Q I am 40 and have always had irregular menses since my teens. This is normal for me.
Lately, I have also been experiencing heavier menstrual flow and painful cramps.
Should I be concerned and get this checked?
A It is common for women in the reproductive age group to have irregular menstrual cycles, especially teenage girls and perimenopausal women.
For young girls, the hormonal circuitry of the body may be immature and lacks regularity.
In perimenopausal women, the ovaries have been depleted of eggs, which leads to infrequent ovulation as well as irregular menstruation.
The inability to ovulate regularly is a common cause of irregular menstrual cycles in young women.
As a result, this group may be less fertile than normal. During menstruation, women's bodies shed the lining of the uterus.
So, apart from experiencing difficulty in conceiving, women who ovulate infrequently do not allow their womb lining to be shed regularly.
Unshed lining that stays in the womb for too long may lead to pre-cancer changes, or eventually even cancer.
The risks of such occurrences increase with age, obesity, diabetes mellitus and family history of similar types of cancer.
These women would be considered at high risk for cancer.
There are many causes for heavy menstrual flow, with or without pain.
The more common ones are:
• Adenomyosis, the thickening of the womb wall;
• Fibroids, which are benign muscle tumours of the womb wall;
• Polyps, which are growths in the lining of the womb;
• Endometrial hyperplasia, known as pre-cancer of the womb lining;
• Endometrial cancer, which is a cancer of the womb lining; and
• Bleeding disorders, which happen when a person is deficient in any of the clotting factors.
A detailed interview, physical examination and ultrasound scan of the pelvis will let your doctor determine which of these conditions are likely to be present.
For those in the high-risk group, a biopsy of the womb lining is often necessary to confirm the presence of cancer.
This is often coupled with an endoscopic assessment of the womb, during which a tube-like device is used to allow the doctor to observe the inside of the body.
Treatment will depend on the diagnosis, and the objectives set by the patient and doctor.
Some women may wish to eradicate only menstrual cramps, while others may want to reduce menstrual flow.
For some women, fertility takes priority. In general, painkillers and hormonal therapy are effective for relieving the symptoms, but surgery is often necessary for a cure.
Women who experience irregular and heavier menstrual bleeding, especially those above 40 years old, should seek help early to determine the cause of their symptoms and receive the appropriate treatment. Many of these cases will turn out to be disease-free, but that assumption should not be made without a thorough check-up, especially if you fall into the high-risk group.
DR STEVEN TEO
