Irregular Menstrual Periods

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Chapter 116 Irregular Menstrual Periods

INTRODUCTION

Description: Menstrual cycles that do not follow a rhythmic pattern or with a pattern differing significantly from that expected as “normal” are considered irregular.

Prevalence: Ten percent to 15% of all gynecologic visits.

Predominant Age: Reproductive, greatest in adolescents and patients who are experiencing climacteric changes.

Genetics: No genetic pattern.

ETIOLOGY AND PATHOGENESIS

Causes: Anovulation or oligo-ovulation, climacteric or menopause, hypogonadism (including exercise induced: excessive, associated with low body weight and anovulation), excess estrogen (obesity, polycystic ovary disease, exogenous estrogen), elevated prolactin, psychosocial conditions (anorexia, bulimia, stress), chronic illness, renal or hepatic failure, thyroid disease.

Risk Factors: Those associated with possible causes.

CLINICAL CHARACTERISTICS

Signs and Symptoms

• Irregular menstrual interval

• Variable character of menstrual flow

MANAGEMENT AND THERAPY

Nonpharmacologic

General Measures: Evaluation.

Specific Measures: Focused on underlying causation and desires of patient. If anovulation is the cause and fertility is not desired, periodic progestin therapy may be used to stabilize the cycles and suppress intermenstrual bleeding.

Diet: No specific dietary changes indicated.

Activity: No restriction.

Patient Education: Reassurance; American College of Obstetricians and Gynecologists Patient Education Pamphlet AP095 (Abnormal Uterine Bleeding), AP049 (Menstruation [Especially for Teens]), AP162 (Menopausal Bleeding).

Drug(s) of Choice

Medroxyprogesterone acetate 5 to 10 mg for 1 to 14 days each month.

Contraindications: Undiagnosed amenorrhea or bleeding.

Precautions: Progestins should not be used until pregnancy has been ruled out.

Alternative Drugs

Norethindrone acetate 5 to 10 mg for 10 to 14 days each month. Combination oral contraceptives may also be used.

FOLLOW-UP

Patient Monitoring: Normal health maintenance.

Prevention/Avoidance: None.

Possible Complications: Endometrial hyperplasia or carcinoma if anovulation is left untreated.

Expected Outcome: Return to normal menstrual pattern with correction of underlying pathologic condition or periodic progestin therapy.

MISCELLANEOUS

Pregnancy Considerations: No effect on pregnancy once pregnancy is achieved.

ICD-9-CM Codes: 626.4.

Adams Hillard PJ, Deitch HR. Menstrual disorders in the college age female. Pediatr Clin North Am. 2005;52:179. ix.

Fraiser IS. Treatment of ovulatory and anovulatory dysfunctional uterine bleeding with oral progestogens. Aust N Z J Obstet Gynaecol. 1990;30:353.

Hannoun AB, Nassar AH, Usta IM, et al. Effect of war on the menstrual cycle. Obstet Gynecol. 2007;109:929.

American College of Obstetricians and Gynecologists. Management of anovulatory bleeding. ACOG Practice Bulletin 14. Washington, DC: ACOG, 2000.

Cowan BD, Morrison JC. Management of abnormal genital bleeding in girls and women. N Engl J Med. 1991;324:1710.

Diddle AW. Athletic activity and menstruation. South Med J. 1983;76:619.

Field CS. Dysfunctional uterine bleeding. Primary Care. 1988;15:561.

Neese RE. Managing abnormal vaginal bleeding. Postgrad Med. 1991;89:205.

Thorneycroft IH. Cycle control with oral contraceptives: a review of the literature. Am J Obstet Gynecol. 1999;180:280.

Van Voorhis BJ. Genitourinary symptoms in the menopausal transition. Am J Med. 2005;118:47.

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