Irregular Menses Management Guidelines

Patient Assessment

• A comprehensive assessment of menstrual patterns, including duration of irregular menses, should be documented, with polymenorrhea defined as <23 days, oligomenorrhea as >35 days, and amenorrhea as no bleeding >6 months, according to the American College of Obstetricians and Gynecologists 1
• Specific bleeding characteristics, such as frequency, duration, and amount of flow, should be recorded, as recommended by the American College of Obstetricians and Gynecologists 1
• Presence of intermenstrual bleeding or spotting should be documented, as advised by the Centers for Disease Control and Prevention 2
• Pattern changes over time should be assessed, as suggested by the American College of Obstetricians and Gynecologists 1
• Presence of pain, such as dysmenorrhea, pelvic pain, or dyspareunia, should be evaluated, according to the American College of Obstetricians and Gynecologists 1
• Weight changes, such as gain or loss, should be recorded, as recommended by the American College of Obstetricians and Gynecologists 1 and the Centers for Disease Control and Prevention 3
• Galactorrhea should be assessed, as advised by the American College of Obstetricians and Gynecologists 1
• Previous pregnancies and outcomes should be documented, as suggested by the American College of Obstetricians and Gynecologists 1
• Current contraceptive method and any side effects should be recorded, as recommended by the Centers for Disease Control and Prevention 2 and 3
• History of sexually transmitted infections should be evaluated, as advised by the Centers for Disease Control and Prevention 4
• Current medications should be documented, as suggested by the Centers for Disease Control and Prevention 3

Management of Bleeding Irregularities

• For hormonal contraceptive users with irregular bleeding, NSAIDs (5-7 days of treatment) may be used for unscheduled spotting or heavy bleeding, as recommended by the Centers for Disease Control and Prevention 2
• Hormonal treatment options based on contraceptive method may be considered, as advised by the Centers for Disease Control and Prevention 2
• Alternative contraceptive methods may be considered if bleeding persists, as suggested by the Centers for Disease Control and Prevention 2
• Non-hormonal medication options may be used, as recommended by the Centers for Disease Control and Prevention 2

Patient Education and Follow-up

• Expected timeline for improvement should be discussed with the patient, as advised by the Centers for Disease Control and Prevention 2
• Potential side effects of treatments should be explained, as recommended by the Centers for Disease Control and Prevention 3
• Importance of follow-up should be emphasized, as suggested by the Centers for Disease Control and Prevention 3
• When to seek urgent medical attention should be instructed, as advised by the Centers for Disease Control and Prevention 3
• Timing of next appointment should be scheduled, as recommended by the Centers for Disease Control and Prevention 3
• Parameters to monitor at follow-up visits should be determined, as suggested by the Centers for Disease Control and Prevention 3
• Instructions for patient self-monitoring should be provided, as advised by the Centers for Disease Control and Prevention 3
• Importance of regular gynecological care should be emphasized, as recommended by the Centers for Disease Control and Prevention 3
• Contraceptive counseling may be provided if appropriate, as suggested by the Centers for Disease Control and Prevention 2
• Screening recommendations based on age and risk factors should be discussed, as advised by the Centers for Disease Control and Prevention 3
• Vaccination status should be evaluated, as recommended by the Centers for Disease Control and Prevention 3