My friend said the other day that she has a colleague who is around 30 years old and has been having her periods for a long time since a few years ago, taking 3 weeks each time, every month. Recently, she wanted to go to the doctor because she felt tired easily and wanted to consult with me first to see what tests were needed. A normal menstrual cycle is every 24 to 35 days, usually once a month. Some people are very punctual, while others are occasionally off by a day or two. Normal periods last no more than 7 days at a time, and the flow varies from person to person, with each woman having her own set. Many women don’t like their period, but if it is late, they are worried about its well-being and wonder if she is stuck somewhere and can’t get out, which is very contradictory. So how do you count abnormal menstruation? 1. too early, 8-year-old girls have periods; 2. too late or late every month, for many reasons; 3. no, 17-year-old girls have never had a period; 4. irregular, once every few months, not necessarily; 5. the stop, usually 7 days, but a month is still bleeding; 6. finally stop and then come, women bleeding after menopause; 7. too much flow, every 1 to 2 hours to change the tampon. A lot of blood clots, or the patient feels a lot; 8. Too little flow; 9. Accompanied by pain, emotional changes, affecting work, relationships, whether it is normal or not depends on the situation. There are many causes of irregular menstruation or abnormal uterine bleeding, but the vast majority are due to endocrine (hormonal imbalance, no ovulation), pregnancy, congenital abnormalities of genital structures, diverticulae of the uterine incision after scarred uterus, fibroids, polyps, coagulation disorders or cancer. Regular and irregular menstrual irregularities When diagnosing menstrual irregularities, we must first clarify how the patient’s menstruation is irregular: is it regular or irregular? Then, based on the patient’s age, medical history, and family history, we can determine what tests should be done next to diagnose what is wrong. When evaluating menstrual irregularities, the medical community often classifies them as “ovulatory” or “anovulatory” periods. Irregular, “non-ovulatory” menstruation may occur only once every few months and the volume of menstruation may be high or low. For regular irregular periods, these tests should be done The patient we talked about at the beginning, she is considered regular, having her period every month, but for too long, three weeks at a time. Whenever I encounter this situation, I would like to ask the patient why she is coming to the doctor now, after all these years. Usually a regular period means that the patient is ovulating, while an irregular period that only comes once in a while means that the patient is not ovulating. This patient sounds like she is ovulating normally and that is why she has regular periods every month. If she is under 35 years old and has no family history of uterine cancer, we are less concerned about cancer because the chances are very, very small. Therefore, if a woman under 35 years old has regular menstruation, and if there is no problem with the internal examination and pregnancy is ruled out, we will recommend the following tests: 1) Routine blood count: to see if there is anemia, how serious it is if there is, and if there are any problems with platelets; 2) Thyroid function: all people with irregular menstruation should have it checked because it is an important hormone that controls metabolism; 3) Coagulation test: especially if the patient is prone to bleeding. If the patient is prone to bleeding more than once, brushing her teeth and bleeding more than once, bruising her skin when she hits it; 4, liver function: having liver disease can affect the production of clotting factors; 5, ultrasound or saline infusion hysterosonography: to rule out structural problems in the endometrium such as fibroids or polyps. 6. At present, after the liberalization of the two-child policy, the number of patients with scarred uterus has increased. For prolonged menstruation caused by scarred uterus, special attention should be paid to whether it is a diverticulum of the uterine incision at the scar, which needs to be carefully observed with B ultrasound after providing medical history to the B ultrasonographer. If all of the above tests are normal, then we will recommend an endometrial biopsy to see if we can find the cause. These tests are needed for irregular periods. Generally, if there is no fertilization after ovulation, the period will start in about 14 days and last for a few days before starting a new cycle. Except for pregnancy and breastfeeding, which interrupt this pattern, this physiological phenomenon will continue month after month until menopause. Only 9% to 14% of women do not have menstrual periods as regularly as mentioned above. Some women’s periods come on time every month, but they stay for at least 10 days and a half months, unlike others who have the good sense to leave after a week. Some people have irregular periods, sometimes coming only once every few months, sometimes disappearing and then suddenly appearing again, often at the most inconvenient times, making the patient very annoyed. The endometrium of these patients is chronically stimulated by estrogen, and since they are not ovulating, they are unable to produce the proper amount of progesterone to guide their monthly period.