Dear Dr Mitchell,

Is it normal for a young woman in her 20s to be having her period twice per month and if not, what can she do to prevent this from happening? I do not do any strenuous exercise. The most I do is carry water if there is a shortage and lift up the big bath pans.

The problem that you experience with having two periods in one month is a common problem in young women. The normal menstrual period is on average 28 days but may range anywhere from 21 to 35 days. Anything that causes a change in ovulation pattern will cause the menstrual period to change. The most common problem is that ovulation does not take place and so the cycle becomes irregular or ovulation may be delayed resulting in longer cycle lengths.

Some causes of failure to ovulate include stress, excessive physical activity or exercise, excessive weight loss, excessive weight gain, severe dietary changes as in anorexia nervosa, polycystic ovarian disease, hormonal problems such as thyroid disorders and high prolactin levels, and rarely, premature ovarian failure.

In the early years of the menstrual cycle, it is not uncommon for some women not to ovulate and have this irregular menstrual cycle and this usually settles down as the ovaries mature. The problem that having two periods in one month cause is excessive blood loss and the possibility of becoming anaemic. The risk of this happening can be reduced by eating food rich in iron such as peas, beans, green leafy vegetables, liver and fish, especially sardines.

Taking regular iron supplements is also a good habit. The menstrual cycle may also be regulated by using low dose oral contraceptive pills which will make the cycle regular, predictable, and the flow lighter, thus reducing blood loss.
It is also important for you to have a pelvic ultrasound done to check for polycystic ovaries and have a hormone profile done to look at your prolactin levels, thyroid function and to check your leutinising hormone (LH) and follicular stimulating hormone (FSH). The levels of your LH and FSH will help to confirm the diagnosis of polycystic ovarian disease and also rule out premature ovarian failure.

Polycystic ovarian disease classically is associated with excessive weight gain, irregular menses, infertility, and evidence of excessive male hormones in the system. This includes excessive hair growth on the face and chest, increase in the size of the clitoris and rarely, deepening of the voice. There is also an increased risk of becoming diabetic later on in life. It can be successfully treated however, but requires a lot of discipline. Weight loss is usually the first step in the management as this has lasting benefits in inducing ovulation and causing regular periods, improved fertility and reduced risk of diabetes mellitus.
Consult your general doctor or gynaecologist who will advise you further and do the appropriate investigations.
Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; mail c/o Jamaica Observer, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025.

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