Mysterious flow: Those confusing irregularities during menstruation

Most women will admit that periods can be a real pain. Some have sometimes wished not to have them anymore. But not having them can be sign of a bigger problem, writes Gloria Kemigisha.

Periods can sometimes be a real pain. They can make you feel sick, give you a headache, stomach ache and backache. No doubt you have sometimes wished not to have them anymore. But what happens when they do not show up at all? You might panic no doubt.

A woman’s period might disappear for weeks or sometimes months. Sometimes, you may experience a very heavy flow after your period has disappeared for a few months unlike the usual 28-32 days. There are times when it only comes for half a day, or goes on for weeks. Then it just keeps on coming regularly. These are times when you start to panic and think that you are either sick or pregnant.

According to Dr. Herman Ssewaggudde, an obstetrician and gynaecologist at Angel Medical Centre in Bukoto, Kampala, these are only some of the common irregularities some women experience with their monthly menstrual periods.

He explains, “Irregular periods aren’t unusual because they affect about 30 per cent of women in their reproductive years. An irregular period is any type of bleeding that is abnormal when compared to your usual menstrual cycle. This can include a late period, an early period or bleeding between periods. It can also appear in the form of a missed period, continuous periods, or periods that occur twice in one cycle.”

Ssewaggudde explains that there are various reasons for irregular periods. They may include stress, pregnancy, extreme weight loss or weight gain, intense exercise, excessive consumption of caffeine or alcohol, and smoking. In some cases, certain pelvic inflammatory diseases such as gonorrhoea can affect the regular menstrual flow. While the gynaecologist says that these irregularities are usually nothing to worry about as they will get themselves back in the right order in no time, he insists there are occasions they can signal health complications. It would therefore be wise for every woman to have some knowledge about when these irregularities may be normal and when they may need to be medically checked out.

Missing periods
The doctor explains that sometimes, when a girl has just gotten her first period, it may take up to three years before it becomes regular since the flow has not been properly established. In addition to that, most women between 45-55 years may experience peri-menopause, caused by changes in hormone levels, and often signalled by irregular periods that may appear a few months before the onset of menopause. “Otherwise, in cases where the period disappears for more than four months, and a pregnancy test is negative, seek medical help immediately,” he warns. Among the possible implications of this is severe stress, poor diet and blocked tubes.

Heavy periods
Such periods are, according to the doctor, characterised by appearances of big clots or where one goes through more than one pad or tampon in an hour, usually coming with backache and pain in the lower abdomen or pelvic cramps that can be felt for a week or two before menstruation.

Long periods
A regular period typically lasts five days, but it is completely normal to menstruate for anywhere between three and seven days. More than a week therefore becomes abnormally long and could be due to changes in hormone levels, blood clotting or even uterus disorders. Heavy and long menstrual flows may also be caused by a thickened endometrium (womb lining), uterine or cervical cancer, ectopic pregnancy, thyroid problems, pelvic inflammatory disease, and problems with intrauterine devices like the family planning coil. Ssewaggudde says that heavy and long periods could result in anaemia due to loss of blood and, in some cases, make getting pregnant more difficult. This in addition to the possible underlying causes, would necessitate a visit to a gynaecologist as soon as any of these irregularities became consistent.

Scanty periods
A scanty menstrual period is one in which the duration of flow is less than two days or the amount of blood flow is less than normal, say for just a few hours and not even fill up one sanitary towel. According to Dr. Lawrence Kazibwe, an obstetrician and gynaecologist at Mbarara Referral Hospital, this may be genetic and therefore normal among some women, evidenced by the fact that the bulk of the female relatives have light flows too.

Scanty blood flow however may also occur because ovulation is irregular at this time and the endometrial lining fails to develop normally. This can be caused by misuse of contraceptive pills or by simply starting on a birth control method as it can be a while before the body adjusts to the new hormonal levels delivered by hormonal birth control.

Kazibwe says that it is advisable to see a doctor if it is recurring consecutively as scanty flows are one of the symptoms of endometriosis—a condition in which the tissue that behaves like the cells lining the uterus grows in other areas of the body, causing pain, irregular bleeding and possible infertility. He also adds that certain medications may lead to short term irregular menstrual cycle.

Spotting in between periods
This may occur when you are ovulating mid-cycle. Sometimes early in pregnancy you may have spotting or a brownish discharge at the time your period would normally come. Ssewaggudde points out that it is normal for a brown discharge to appear just after one’s period as it’s just “cleaning out” your uterus and old blood appears brownish so there’s nothing to worry about. “It is old blood and is harmless. However, if it appears for more than two consecutive days, see a doctor,” he warns.
According to the gynaecologists, if you have only been experiencing irregular periods for a short time (less than seven months), it is likely that your periods will become regular again on their own. If you are noticing particularly heavy periods, or have gone a year or more with missed periods, experience extreme cramping, heavy period bleeding, dizziness, nausea or fainting, get medical attention. Dr Ssewaggudde advises, “If there is an underlying medical condition that is causing your irregular periods, receiving treatment for the condition should help to get your periods back on track.