Q. My periods have been slightly irregular. What may be the reason?

Answered by
Dr. Sameer Kumar
and medically reviewed by Dr. Hemalatha
Published on Jan 27, 2016 and last reviewed on: Apr 10, 2019

Hi doctor,

I am 24 year old and I had an ultrasound for the first time today. My periods have been slightly irregular for last few months and hence I went for a checkup. I am attaching my scan reports for your reference. Kindly guide me. Thank you.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome to icliniq.com.

The ultrasound scan report (attachment removed to protect patient identity), which you have posted shows a single follicle dominant, may be in the right ovary.

  • The endometrial thickness and uterus seems normal size. This does not appear to be a polycystic ovarian syndrome with normal size ovaries. So, PCOS may not be a cause for the irregularity.
  • I would suggest you to attach the complete written ultrasound report in follow up.
  • I request the following tests thyroid profile, serum prolactin levels, serum progesterone levels on day 21 of cycle and serum testosterone to check. If done, then please submit reports for evaluation or else get them done.

Also, please mention your details of menstrual cycles and dates for last three months to understand the pattern of bleeding.

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

Hello doctor,

Please go through the written report. TSH levels were done today. Prolactin reports will be available only by next week. Also, my report mentions that dominant follicle is in the left ovary, but in the USG, the right one looks bigger. Please explain.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hi,

Welcome back to icliniq.com.

I have checked your ultrasound scan and the written reports (attachment removed to protect patient identity).

Your TSH (thyroid stimulating hormone) levels are normal and rest of the ultrasound is also normal.

  • The dominant follicle is seen in the right ovary as marked in the scan report. So, there is a likelihood that the written report has been mistakenly mentioned the wrong ovary.
  • So, stay informed. The reports are fairly normal and we should await the prolactin levels.
  • Get me the details of your last three menses. Please mention them to understand your irregularity.

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

Hello doctor,

Last year, one month I skipped a period. Then, the subsequent two months, it was timely and got it by the second of each month. Immediately in the next month, it was delayed by almost 2 weeks. This month I am still due.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

The single episodic delay in a month is likely to have been stress induced during the cycle.

Stress is most likely and the commonest cause of delay in reproductive age group, when no obvious causes are present, be it hormonal or organic causes (like fibroid, polyps and adnexal masses).

As your last menses arrived on 16th of last month, this month your menses should be between 16th and 19th. Hence, you should wait for this month.

Ideally speaking, if your 3 menstrual cycles are irregular, then it is said to be an irregular menses or oligomenorrhea cycle. I feel this irregularity in your case is more likely to be stress induced and hence maintain a menstrual calendar for next three months.

We should wait for the prolactin results. Keep me informed.

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

Hi doctor,

Pertaining to the above queries, I had very regular periods till last year. Then, it was delayed by 10 days, and then I missed the period. Later, my period was scant in one month and the next month I bled heavy. Finally, I am miss my period for the last two months. Should I go for an ultrasound again? Is it possible that cysts which were not there earlier have developed now?

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

It would be a better idea to get an ultrasound pelvis repeated to check for endometrial thickness and if any ovarian cysts. Also, please share your serum prolactin reports.

Hi doctor,

I am attaching the ultrasound report and the advised medicines. I am already on Primolut N since yesterday. Also, I do not have hirsutism or abnormal weight gain. According to my doctor, it is a mild case of PCOD. Earlier, I was 70 kg and currently, I weigh 63 kg. The ultrasound report back then was usual. How did these PCOD changes happen suddenly? I thought PCOD manifests right from puberty. Kindly advise and help since I am really confused.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

I have gone through the USG report and the prescription (attachment removed to protect patient identity). It confirms that you have polycystic ovaries with each ovarian volume more than 10 cc which is the cut-off. Also, multiple small subcentimeter follicles were seen in each ovary which are immature follicles and no dominant follicle indicating anovulation or no ovulation during the cycle. It leads to delayed or no menses or scanty anovulatory cycles (which is endometrial shedding following non-advancement towards the secretory phase in the absence of progesterone-secreted after ovulation).

PCOD is purely a lifestyle disease and can flare up anytime during the reproductive period when guards are brought down with regards to eating and exercise habits. Weight gain increases insulin resistance and further contribute to PCOD.

You can continue the Primolut for 5 days and then wait for withdrawal bleed. However, Formitol can be started from now itself daily for the next three months. Also, suggested is to start low dose oral contraceptive pill like Ginette 35 once daily from day 3 of your cycle till 21 days and then next pack from day 2 of next menses after you stop the first pack. This again for three cycles in all. Along with this plenty of water intake, daily 45 minutes brisk walking and avoidance of fatty, spicy and fried foods shall help.

Post three months treatment you can be reviewed. Regards.

Hi doctor,

Last month I did not ovulate. Also, there is a hemorrhagic cyst in the right ovary which also indicates ovulation. The endometrial thickness is also 12mm indicating ovulation. So, could this cystic appearance be temporary? My exercise routine has been perfect, and I have lost 9 kg since last year. Current weight is 63 kg, and my height is 5’7" so I am not even overweight now.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hi,

Welcome back to icliniq.com.

The hemorrhagic cyst does not indicate ovulation, and neither does 12 mm endometrial thickness. These indicate anovulation. Ovulation is indicated by fluid in the pouch of Douglas and a corpus luteum cyst, nota hemorrhagic cyst. Endometrium grew in response to unopposed estradiol effect. Your weight is controlled. I guess you need to maintain a healthy diet and plenty of water. Stress-Inducing factors should be avoided. Just follow the prescription, and you should be good.

Thank you doctor,

I have a few more doubts. I am not too keen on starting with Metformin and hormonal pills. Can I focus on getting my diet and exercise to see how the hormones act up? I am worried about making me periods reliant on the pills. Is this a life long condition or my ovaries can go back to a normal state?

I have been in great psychological stress when my periods first got late by 10 days, Could this be a contributing factor? I was advised to go for hormone levels after a month. Should I wait that long or get it done once I get periods after taking Primolut N?

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

If you are not keen on starting the hormones now and would like to give yourself a chance to regulate ovulation naturally, then I appreciate that.

You may continue Formitol alone for three months post your Primolut-N induced withdrawal bleed and get your basal hormonal levels by day 3 of your cycle.

PCOD is like diabetes; it needs to be controlled to disallow it to flare up. Anyone who is at its predisposition would have to be strict on weight control and lifestyle modifications. Diet and exercise form a part of it for sure, but significant reliance should be one adequate water intake, which shall help improve your metabolism and also help to reduce your insulin resistance (which Formitol shall help as well).

Stress is a significant contributor (about 85%) for causing irregularity in menses across the world and as symptoms overlap with PCOD. It is often seen that women who overcome stress in the next few cycles, their cycles regularise and PCOD features diminish.

Hormones do not make your cycles habitual unless you are not following diet, exercise, and water advises completely. The regimen is for three months and then a break for a month to allow natural menses, and if the next menses again arrive on time, then the lady is switched to a natural treatment regimen, without any medications.

So, if you want to give yourself a try, which is good, I would suggest you give your self two months at least. Do not overexercise, just 45 minutes of brisk walking twice daily shall suffice as you are already 63 kg, as it may rebound sometimes. Also, maintain a menstrual calendar for the next three months. Good luck.

Hi doctor,

Concerning the above queries, I have been on Formitol tablet for two months. After the Primolut induced bleed, I got my regular menstrual cycle last month. This month I have still not got a period. I also have noticed a correlation between acne (which I never got in my life) and my missed periods. Last month I did not have any acne and periods were regular. Around the date of ovulation acne flared up, and I have still not got periods. What should I do if periods do not come this month? I have been following a diet and exercise regime, and weight is maintained.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

Did you take Ginette 35 OC pill as well or just took Formitol tablet? If Ginette was taken then once the pack ends then in next three to five days you should be getting the menses. If not started then considering the withdrawal bleed, menses should naturally start in the next five days if you have been eating healthy, drinking plenty of water and also exercising.

Hi doctor,

I have not been on any hormonal tablets. My withdrawal bleed was on 3rd of that month after taking Primolut N after which I got normal periods on 5th of next month. I am still awaiting periods of this month.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

In that case, when you had a normal period post-withdrawal bleed, you should wait for your menses to arrive naturally for another five days. The menses are usually never on time for women, however, some women have been lucky. Delay of 3-4 days or even preponement is not considered irregular. So, presently wait for your menses, and if they do not arrive naturally in next five days, then we would have to consider a progesterone withdrawal again and then you would have to be on hormonal pills as well.

The arrival of acne indicates that your testosterone balance is getting disturbed in spite of your lifestyle changes, maybe they are inadequate, and this would call for the incorporation of Ginette. PCOD cannot be treated without cyproterone acetate pills.

Hi doctor,

With respect to the above query, I got my normal menses today. I am taking Formitol for 2 months (no hormonal pills) acne has flared up on one side of the face since the time periods were near. I have no abnormal hair growth. A doctor I had consulted had advised Formitol for three months. This is the last month. What should be my next course? How can I clear up the acne? I have had clear skin usually.

Dr. Sameer Kumar

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome back to icliniq.com.

Good to hear that your menses have arrived and have been just three days delayed as per last months menses. So, you can avoid Ginette even during this cycle and continue Formitol for another month. The flaring of acne can be conservatively tackled with neem face wash thrice a day and also with increased intake of water daily, say about 10 to 12 glasses a day to improve BMR and local facial blood circulation which should decrease acne in a week or so.

Antibiotics cream for acne are not recommended until natural methods for oily skin and acne control have been exploited (keeping in viewing your age).

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