Gynaecologist: When to make an appointment

Gynaecologist: When should you tell your gynaecologist about irregular periods?

Many of us have irregular periods, with little regularity between cycles and rarely "normal" periods. Here's some advice on whether you should see your gynaecologist.

What's normal?

For women who have regular, predictable menstrual cycles, periods occur a certain number of days apart consistently over time, and the symptoms associated with menstruation do not vary much from cycle to cycle. What's more, if your periods last four to seven days and are 21 to 35 days apart, your cycle is considered normal. On the other hand, other situations may require an appointment with a gynecologist:

What's abnormal?

Menstrual cycles less than 21 days or more than 35 days apart
Absence of more than three consecutive periods with negative pregnancy tests
Menstrual flow much heavier or lighter than normal
Bleeding periods lasting more than a week
Painful periods accompanied by cramps, nausea or vomiting
Bleeding or spotting between periods, after menopause or after sexual intercourse.

Do I need to make an appointment with my gynaecologist?

Some of these symptoms may be due to stress and lifestyle factors, such as weight gain or loss, a change in diet and exercise routine, illness or other daily disruptions, or to the contraceptive pill. Many contraceptive pills contain hormones, oestrogen and progestin, which prevent pregnancy by stopping the ovaries from releasing an egg. Starting, stopping or changing contraceptives can have an impact on your menstrual cycle. These irregularities and missed cycles can last for about six months after starting, stopping or changing a contraceptive method. In addition, some women taking progestin-only contraceptive pills may experience bleeding between periods.

If you are experiencing one or more of these symptoms and you have not made any changes to your diet, lifestyle or contraception, we recommend that you make an appointment with your gynaecologist. There are other, sometimes more serious reasons why you may experience irregular periods. These include

Benign uterine polyps : Small growths on the wall of the uterus.
Endometriosis : Growth of endometrial tissue outside the uterus.
Pelvic inflammatory disease: Bacterial infection affecting the female reproductive system.
Polycystic ovary syndrome: Overproduction of androgens, i.e. male hormones, by the ovaries. This can cause cysts to form around the ovaries and have an impact on regular ovulation, which can eventually have an impact on a woman's ability to conceive a child.
Premature ovarian failure : It is in fact a pre-menopause, i.e. a menopause before the age of 40, due to a condition in which a person's ovarian function declines earlier than expected.
Cancer of the cervix, uterus or ovary
Medicines (such as anticoagulants)
Medical conditions having an impact on hormonal balance
Complications pregnancy-related
Toxic shock syndrome Symptoms include fever over 102 degrees, vomiting, diarrhoea, fainting or dizziness.

What can I expect from my gynaecologist?

If you visit your gynaecologist with complaints and problems relating to abnormal periods, he or she may wish to start a check-up involving a full physical and pelvic examination, and possibly a smear test if indicated. A smear test involves checking for the presence of abnormal cells in the cervix by inserting a speculum into the vagina and removing a few cells from the cervix using a small brush or spatula. This swab can also be used to perform a vaginal culture and check for other possible infections. Other monitoring measures may include blood tests, a pelvic ultrasound to look for cysts or fibroids, or an endometrial biopsy. A biopsy involves removing cells from the lining of the womb to determine the presence of endometriosis, hormonal imbalances and cancerous or precancerous cells.

There are different terms used to describe abnormal periods. If a person is not pregnant, breastfeeding or menopausal, the absence of periods for more than three months is called amenorrhoea. People who have not had a period by the age of 15 or 16, or three years after breast development, may also be diagnosed as having amenorrhoea. Scanty periods are called oligomenorrhoea, and dysmenorrhoea refers to painful periods and severe menstrual cramps. It should be noted that it is normal to feel some pain during menstruation. Dysmenorrhoea is a diagnosis for people who experience abnormal menstrual pain.

Depending on the outcome of your visit to the gynaecologist, you will be offered different treatment options.