I’m off the pill, now my period is irregular. Why?
Dear Dr Mitchell,
After having my son in 2000, I started taking the family planning minigynon. In February this year I stopped taking the pills. Since then, I have been having irregular periods. Sometimes it comes for fourteen (14) days and sometimes eleven (11) days then it stops and comes back for twelve (12) days again, then it comes for seven days.
I was first put on the pills because I had ovarian cysts.
I went to my doctor and explained to him, he said nothing is wrong and that I should start taking back the pills. He also told me to do a pelvic ultrasound.
Am I OK?
The normal menstrual cycle ranges from 21 to 35 days with an average of 28 days. The usual average flow lasts for approximately 3 – 5 days. Your cycles are definitely abnormal with flow lasting 7 to 14 days. The use of the birth control pill usually gives good cycle control and masks any underlying abnormality in the menstrual cycle. Once the pill is discontinued, then the true cycle is manifested.
A menstrual period lasting for 7 to 14 days needs treatment since this will eventually cause anaemia resulting in weakness, dizziness or fainting spills. It is therefore important to determine the underlying cause of this heavy and prolonged flow. The most common cause in our population is uterine fibroids. These are abnormal growths in the muscles of the uterus and may be present inside the cavity, in the wall or outside the wall of the uterus. The common presentation is heavy prolonged periods and painful periods
(Dysmenorrhoea). In some instances, fibroids do not cause any changes in the periods but cause an increase in the size of the abdomen as they can sometimes grow fairly rapidly.
Fibroids are not usually malignant and in only approximately 0.5% of patients will these growths become cancerous. The diagnosis is usually suspected in pelvic examination and confirmed on ultrasound.
The symptoms can be controlled by the use of the oral contraceptive pills, the Depo-Provera injection or by drugs which cause a temporary menopausal state (Zoladex or Leucrin).
These drugs cause a reduction in flow or complete cessation of the menses allowing time to correct any anaemia until surgery can be done to remove them. Uterine artery embolization as a form of treatment cuts off the blood supply to the fibroids and may be used in a select group of patients to reduce symptoms. This treatment, however, is still fairly new, not widely available, has significant complications and is therefore not appropriate for all women.
The abnormal bleeding that you experience may also be due to a hormonal problem. Anovulation (failure to release an egg every month) may result in prolonged or irregular menstrual flow. An abnormality of the lining of the uterus may also cause heavy menstrual flow.
This may also include an abnormal thickening of the lining or even cancer of the lining of the uterus. This is not common and tends to be seen in women of advanced age.
It is important that you consult your Gynaecologist who will do the appropriate evaluation such as physical examination, a Pap smear, pelvic ultrasound, and endometrial biopsy if there is suspected abnormality in the lining of the uterus.
Best Wishes.
Dr Sharmaine Mitchell is an Obstetrician and Gynaecologist. Send questions or comments by e-mail to allwoman@jamaicaobserver.com, fax to 968-2025 or call 511-2502 to leave a 30-second voicemail message.
