Menstrual cycle disorders

Heavy periods

Periods are considered heavy when they interfere with daily life: very frequent pad changes, large clots or fatigue. Blood loss can lead to iron deficiency anemia, so a blood count and ferritin are checked. Causes include fibroids, polyps, adenomyosis, ovulation disorders, thyroid disease, clotting disorders and some medicines; often no cause is found and it is called functional bleeding.

Irregular cycle and amenorrhea

An irregular cycle is often linked to lack of ovulation, as in polycystic ovary syndrome, thyroid disorders (hypothyroidism), raised prolactin, stress, rapid weight loss or excessive exercise. Absence of periods first calls for exclusion of pregnancy. Onset of menopause before age 45 or an irregular cycle after age 40 is also assessed.

The cycle diary: what to record and how to interpret it

Keeping a menstrual calendar for three months is one of the most useful tools for the doctor. Record the first day of each bleed, its duration, the amount (number of pads a day, size of clots), pain and any bleeding between periods. A cycle is counted from the first day of one period to the first day of the next; it is normal for it to vary by a few days from month to month, but variation over 7–9 days or cycles shorter than 21 or longer than 38 days are considered irregular. In adolescence, irregularity in the first two years after menarche is common because the hormonal axis is still maturing.

Periods are considered heavy when a pad is changed every one to two hours, when clots are larger than a coin, or when fatigue, dizziness, headache or breathlessness appear, which may indicate anemia. Primary dysmenorrhea (pain without a pelvic cause) often improves with nonsteroidal anti-inflammatory drugs taken at the start of pain, local heat and physical activity. Pain that worsens over time, pain accompanied by pain during intercourse or with reduced chance of pregnancy may indicate endometriosis, which requires specialized assessment.

Iron, lifestyle and when to seek help

Heavy periods are the most frequent cause of iron deficiency in women of reproductive age. Symptoms are not limited to pallor: they include fatigue, hair loss, feeling cold, weakness and poor concentration; sometimes iron deficiency appears with low ferritin even without anemia. Iron intake from food (meat, liver, legumes) is improved by vitamin C and by avoiding tea or coffee at meals; iron tablets are preferably taken every other day, on an empty stomach or as tolerated, and checked with a test after a few weeks. The ferritin value should return to normal levels and not just hemoglobin improve.

Very low weight, excessive training, persistent stress and eating disorders can interrupt ovulation and periods, while overweight is linked to irregular cycles in polycystic ovary syndrome. Regaining a healthy weight and moderate activity often regulate the cycle. Seek earlier assessment if periods are absent for more than three months without pregnancy, if bleeding is heavy with signs of anemia, if there is bleeding after intercourse or after menopause, or if pain prevents you from working. Bring the calendar and earlier tests.

Assessment and treatment

The doctor asks about the cycle pattern, examines and requests tests (blood count, TSH, prolactin, hormones as appropriate, pregnancy test). Pelvic ultrasound and other gynecological examinations are performed at another center when needed, and we interpret the results. Treatment depends on the cause: correcting the thyroid, hormonal therapy, medicines that reduce bleeding or specialized interventions. Iron replacement is given when there is a deficiency. Do not accept “it is normal” without assessment when bleeding affects energy or work.

Care at Tirana Polyclinic: we offer gynecology consultation and interpretation of tests. Reviews are every 6 months to a year or sooner when the doctor considers it reasonable.