Understanding Menstrual Irregularities
A menstrual cycle that varies by a few days is perfectly normal. What is not normal, and what too many women accept for years, is bleeding heavy enough to disrupt work and sleep, pain that requires planning your month around it, or cycles so unpredictable that you can never be prepared.
Irregular periods are a symptom rather than a diagnosis. The cause may be hormonal, as in thyroid disorders or PCOS; structural, as with fibroids, polyps or adenomyosis; or related to stress, weight change or medication. Identifying which of these is at work is the whole point of the consultation, because the treatment differs entirely.
How We Evaluate and Treat
Assessment is stepwise, and we do not order tests that will not change the plan.
- Detailed history and examination - cycle pattern, bleeding volume, pain, weight change and family history.
- Pelvic ultrasound - to look for fibroids, polyps, ovarian cysts, adenomyosis and endometrial thickness.
- Blood tests - haemoglobin, thyroid function, prolactin and hormonal profile as indicated.
- Endometrial assessment - a biopsy where age or findings make it appropriate.
- Hysteroscopy - a direct look inside the uterus, allowing polyps to be removed in the same sitting.
- Medical management - hormonal and non-hormonal medication, tranexamic acid, or a hormonal intrauterine system for heavy bleeding.
- Minimally invasive surgery - hysteroscopic or laparoscopic procedures where medication is not enough.
- Correcting anaemia - iron replacement alongside treatment of the bleeding itself.
Bleeding after intercourse, bleeding between periods, or any bleeding after menopause needs prompt assessment rather than watchful waiting. Please book an early appointment if these apply to you.
