Menstrual issues are pretty frequent throughout girls’s reproductive years and might trigger important bodily and psychological misery.
Regular menstruation begins with menarche round age 12 and continues till menopause round age 50. This bleeding is managed by the hypothalamic-pituitary-ovarian axis and consists of periodic adjustments within the ovary and endometrium (endometrium). A standard menstrual interval consists of blood and uterine cell particles. It often lasts 2-7 days and happens each 21-35 days.
irregular bleeding from the uterus
Irregular uterine bleeding contains extended bleeding for greater than 7 days, heavy bleeding if a blood clot is current, bleeding that stains materials or causes anemia, bleeding that’s extra frequent than 21 days or delayed for greater than 35 days, intermenstrual or postmenopausal bleeding, or bleeding that loses its cyclic sample. The time period “dysfunctional uterine bleeding” implies that there isn’t a structural or pathological trigger for this, however solely endocrine abnormalities.
Causes of irregular uterine bleeding in teenagers embody anovulation, pelvic infections, use of hormones, clotting issues, and hormone-producing tumors. In reproductive age, causes embody being pregnant, polyps, adenomyosis, uterine fibroids, anovulation, endometrial hyperplasia, and endometrial most cancers. Within the perimenopausal age group, potential causes embody anovulation, endometrial hyperplasia, endometrial most cancers, and endometrial atrophy.
Administration of irregular bleeding
Administration objectives are based mostly on the affected person’s age, fertility needs, household historical past of most cancers, and useful impairment. Investigations embody testing hemoglobin ranges, kidney and liver perform, clotting issues, ultrasound scans, cervical cytology, and endometrial biopsies. Your physician will need to find out about your earlier exams and coverings to find out the reason for your bleeding issues. Sufferers are suggested about menstrual hygiene and the best way to hold a menstrual diary. Bleeding patterns must be evaluated over a number of months. Extreme bleeding could should be managed, and anemia could should be corrected with iron dietary supplements or blood transfusions. Ache may also be an issue and must be decreased.
For adolescents, heavy menstrual bleeding can result in psychological misery, college absences, social withdrawal, and anemia. After an in depth historical past and bodily examination, exams are carried out to rule out liver, kidney, and coagulation issues. An ultrasound is carried out to rule out uterine fibroids or ovarian cysts. Endometrial biopsies are not often carried out. Ladies are taught to deal with heavy intervals by monitoring their intervals, utilizing absorbent pads, guaranteeing menstrual hygiene, staying hydrated, consuming iron-rich meals, and managing their weight. Non-hormonal medication similar to tranexamic acid and mefenamic acid are the first-line remedy. If these can not management menstruation, hormonal therapies similar to progesterone or oral contraceptives could also be prescribed. Surgical procedure isn’t wanted and is barely finished for big uterine fibroids or ovarian tumors.
In reproductive age, being pregnant should all the time be excluded. Causes of irregular uterine bleeding embody polyps, adenomyosis, uterine fibroids, endometriosis, malignancy, hyperplasia, endometrial illness, and iatrogenic causes. Remedy of the underlying trigger have to be carried out. Bleeding and ache will be managed with tranexamic acid, mefenamic acid, oral and injectable progestogens, mixture tablets, levonorgestrel intrauterine gadgets, mifepristone, ormeloxifene and gonadotrophin analogs. Surgical procedure will be carried out endoscopically: laparoscopically, robotically, or hysteroscopically. For younger girls, surgical procedure is most frequently organ-sparing.
In perimenopausal and postmenopausal teams, malignancy and hyperplasia must be excluded. The danger of malignancy with postmenopausal bleeding is 10-20%. On this age group, endometrial biopsy is obligatory earlier than hysterectomy. In such girls, removing of the uterus is less complicated. All therapies, medical or surgical, contain issues. Subsequently, earlier than embarking on remedy, physicians should weigh the dangers and advantages and take into account the affected person’s needs and preferences. The final rule is to decide on the only, most secure, and most cost-effective choice.
What girls ought to know
Ladies want to know their our bodies and the way their physiology adjustments over time. Menstrual issues shouldn’t be ignored and girls ought to endure common gynecological examinations. Well timed remedy can keep away from pointless psychological and bodily struggling. A wholesome life-style, a preventive method to well being, and applicable behaviors in pursuit of well being go a good distance in guaranteeing high quality of life.
This text was first printed in The Hindu’s e-book Care and Treatment.
(Dr Abraham Peedcayil is a Senior Advisor within the Division of Gynecology and Oncology, Narvi Hospital, Vlolore, Vlolore Apeedcayil@yahoo.com; PB Akilasree is a Senior Advisor within the Division of Obstetrics and Gynecology, Narvi Hospital, Vlolore Akilasree.pb@nruvihospitals.com; Gynecology, Obstetrics and Gynaecology.ok@nruvihospitals.com)
issued – January 16, 2026 3:33pm IST
