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What causes menstrual irregularities?

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Menstrual irregularities can be caused by a variety of conditions, including pregnancy, hormonal imbalances, infections, malignancies, diseases, trauma, and certain medications.1,2,3,4,5,6

Common causes of anovulatory bleeding (absent, infrequent periods, and irregular periods) include2:

  • Adolescence
  • Uncontrolled diabetes 
  • Eating disorders
  • Hyperthyroidism or hypothyroidism
  • Hyperprolactinemia (an abnormally high concentration in the blood of prolactin, a protein hormone)
  • Medications, such as antiepileptics or antipsychotics
  • Perimenopause
  • Polycystic ovary syndrome (PCOS)
  • Pregnancy

Common causes of ovulatory bleeding (heavy or prolonged menstrual bleeding) include2:

  • Structural problems, such as uterine fibroids or polyps
  • Bleeding disorders, such as leukemia, platelet disorders, the various factor deficiencies, or von Willebrand disease
  • Hypothyroidism
  • Advanced liver disease

Common causes of dysmenorrhea (menstrual pain) include6:

  • Heavy menstrual flow
  • Smoking
  • Depression
  • Never having given birth
  • Endometriosis
  • Chronic uterine infection

Additional causes of menstrual irregularity include1:

  1. American College of Obstetricians and Gynecologists (ACOG) Committee on Adolescent Health Care. (2006). ACOG Committee Opinion No. 349. Menstruation in girls and adolescents: Using the menstrual cycle as a vital sign. Obstetrics & Gynecology, 108, 1323-1328. [top]
  2. Sweet, M. G., Schmidt-Dalton, T. A., Weiss, P. M., & Madsen, K. P. (2012). Evaluation and management of abnormal uterine bleeding in premenopausal women. American Family Physician, 85, 35-43. [top]
  3. Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician, 73, 1374-1382. [top]
  4. Apgar, B. S., Kaufman, A. H., George-Nwogu, U., & Kittendorf, A. (2007). Treatment of menorrhagia. American Family Physician, 75, 1813-1819. [top]
  5. Practice Committee of the American Society for Reproductive Medicine. (2008). Current evaluation of amenorrhea [Review] Fertility and Sterility, 90, S219-225. [top]
  6. French, L. (2005). Dysmenorrhea. American Family Physician, 71, 285-291. [top]

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