Madeleine Keenan, 3rd year medical student at Florida State University College of Medicine
Madeleine Keenan, Period Pro
Age of first menarche? Age of menopause? Last menstrual cycle? Length of cycle? Amount of bleeding? Any unusual vaginal bleeding? These are common questions we’re taught to ask in medical school, but are cardiologists or other specialists asking these questions? And should they be asking them?
Menstrual irregularities, including extreme variations in cycle length and blood flow, are left to the domain of gynecologists, right? Well, the answer may not be so simple. While we generally consider menstrual health to be a topic for discussion during a gynecologic health visit, patients and physicians alike may want to take menstrual health into greater consideration. Particularly, as we enter February, American Heart Health Month, we want to illuminate the link between irregular menstrual cycles and devastating heart disease.
What is a menstrual irregularity?
Periods typically begin (menarche) between the ages of 9 and 16, with the average starting around 12. They usually stop around ages 45 to 50 (menopause). During adolescence, a regular menstrual cycle occurs every 21 to 45 days, and about 3 years after menarche, it tends to settle into a cycle of 21 to 35 days. Periods usually last 3 to 7 days.
Here are a few ways we define Irregular periods:
- Cycles that last longer or shorter than 21 to 45 days in teens and 21-35 days in adults
- A period lasting more than 7 days
- Bleeding or spotting between periods
- Using more than 6 period products a day
- Absence of a period for 3 or more months
What causes the irregularities?
Although the exact mechanism of menstrual irregularities remains unknown, researchers speculate they result from changes in progesterone and estrogen levels. These changes can be caused by various factors, including birth control, breastfeeding, excessive exercise, intrauterine devices, thyroid disorders (both hyperthyroidism and hypothyroidism), high or low body fat, and polycystic ovarian syndrome (PCOS)—the leading cause of menstrual irregularities. Additionally, any disruption to the hypothalamic-pituitary-adrenal axis, which regulates hormone secretion for menstrual cycles, can also lead to irregular periods.In addition, genetic predisposition, lifestyle habits, and environmental exposure contribute to irregularities. This cycle is a delicate balance, and any disruption causes menstrual irregularities in 5%-35% of women depending on age, country, and occupation.
What are the health risks of menstrual irregularities?
Now that we’ve discussed a bit about what defines a menstrual irregularity and some potential underlying causes let’s turn to the main point of this discussion:
Why should all physicians and patients care about these irregularities?
A literature review conducted by Attia, et al. in 2023 found irregular menstrual periods to be associated with metabolic syndrome, type 2 diabetes, cardiovascular disease, anemia, osteoporosis, and rheumatoid arthritis—to name a few. This is not to say that menstrual irregularities cause these diseases, but that these diseases and menstrual irregularities are likely both affected by dysregulation of estrogen and progesterone within the body due to the multitude of comorbidities discussed above. In any case, menstrual irregularities can be an early indicator that these disease processes may be taking place. Therefore, astute physicians should realize that inquiring about menstrual irregularities in patients can help them effectively treat and understand other systemic diseases.
In honor of February, American Heart Health Month, let’s take a moment to shine a spotlight on the link between irregular menstrual cycles and cardiovascular mortality. The American College of Obstetricians and Gynecologists has gone so far as to support the idea of considering menstrual cycles as an additional vital sign when evaluating patients starting in adolescents. Several studies have demonstrated increased risk of cardiovascular morbidity or mortality in those with irregular menstrual cycles. However, the associations throughout reproductive lifespan as well as the degree to which conditions such as hyperlipidemia, hypertension, and type 2 diabetes mediate the association between increased cardiovascular risk and menstrual irregularities remains unclear. Wang, et al. investigated these relationships finding that irregular menstruation was associated with increased risk of cardiovascular disease. They found hyperlipidemia, hypertension, and type 2 diabetes drove the increased risk of cardiovascular disease in only a small portion of patients. They believe the association observed between menstrual irregularities and cardiovascular disease is likely mediated by PCOS which is observed in nearly 90% of women with menstrual irregularities. They concluded that menstrual irregularities could serve as an early warning sign of increased cardiovascular risk.
To all future and practicing physicians in all specialties, consider inquiring about this important vital sign, the menstrual cycle, when caring for patients. Menstrual irregularities could serve as an early indicator that a more insidious disease process is taking place and could allow for early, life-improving treatment.
References
Attia, Ghalia M., Ohood A. Alharbi, and Reema M. Aljohani. “The Impact of Irregular Menstruation on Health: A Review of the Literature.” Cureus 15.11 (2023).
Wang, Yi-Xin, et al. “Menstrual cycle regularity and length across the reproductive lifespan and risk of cardiovascular disease.” JAMA network Open 5.10 (2022): e2238513-e2238513.
Recent Comments