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    Irregular Cycles
    righttime posted:
    Hi, I have posted before. Age 46, in the UK. I started having irregular cycles 18 months ago, definately a mix of short cycles then longer ones and a couple missed.

    Last Autumn I had an ultrasound after going to my GP when I had two cycles in a month that were quite heavy. She suggested this was perimenopausal pattern but to check for structural reasons, she did mention the coil might help if hormonal. I had the US and multiple fibroids were found, lining wasnt mentioned. I was referred to a consultant Gynae. He examined me and said the fibroids were fine to leave, if pressure symptoms or extremely heavy bleeding were to appear, then hysterectomy was the treatment.

    He didn't make comment on irregular cycles particularly saying this might come and go for a while yet or might not and to try and relax. Well, my periods have been more manageable since then. I skipped one, then a heavy one and then two short cycles and back to a few more normal cycle lengths of 28/33/25 with regular flow.

    Now I am back to two short cycles 19/16 days and am worrying about it. Do I need to consider balancing this imbalance with hormones? I know it is a natural decline in progesterone from lack of ovulation etc but also read that if this goes on a thick lining and rise in cancer risk is possible? My GP never mentioned this and in the UK they seem not to scan for this unless bleeding is really heavy or ongoing patterns emerge. Would it be a reasonable rule of thumb for me to contact my doctor if the short cycles continued for say 3 months or more or do I need to investigate?

    I am so underconfident as to how to address whether I have regular perimenopause changes or indications of something else. My GP really did say it is normal to bleed irraticaly, sometimes a week later etc. I have had no bleeding inbetween periods - when I missed a period, I had a couple of days of very light spotting, which i put down to a missed period.

    I am fairly sure this pattern is just the pattern for me, as although erratic it does seem to have a vague pattern. Mixed cycles, some long, some short, some heavy and some not, it seems to be moving to less heavy though. The short cycles under 21 days seem to throw me the most - that's not enough time for an egg to cycle, so is it happening because the lining is heavy or just because no progesterone to manage when it sheds?

    I'd like to relax into only worrying if things were heavy and continuing to be short cycles - I have been really stressed the last two months, maybe that throws things? Am I over thinking? lol

    Thank you
    Mary Jane Minkin, MD responded:
    Dear righttime,
    I would just try to find out what the lining looked like: if it was nice and thin, then you can be reassured that it would be very unusual to contain any significant abnormalities. If it was thickened, it would be quite reasonable to sample the lining of the uterus (endometrial biopsy) to make sure that nothing unusual is going on in the lining. A combination of perimenopause and fibroids can certainly lead to the type of bleeding you are experiencing. If you are maintaining a good blood count, and the lining is fine, you don't have to do anything, as long as the bleeding isn't driving you crazy. After menopause, the fibroids should indeed shrink and become less of a problem. If the bleeding is driving you crazy (or you are becoming anemic), then it is totally reasonable to insert a Mirena IUD, which will likely help with the bleeding. or try a low dose birth control pill as long as you are a good candidate (non smoker, normal blood pressure). So there are options. Good luck,
    Mary Jane
    righttime replied to Mary Jane Minkin, MD's response:
    Many thanks for your reply - am I right in assuming an ultrasound is how they check the lining? I am in the UK and it isn't usual to request investigations but I can try. The consultant suggested the bleeding was not fibroid related, due to it's position I think and when they did the ultrasound I don't think they could see very well. My GP didn't mention the lining when she ordered the first Ultrasound, only looking for polyps or fibroids. I picked up the lining issue from reading online

    The bleeding is actually manageable and I am supplementing some iron (Floradix) just incase. If you could confirm that an ultrasound is the way to check the lining, I would be grateful. I might just see how things go as I don't think without really heavy bleeding I will get the tests from our NHS service.
    Mary Jane Minkin, MD replied to righttime's response:
    Dear nighttime,
    To rule out pathology for uterine cancer, the endometrial biopsy was considered the gold standard for many years. When folks started using the ultrasound to measure the thickness of the uterine lining, they discovered that when the lining of the uterus was about 5 mm or less in thickness, they very rarely found abnormalities in the lining of the uterus. So over the course of the last 15 years or so, many gynecologists came to rely on a thin lining of the uterus as acceptable in ruling out endometrial abnormalities. Now the converse is not true: if the lining is 6 mm or more, it doesn't mean that something is wrong-it just means the ultrasound cannot "clear" you. So folks would then suggest a biopsy of the lining to rule out overgrowth or cancer.
    At least that's the way most gynecologists look at things in the US.
    Good luck,
    Mary Jane
    righttime replied to Mary Jane Minkin, MD's response:
    Hi - many thanks for the explanation. On reflection, I don't know for sure that the ultrasound didn't measure the lining, I wasn't told. The focus moved to the fibroids and a referral for that. My GP did initally mention that she was not considering cancer or ruling that out and the consultant didn't suggest further action.

    I think I am worrying unduly at this point (not unusual for me when i don't understand things). My period did not fully arrive, it is slow to start so isn't as early as I thought. I think I will keep an eye and if bleeding becomes heavy will make the suggestion as to whether I need further investigations. In the main the bleeding is not as heavy as last year.

    Thanks again for explaining things

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