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I am an adult of 25 years old; I usually experience irregular monthly flow.

It may come once in three months, why sometimes it's regular.

Please what is the problem with me?



Dear Helen,

Metrorrhagia is menstrual bleeding that is irregular in quantity, acyclical in nature and often prolonged in nature.

The condition is usually due to a pathological condition in the uterus or other internal genital organs.

A wide variety of factors can be responsible for irregular periods, among them:

-Significant weight gain or loss
-Poor nutrition (or a diet too high in carbohydrates)
-Drug use
-Excessive alcohol use (interfering with how the liver metabolizes estrogen and progesterone)
-Eating disorders
-Increased stress
-Polycystic ovarian syndrome/estrogen dominance
-Uterine abnormalities (fibroids/cysts/polyps/endometriosis)
-Hormonal imbalance related to perimenopause
-Recent childbirth, miscarriage, or D&C

It's a good idea to do the following:

-Have a complete physical, including evaluations of thyroid function and blood pressure. Also, a complete blood count (CBC) test is quite important for the diagnosis of anemia.

-A pelvic exam is critical to rule out any uterine abnormality, a cervical polyp or fibroid, or a uterine infection. These are less common causes but should be considered. Often an ultrasound will be required to evaluate the uterus, the ovaries and the fallopian tubes. Ultrasound of the uterus is useful and painless - you may already be familiar with this technique from pregnancy. If infection is a concern, antibiotics will be prescribed.

The best non-prescription treatments to make menses more regular are:

For a low estrogen, irregular menstrual problem, the key treatments are:

-Stress reduction and/or relaxation techniques
-Elimination of overly strenuous physical exercise
-Eliminate any eating disorders such as purging, bulimia, or anorexia
-Take supplemental, measured estrogens such as phytoestrogens in soy or clover products.

For a high estrogen irregular menses pattern such as that found in PCOS, weight reduction using a low carbohydrate diet is essential.

Even a 10% weight loss will help restore normal menstrual patterns in obese women who are anovulatory .

The best prescription treatments for menstrual irregularities are:

Oral contraceptives (OCPs) are the most commonly used hormonal treatment for irregular menses. They do not correct the underlying problem that causes the irregularity but they will regulate the pattern very precisely to the same day of the week each cycle. In general, oral contraceptives are very safe and will not cause an alteration in the body even after taking for a very long time. Some women cannot take birth control pills, however, so other treatments are also used.

Women with irregular menses due to hypothalamic factors can take a sequential hormone regimen. In this regimen, estrogen is given each day and then progesterone is given for 10-14 days each month in order to induce a withdrawal bleed. This regimen will not protect against pregnancy should ovulation occur so if a pregnancy is desired, this may be the best regimen.

For polycystic ovarian syndrome most physicians will prescribe oral progestins or progesterone to take for 10 days every two months if there has not been a spontaneous menses. This is thought to protect against the development of endometrial cancer or hyperplasia from the long term elevation of estrogens.
Carbohydrate metabolism abnormalities are often successfully treated with a combination of diet and medications, and the menstrual irregularities may disappear. Metformin, a drug which reduces high insulin levels has been shown to make women with PCOS resume normal menses in almost 90% of cases. This is a dramatic breakthrough in treatment and one worth seeing your physician about if you have PCOS.

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