What causes irregular periods?

Patient's Query

Hello doctor,

I have been having issues with on and off periods for nearly four years now. When my periods started, they were normal, neither heavy nor light, and nothing unusual. But, I started missing my cycle for about six months, and then I would come back completely normal. My last episode of missing my periods had lasted for nearly ten months, and I have had no unusual symptoms, discharge, or pain. I have been to my doctors twice, and I have had an ultrasound, which came back completely normal, blood tests, and hormone tests, which also did not pick up anything unusual. I want to get to the bottom of this problem. Is there anything else you think I could do? What do you reckon about this? I am not stressed, obese, or underweight. I do not smoke or drink. I am a healthy 18-year-old. Any of your advice would be very grateful. Thank you.

Answered by Dr. Sonal Prasad

Hello,

Welcome to icliniq.com.

The menstrual pattern you quote sounds like PCOS (polycystic ovarian syndrome). It is a hormonal imbalance characterized by menstrual abnormalities. I suggest doing the following tests on day two of periods to diagnose and classify the type of PCOS. The timing is crucial. 1. LH - luteinizing hormone. 2. FSH - follicle-stimulating hormone. 3. E2 - estradiol. 4. FBS - fasting blood sugar. 5. Fasting insulin. 6. DHEAS - dehydroepiandrosterone. 7. Free testosterone. 8. Gynecologic ultrasound.

Once you had all these tests done on day two of periods, I request you to upload the reports as it is the ratio of hormonal levels rather than their absolute values deranged in PCOS.

Since you say certain hormonal tests were done and came out normal, I presume that your thyroid and prolactin levels were normal. Get them done, too, if the report is more than three months old.

Would you please tell me if you have already missed a period by a month in this cycle so that I can suggest medication to induce periods? Would you please give the exact date of periods in that case? If you have not missed your periods yet, then wait for your periods and get the test repeated on day two.

The Probable causes:

PCOS.

Investigations to be done:

Hormonal profile.

Differential diagnosis:

1. Hypothyroidism.
2. Hyperprolactinemia.

Treatment plan:

Progesterone withdrawal if required and combined oral contraceptive pills (COC) after reports.

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