Without a shred of doubt, this issue is one of the most worrying dilemmas faced by teenage girls and their mothers. In many cases, some of our readers do not even wait for the diagnosis of menstrual irregularity to be properly made before they rush to label it as such. But we understand that the technical niceties behind the term are not clear to most people, nor is it really necessary for them to know the technical details, but it is largely because of them that this essay came into being. Considering the demographics of our country today, women of reproductive age and teenage girls may constitute more than 25 per cent of the entire population, given the fact that the entire population is predominantly youthful. This topic, therefore, applies to a significant subset of the entire population, which goes to show how important it really is.  Menstrual irregularities refer to any deviations from the normal menstrual cycle in terms of frequency, duration, or amount of bleeding. A typical menstrual cycle lasts between 21 to 35 days, with bleeding lasting between 2 and 7 days. Menstrual irregularities can manifest in various ways and may indicate underlying health issues. They can occur during puberty, menopause, or perimenopause. There are some common types and causes of menstrual irregularities.

These irregularities can indeed seem overwhelming due to the wide range of potential causes and manifestations. To make it more manageable, we shall attempt to break it down into simpler, more digestible parts. There are certain key points to understanding menstrual irregularities. In addition, certain other associations are important to consider. Keep a menstrual calendar to note the start and end dates, the pattern of flow, and any symptoms that may be associated with that flow.

It is also important to look for any irregularities or changes in your normal cycle. Tracking your cycle and being aware of any changes can empower you to take control of your health.

Therefore, if you notice anything that seems out of the norm or have concerns based on what you saw, seek medical advice. While menstrual irregularities can be complex, understanding the basics can help you manage and seek appropriate care. The normal menstrual cycle is what we would first need to understand. Typically, the cycle lasts between 21 and 35 days. It often starts sometime between 12 and 13 years of age, but there is evidence that the age of starting this important journey into the reproductive years is falling all the time, with some girls beginning as early as 10 or even 9 years.  The bleeding can last between 2 to 7 days. It may be bright red blood, or it may be a brown kind of loss. Sometimes, it could be dark brown or even black.

Due notice should also be made of the flow, and it is important to be able to determine early on whether that rate of flow is considered to be normal, light or moderate. It should not be excessively heavy or unduly light. Common types of irregularities are missed periods, also known as Amenorrhea. The absence of menstruation can be described as primary when a woman has not started menstruating by the age of 16 or secondary, when a woman who previously had regular periods stops menstruating for three or more consecutive months. This diagnosis is made when there are no periods for three months or more. In young girls and women of reproductive age, such a complaint should trigger every effort to confirm if a pregnancy is present before other steps are taken to make further evaluations in order to determine the underlying cause. Painful periods, known as dysmenorrhea, is another common menstrual irregularity. It is characterised by severe menstrual cramps, which is severe enough in some cases to send some women to the hospital. Periods occurring more than 35 days apart are typically described as oligomenorrhea or infrequent periods. In the same way, frequent periods, also known as polymenorrhea, are periods occurring less than 21 days apart. This is often a challenge to women who seek to get pregnant.

Excessive bleeding or periods lasting more than 7 days are also described as menorrhagia. At the opposite end of this spectrum is something known as hypomenorrhea, which describes very light bleeding or periods lasting less than 2 days. Irregular bleeding, called metrorrhagia, is known as bleeding between periods. The common causes of these problems are hormonal Imbalances, the most common of which are difficulties with typically female hormones such as oestrogen and progesterone as well as prolactin, the hormone responsible for the regulation of the production and release of breast milk. Therefore, fluctuations in the circulating levels of estrogen, prolactin and progesterone can affect menstrual cycles. However, there are also normal conditions that can bring this situation about, which are recognised as mandatory life stages like pregnancy, as we declared before, breastfeeding and the peri-menopausal period in those who are fortunate enough to grow old enough. In the old days, our grandmothers knew that when a woman was breastfeeding, she would not ovulate and so would not be able to get pregnant. Their husbands also understood this and in order to satisfy their sexual and other urges, they married several wives.

Besides, medical conditions like polycystic ovary syndrome, and various thyroid disorders, such as a hyperactive orientation, called hyperthyroidism, and the opposite aspect known as hypothyroidism, can similarly affect normal periods adversely. Polycystic ovaries can cause irregularities in the normal cyclical pattern by causing irregular ovulation and therefore, cause abnormalities in the pattern of menstruation, especially its regularity and amount of flow. The same is true of fibroids due to the increased surface area of the uterus and endometriosis, where uterine tissue embeds in sites other than the uterus. Uterine fibroids are noncancerous growths in the uterus that can cause heavy bleeding and irregular periods, as a result of the changes in the landscape that they cause. Other disorders of the reproductive system, such as endometriosis and adenomyosis, are also known contributors to this dilemma. Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, leading to painful and irregular periods, basically as a result of the reasons already advanced above. Adenomyosis is another related but dissimilar condition where tissue similar to the uterine lining grows into the uterine wall, causing heavy bleeding and irregular periods.

Lifestyle factors such as the kind of stress a woman is exposed to also have a bearing on the regularity of her menstrual cycles and even the amount of flow of the menstrual blood. Such stress, be it physical, emotional or related to illness, can have a significant effect on how the menstrual cycle is regulated. In a related way, women and young girls who are menstruating can have that pattern significantly affected in both their regularity and frequency by notable weight changes. A huge degree of weight gain or weight loss can affect the regularity of the menstrual cycles not least because of the profound effects that these changes can bring about in the physical and biological attributes of such women, but also because such dramatic changes in weight are often caused by certain chronic disease conditions such as diabetes and celiac disease. Furthermore, when a woman indulges in excessive exercise, sometimes due to peer pressure or occasionally due to some newfound obsession, the regularity of her cycles can be affected. There are less prominent factors that are sometimes of genuine interest to the attending doctors who seek an explanation for what is going on with a particular patient, and this is something within the realm of the patient’s genetic predisposition.

Questions and answers

Good evening, dear Sunday Doctor. I must commend you for the free and useful advice you give to the public. Doctor, my own problem is about my two shoulder bones, or should I call them joints? I get periodic joint dislocations. This has been happening for over 30 years now, but it seems to have become frequent these days. I could be sleeping, and all of a sudden, either of the joints would dislocate, giving me severe pains that I cannot describe here. I could be wearing a shirt, and one of them could dislocate. I usually manage to fix it back after a little struggle, writhing in pain. The bone would return to its normal position and I would get myself back. Please, what can I do to be free from this? It has even embarrassed me a couple of times in public.                                 07061475***

Good evening, sir. Thank you very much for your warm words of encouragement. 30 years is a long time indeed, and it is likely the case that you have gone through hell in the time since then. What you have described is recurrent shoulder dislocation, which is a very painful occurrence.  However, a problem of this nature that comes and goes suggests that you need to go to a hospital to get it properly evaluated for severity and possible underlying cause, following which you can then get it treated. You need to see an orthopaedic surgeon for such an examination and treatment.

Good day, doctor. I am a regular reader of your column in The Sunday PUNCH. I am a-57 57-year-old man with hypertension and on Ramipril 5mg with Indapamide 1.5mg every day. I take my drugs regularly, and my BP is well controlled. I carried out general medical check-ups every year for the past seven years, and the results have always been good. However, my result for this year, which was done this month, shows that I have an enlarged prostate. The PSA (prostate-specific antigen) was 6.7 ng/ml, but as of last year, it was 0.2 ng/ml. The doctor told me that I should come back after 2 months when the PSA test will be done again, before further action is taken. Kindly explain to me what sort of medical help is available for men with an enlarged prostate. Can the prostate be returned to its original size? I will send my medical report along with this message. Thanks                                            08033909***

Thank you very much for your kind words of appreciation and for keeping a date with us every Sunday. The huge gap between the figure obtained last year and the current one is large, and it has moved into the range of PSA readings that is classified as suspicious. It is important to abide by your doctor’s advice, which should appropriately be that a return visit would be considered necessary after 3 months for a repeat investigation. However, you must undergo a prostate biopsy to properly confirm what could be going on with your prostate. This is an important step with significant implications for how the rest of your management of the present condition is perfected. There is no way by which your prostate can be returned to its original size; an enlarging prostate is a fact of increasing age, and it is natural for it to grow.  As for your results, it has not been possible to download them, so one is not able to make comments about them.

Hello, Dr Ikhisemojie. I saw your stuff in the newspaper on back pain. I am feeling pain in the lower region of my back. The pain comes and goes anytime I am walking, sitting or doing different things. I am a busy man.                                      08075191***

Thank you very much for your contribution and your question. However, it is difficult to determine what you mean by being a busy man. You did not disclose what work you do, how old you are and how long you have experienced this pain. At any rate, you need to visit a doctor and get a proper examination done, including X-rays, at least of your lumbar area so that the underlying cause of your back pain can be determined. It is only by doing so that treatment can be effectively offered to you.

Good evening, doctor. I am currently visiting my elder sister in Canada and saw some Ozempic in her fridge, which her doctor gave her around November or December last year. She is no longer using it, and when I asked her if I could take it, she said yes. But she does not really know what the drug is used for, and the husband does not know either. Can I actually use it?                          07036509***

Well, to be honest, Ozempic was originally developed as an injectable form of an effective diabetes treatment. However, it has quickly gained much popularity as a drug for achieving weight loss. So, if you are not overweight or obese or diabetic, you have no business with its use.

Dear doctor, I heard that anything to do with surgery is a risk. At times, a patient can die from complications. A doctor just said that in The Punch newspaper. My late mom had 3 surgeries before her death.  Thanks and have a nice day. 08063871***

Thank you very much for this contribution. Every operation carries a potential risk, and this is usually explained to the patient as part of the process involved in obtaining the person’s consent before the day of the operation. Risks are weighed depending on the nature of the operation, which is often gets to be divided into minor operations, intermediate surgeries and major ones. Operations are further subdivided into day-case surgeries, elective operations and emergencies. Most deaths will result from emergency surgeries because the causes of whatever has led to such an operation often occur suddenly and leave the patients significantly compromised regarding their eventual recovery. However, that is actually not a common outcome. Wound infection, failure of the operation, scar formation adverse reactions to anaesthetic medications are far more common results of having an operation than death. After all, even people who never had surgery still die.

Good morning, sir. I am having an issue with my 10-year-old daughter, who has been complaining about stomach aches for many months now. Despite the pain, she does not refuse to eat, and she does not vomit or run a temperature. So, knowing that I had never given her a worm medicine, I decided to deworm her last week. But to my greatest surprise, she has stopped complaining since that time. Should I continue to worry about her tummy? Thank you very much.                  07081317***

Good afternoon, too. You certainly did well by administering a worm expeller to your daughter. Whether that was effective or not in relieving her of the troublesome abdominal pains remains to be seen and the advice would be that you should remain vigilant because the pain may have been provoked by another factor and could return. Besides, if you were inspecting her stools and did not see any worms in them, dead or alive, this is unlikely to have been the problem with her.

Good evening, dear doctor. I was diagnosed with cancer of the prostate in August last year and had an operation in early October to remove my testes, which the doctor explained was necessary to control the cancer. I thought that was the end of the problem, but now my urologist has explained to me that although mine was still at an early stage, he needs to monitor me through monthly tests for my PSA and another blood test. He said the essence of placing me on 3 months of the two tests is to monitor the situation so that he will know the appropriate treatment to give me. My question, therefore, is which treatment again? He mentioned that some treatments may have toxic reactions, hence he is being careful in recommending anyone just anyhow. So what do I do?       08034012***

Well, the first thing to do is have an audience with your urologist. It is almost certain that he explained all of these things to you before the operation, but you were probably not listening to him because of your fear about the diagnosis you got and the operation you were due to have. He will certainly go over the relevant steps in the treatment with you. It needs to be emphasised that cancer is a kind of disease in which some of the cells are always left behind even after early, aggressive surgery. It is those cells, which are invisible to the naked eye, that chemotherapy targets. So, in a way, this aspect of the treatment is sort of compulsory and the kind of chemotherapy in this disease is not like the one everyone else is familiar with; if it was early like you say it was and there was no evident spread, it is a tablet you will be required to take daily for 2-3 years or an injection every 3 months for the same length of time.