What could be the reason for irregular periods?

Question

Hello doctor,

I am a 24-year-old female, 151.5 cm in height, 119 pounds. I would like to consult with you regarding my irregular periods. I am on daily medication of Olanzapine 5 mg and Sodium Valproate 200 mg. I have always had irregular menstrual cycles since menarche at the age of 14. According to the period tracking app, based on the past six cycles, my average cycle length is 42 days, with a 37-day cycle variation and an average period length of ten days. I have had about eight periods a year for the past two years.

My longest cycle was for 69 days last year, and the year before that, it was 95 days. Another piece of information is that I had eight months without menstruation between menarche and my second period. I do not experience period cramps or tender breasts, but I rarely have mild cramps. Currently, I am on day 93 of my cycle, and I have not menstruated yet. Should I be worried?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

It sounds like you have been dealing with irregular periods for quite some time, and given your cycle length and variation, it is understandable that you are concerned about your current cycle being 93 days long.

Could your medications be affecting your menstrual cycle?

While Olanzapine (an antipsychotic) and sodium valproate (used for epilepsy and mood stabilization) can affect your menstrual cycle, they are not likely the primary cause of the irregularity, as you have had irregular periods since menarche at age 14.

Potential causes of irregular periods:

Polycystic ovary syndrome (PCOS): PCOS is a common cause of irregular cycles, often with long gaps between periods, and can be associated with weight gain, acne, and excess hair growth. Given that your cycles can extend to 69 or even 95 days, PCOS may be a possibility, but it would need to be confirmed with blood tests (for hormone levels) and an ultrasound to check for cysts on your ovaries.
Hypothalamic amenorrhea: If there is significant stress or weight fluctuation, the hypothalamus can affect the release of hormones, causing missed periods. This does not seem likely in your case, as your weight and diet do not appear to be factors, but it is still something to consider.
Thyroid issues: Hypothyroidism (low thyroid hormone) can lead to irregular or missed periods. A blood test to check your thyroid levels could be useful.
Prolactin imbalance: High levels of prolactin (a hormone related to milk production) can cause irregular periods. A blood test can measure prolactin levels.
Ovulatory dysfunction: If you are not ovulating regularly, this can lead to long cycles. Anovulation is common in conditions like PCOS or may be related to weight changes, medications, or hormonal imbalances.

What to do now:

See a gynecologist or endocrinologist: It is a good idea to consult a doctor to rule out underlying causes, especially if you have had a cycle as long as 93 days. Your doctor may recommend blood tests to check for PCOS, thyroid function, prolactin levels, and possibly an ultrasound of your ovaries.

Consider medications or treatments:
1. Hormonal treatments like birth control pills can help regulate periods.
2. If PCOS is suspected, lifestyle changes (like maintaining a healthy weight) or medications like Metformin can help with ovulation.
  
  Is this a cause for concern?
  1. Having irregular periods is not necessarily a sign of something serious, especially if you have a long history of it. However, the 93-day cycle is a red flag for potential hormonal imbalance, which should be investigated.
  2. Tracking your cycles and seeing a doctor for further evaluation will give you a clearer picture and help guide you toward the right treatment or reassurance.
    
    Please let us know if you have any further queries. We would be happy to answer.
    
    Thank you.