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Date of last update: 10/14/2017.

Forum Name: Gynecology

Question: irregular (frequent) bleeding


 curious16 - Wed Oct 05, 2005 8:00 pm

I am 16 years old and have now been having my period every two weeks steady since about march, about 7/8 months now. It's much more painful than it was when I had it only once a month, and the flow is heavy as usual. I am not sexually active at all, and have had my period since I was 10, so I don't think it's caused by puberty or stress. i've read several things, and if it helps there is type 2 diabetes on my maternal side. i live with my grandma, who doesn't really know whether i should go to a doctor and doesn't know what to make of it either. Any idea what's causing this? Do I really need to see a doctor?
 Dr. Tamer Fouad - Tue Jan 10, 2006 8:08 am

User avatar Hello,
Polymenorrhea is bleeding that occurs at intervals of < 21 days and may be caused by a luteal-phase defect.[1] Polymenorrhea is clinically defined as menstruation at regular cycle intervals but at higher frequency.[2]

Evaluating abnormal uterine bleeding in the reproductive years requires the exclusion of pregnancy or pregnancy-related disorders, medications known to cause abnormal uterine bleeding, iatrogenic causes, obvious genital tract pathology, and systemic conditions.[1] Once all these causes are excluded it can be presumed that you have dysfunctional uterine bleeding.

Dysfunctional uterine bleeding is a diagnosis of exclusion. This ovulatory or anovulatory bleeding. In the vast majority of cases, it is secondary to anovulation (lack of ovulation). If you do not experience cramps or other premenstrual symptoms this could be a manifestation of anovulation.

Anovulatory dysfunctional uterine bleeding is a disturbance of the hypothalamic-pituitary-ovarian axis that results in irregular, prolonged, and sometimes heavy menstrual bleeding. It may occur immediately after menarche but before maturation of the hypothalamic-pituitary-ovarian axis, or it may occur during perimenopause, when declining estrogen levels fail to regularly stimulate the LH surge and resulting ovulation.

Some common causes of hypothalamic anovulation are weight loss or gain, eating disorders, stress, chronic illness, and excessive exercise. Women with chronic anovulation that is not attributable to any of these causes are considered to have idiopathic chronic anovulation.[3]

Anovulatory bleeding can be thought of as estrogen breakthrough bleeding. This type of bleeding is related to the levels of estrogen stimulating the endometrium. For example, high levels of estrogen for prolonged periods result in amenorrhea followed by acute intermittent heavy bleeding, and continually low levels of estrogen availability result in intermittent spotting.[4]

Endometrial evaluation should be considered in women under 35 years of age who show evidence of chronic anovulation. These women are at increased risk for endometrial carcinoma secondary to prolonged unopposed estrogen stimulation of the endometrium.[5]

References:
==========
1. Speroff L, Glass RH, Kase NG. Clinical gynecologic endocrinology and infertility. 6th ed. Baltimore: Lippincott Williams & Wilkins, 1999:201-38,499,575-9.
2. Petrozza J, Poley K. Dysfunctional uterine bleeding. In: Curtis MG, Hopkins MP, eds. Glass's office gynecology. 5th ed. Baltimore: Williams & Wilkins, 1999;241-64.
3. Oreil KA, Schrager S. Abnormal uterine bleeding. Am Fam Physician 1999;60(5):1371-82.
4. Speroff L, Glass RH, Kase NG, eds. Dysfunctional uterine bleeding. In: Clinical gynecologic endocrinology and infertility. 5th ed. Baltimore: Williams & Wilkins, 1994:575-93.
5. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol 1996;175(3 Pt 2):766-9.

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