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Irregular or extra-long periods may portend shorter life span by Prof Oladapo Ashiru OFR

This article presents one of the highlights from the American Society for Reproductive Medicine’s 2019 scientific congress concluded on October 16, 2019.

Dr Wang and his team showed that in terms of the typical menstrual cycle characteristic, irregularity and extra-long cycle length are associated with a higher risk of mortality, according to a study presented at the American Society for Reproductive Medicine’s 75th Scientific Congress and Expo.

In a prospective cohort study, researchers from Harvard and Tonggi Medical College in China teamed up to analyse data on 93,775 women, followed them for the years 1991 to 2013 as part of the Nurses’ Health Study II.

Participants described the history of their menstrual cycles for the study, reporting the usual length and regularity of their cycles at ages 14 to 17, 18 to 22 and 28 to 48. The women had no history of cancer, diabetes or cardiovascular disease at enrollment.

Researchers used statistical methods to determine associations between cycle characteristics and mortality, accounting for relevant confounders, including BMI, race/ethnicity, physical activity, and lifestyle factors.

During 1,729,410 person-years of follow-up, 1,679 deaths were recorded, including 828 from cancer and 166 from cardiovascular disease.

Women whose menstrual cycles were always irregular between the ages of 14 and 17 and 18 to 22 were 21 per cent and 34 per cent, respectively, more likely to die from any cause than women reporting very regular menstrual cycles in the same age ranges. A similar association was seen in women with irregular menstrual cycles from age 28 to 48. Women reporting cycle lengths of 32 to 39 days, or more than 40 days, were also at higher risk of death during follow-up than women whose usual cycles lasted 26 to 31 days.

ASRM Vice President, Hugh Taylor, said, “Irregular cycling could be evidence of an underlying health condition. But these clues are subtle and may not, in themselves, cause much worry. Patients who experience menstrual irregularity should be advised to maintain a healthy lifestyle and be alert to health changes.”

The above story is a prospective study. It is to be used as evidence to alert people who have irregular periods or extra-long cycles to seek medical attention since such cycles have been linked with increased risk of death.

Normal menstrual periods typically last for five days but can vary between two and seven days. When menstruation first starts, it can take up to two years to establish a regular cycle. After puberty, most women’s menstruation become regular, the length of time between each period is similar, and a cycle is about 28 days on an average but can range from 21 days to 35 days.

Menstruation is said to be abnormal if there is an alteration in the time between periods and the volume of the menstrum, for example:

  • Less than 21 days or more than 35 days apart
  • Missing three or more periods in a row
  • Menstrual flow is much heavier or lighter than usual.
  • Periods that last longer than seven days
  • Periods that are accompanied by pain, cramping, nausea or vomiting
  • Bleeding or spotting that happens between periods, after menopause or following sex.

Abnormal uterine bleeding is a common cause of gynaecological visits among women in the reproductive age, it affects about nine per cent to 14 per cent of women between menarche (time of first menses) and menopause (when the menses stops), and approximately 30 per cent of women have heavy menses during these periods. It is not race specific; however, black women have a higher incidence of fibroids and, making them prone to experiencing more episodes of abnormal menses. It is common in the extreme ages of a woman’s reproductive years, either at the beginning or near the end (15 to 45 years), but it may occur at any time during her reproductive years.

What causes abnormal menstruation (periods)?

There are many causes of abnormal periods, ranging from stress to more serious underlying medical conditions:

  • Stress and lifestyle factors: Significant weight gain or loss, dieting, extreme exercise, travel, illness, or other changes in a woman’s daily routine can affect the menstrual cycle.
  • Uterine polyps or fibroids: Uterine polyps are small benign (non-cancerous) growths in the uterine lining, while fibroids are tumors that attach to the wall of the uterus(womb). There may be one or more fibroids that may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort
  • Birth Control Pills: Contain mostly a combination of the hormones estrogen and progestin (some contain progestin alone). The pills prevent pregnancy by keeping the ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. Irregular or missed periods for up to six months may occur after stopping birth control pills. Progestin-only medication may cause bleeding between periods.
  • Endometriosis: The endometrial tissue that lines between the uterus breaks down every month and is discharged with the menstrual flow. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself majorly to the ovaries or fallopian tubes; or some other areas in the body. Endometriosis may cause abnormal bleeding, cramps, or pain before and during periods, and painful intercourse.

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