conditions in your uterus. Depending on what the ultrasound scan shows, the gynaecologist can perform different surgical procedures. The gynaecologist can remove a possible polypus, perform curettage or remove the uterus completely to normalise your bleedings.

Irregular bleedings (metrorrhagia). If your general practitioner finds any abnormal conditions during the gynaecological examination or if your bleedings continue to be irregular despite treatment, the doctor will refer you to a gynaecologist.

The gynaecologist can perform an ultrasound scan and look for signs of cancer in your uterus. If the gynaecologist finds no signs of cancer, the treatment usually consists of hormones. If there are signs of cancer in the uterus you will be treated according to the fixed guidelines.