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The brain receives stimulation from the environment in the form of nutrition, stress, emotion, light, smell, sound etc. This stimulation results in secretion of a hormone called gonadotropin (L.H. & F.S.H). Gonadotropin stimulates the ovaries to secrete female hormones oestrogen (Estradol) and progesterone. These hormones stimulate the uterus lining to prepare it for menstruation. Normal menstruation consists of blood, secretions, and disintegrating uterus lining.
Although the interval of a typical menstrual cycle is mentioned as twenty-eight days, the normal duration can be from twenty-two to thirty five days and bleeding lasts for about three to seven days. The most important criteria for normal period is fixed cyclycity (i.e. coming after fixed duration) of menstrual bleeding whether it is 22 days or 35 days. It can vary sometime 7 day early or late. Sometime occasionally period may be too much delay or too early so don't worry for these. But remember if bleeding is less there is nothing to worry if period is coming on time. The females who try to lose weight or under stress or even without any reason some women may have less menstrual bleeding, late period or absent period.So in young girls if period is irregular get your all hormone tested and if they are normal relax, because in some girls period may not normalize upto 21 years of age, due to still immaturity of hormone system. Sometimes it matures only by the age of 21 year.
What laboratory tests are recommended for (Menstrual irregularity) abnormal bleeding ?
Blood tests for assessment of hormones secretion (LH, FSH, Testosterone, Prolactin,free testosterone, Androstendione, DHEAS, E2, 17-OH Progesterone Thyroid insulin fasting and PP and DHT etc.) and other test to assess general health are essential for evaluating the cause of abnormal bleeding.
Ultrasonography provides valuable information on the size of the uterus, thickness of the uterus lining, ovaries and any tumour in the reproductive organs.
AMENORRHOEA : Absence of menstruation is called amenorrhoea.
What are causes of menstrual irregularity?
Imaturity of hypothmic pituitary ovarion system in early years after start of period is one of the common cause of irregular period. So in girls upto 21 years period may remain irregular due to imaturity of hormone system.
- Abnormal function of the hypothalamus. Decreased secretion of Gonadotropin results in mentrual irregularity ; This problem can occur due to (a) abnormalities of the weight; (b) strenuous exercise; (c) environmental stress; )d) and some disease. Each of these causes abnormal function of the hypothalamus as detailed below:
Abnormalities of the weight: Normal menstruation depends partly upon total body weight and the amount of body fat. Reduced body fats (less than seventeen percent of the total body weight) result in amenorrhoea. Women who alter their eating habits to remain "slim" have low body fat. So weight loss or weight gain due to any cause can lead to menstrual irregularities & even amenorrhoea.
Women with emotional disorders such as stress, depression, sleep disorder; anorexia nervosa and bulimia nervosa have menstrual irregularities. So stress of any kind is the common cause of mestrual irregularities.
Strenuous exercise, Women who undertake severe physical activities such as sports or exercise for more than one hour a day have reduced secretion of Gonadotropin leading to menstrual irregularity.
Environmental stress: Any stress due to any cause leads to irregular period. As when separated from their family, such as when joining a hostel for further studies or separation from loved ones or death of somebody , not getting selection in the course of choice branch in carrier, not liking the present carrier or job stress due to boyfriend or difficulty in getting marriage or stress of examination or family stress after marriage in newly wed women or some medical illness which is not getting cured for long time leads to menstrual irregularities. Also any kind of mental stress family related or work related,or not getting job, will leads to menstrual irregularity or even absent period.
Remember that in most women period becomes irregular 3 to 4 year before it stops (i.e. Menopause). So don't worry. Also once or twice a year period may become abnormal without any obvious cause.
- Abnormal functions of the pituitary gland results in abnormal secretion of some hormones such as prolactin, LH, FSH leading ro high prolactin or low FH, FSH.
- Abnormal functions of the ovaries: Decreased function of the ovaries results in increased blood level of follicle Stimulating Hormone, Failure of ovaries before the age of 35 years is called premature ovarian failure. Aproximately 5% women have stoppage of period by 35 years.
What are the laboratory tests for menstrual irregularity ?
Recommend some of the following laboratory tests confirm the diagnosis :
- Ultrasonography of the pelvis region for ovarian size & uterus.
- Blood tests: L.H., F.S.H., Prolactin, Estradiol (E2) in the blood.
- Increase in Male hormone as Testosterone, Free Testosterone, DHEAS, Androstenidione, 17 hydroxy progesterone (17-OH Progesterone), DHT, Insulin (Fasting & postprandial)
- Thyroid function tests, Excess or deficient functions of thyroid glands can either cause decreased menstruation or amenorrhoea.
- Biochemistry tests as Liver & Kidney tests 25 OH VITAMIN D etc.
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