A normal menstrual cycle is usually 28 days plus or minus seven days, meaning that anything from 21 days to 35 days is normal. So those who complain that they get theirs twice a month could see how this is possible, especially if you fall into the 21-day cycle. Subtle variations are acceptable, like 21 days here this month, 25 days there next month, etc. but wide swings from days to 35 days will seem abnormal. Even then, unless this happens at least three times consecutively, it should not be concerning. This is because a woman’s menstrual cycle is subject to stress hormones so things like sadness as in death, joy as in travelling abroad, purchasing a car, etc. can trigger events that can lead to heavy flow, scanty flow or even cessation. As such, any alteration unless life-threatening is not significant until it happens through three menstrual cycles in a row. The typical thing is for the Nigerian female to start worrying about the little aberration and even having sleepless nights, a bad combination that will worsen the situation.
I am teaching you now not to fret over any of such changes, and by not fretting and thus not releasing stress hormones, your cycle may just restore to normalcy in the next month. Apart from regularity, most people in Nigeria worry about the colour, the quantity of blood flow, especially how scanty and the number of days of flow, when less than their usual number of days. It is like Nigerian women like to lose blood going by how much they fret over discrepancies and they think it is such a natural order of things that cannot be interfered with. It is almost heretical to alter the course of menses in Nigeria that most people cannot even take pain medications for painful menses because the natural order may be upended.
I can understand this ignorance on the part of patients but when a multiplicity of them tell me that they were told by their doctors not to take pain medications for painful periods, then I am about ready to do away with science, embrace religion the Nigerian way and proclaim that we need deliverance!! When i tell some Nigerian girls that most girls like them in the USA take medications that make them not to have their monthly periods, their palpable disbelief is always summed up in the corollary question, ‘where does the bad blood go?’ My answer is that there is no bad blood because unless the uterine lining is stimulated to prepare for a baby and then no baby eventually there is nothing to shed in menses. Here in the USA, most girls are on the oral contraceptive pills to prevent unwanted pregnancy. They take 21 tabs once daily and for the next seven days thereafter take a placebo that lets them have their menstrual flow. Some do not even want to have that, so they just jump to the other 21 tabs in the next pack and continue cyclically like that. Others who do not have the discipline for daily medications resorted to the taking Depo-Provera injections every three months with same result.
At present, the fad is to have an implant called Nexplanon placed in the body after making a short cut into the skin, and for eight years no pregnancy will occur and invariably no menses. With these innovations in the world, we in Nigeria are still worried that our period flow dropped from four days to three days, etc.
An established menstrual irregularity can be investigated with checking the blood count to ascertain the extent of blood loss, checking coagulation profile to see proneness to bleeding, doing hormonal assays to ascertain menopausal status, doing ultrasound of the pelvis for structural abnormalities and then surgical interventions like diagnostic and therapeutic D&C and finally laparoscopy.