What causes irregular periods?

Patient's Query

Hello doctor,

I have been having issues of on and off periods for nearly four years now. When I started my periods, they were completely 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 10 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, many blood tests and hormone tests, which also did not pick up anything unusual. I just 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.

To diagnose and classify the type of PCOS, following hormonal tests should be done on day 2 of periods. The timing is very important.

LH - luteinizing hormone.
FSH - follicle stimulating hormone.
E2 estradiol.
FBS - fasting blood sugar.
Fasting insulin.
DHEAS - dehydroepiandrosterone.
Free testosterone.
Gynecologic ultrasound.

Once you had all these tests done on day 2 of periods, I request you to upload the reports as it is the ratio of hormonal levels rather than their absolute values that are 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.

Please do tell me if you have already missed a period by a month in this cycle, so that I can suggest medication to induce periods. 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 2.

For further information consult an endocrinologist online --> https://www.icliniq.com/ask-a-doctor-online/endocrinologist

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.

Regarding follow up:

Revert back with the reports to an obstetrician and gynaecologist online.---> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

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