Dr Sharmaine Mitchell
Dear Dr Mitchell,
I am 19 years old and my menstruation comes twice each month. Should I be worried doc? I've done a pap smear and it was normal.
The normal menstrual cycle ranges from 21 to 35 days with an average of 28 days. The usual flow may range from three to seven days. It is not uncommon for teenagers to have irregular menstrual cycles when the menstrual period starts and then the cycle settles down as you get older. This is because most young women or teenagers tend not to ovulate in the early years of the menstrual period so the cycle tends to be erratic and then settles down to a regular, predictable flow.
Irregular menstrual cycles may also be due to excessive body fat or weight gain or even drastic weight loss. Excessive dietary restriction or overzealous exercise programmes can also cause abnormal menstrual cycles. It is always a good practice to strike a healthy balance with diet and exercise.
Polycystic ovarian disease can also cause an abnormal menstrual pattern. This is usually associated with excessive weight gain and features of excessive male hormones (testosterone) production. This includes excessive hair growth on the face, chest and abdomen, enlarged clitoris, hair loss in a male pattern type (temporal baldness) and sometimes deepening of the voice. This condition may also be associated with an increased risk of developing diabetes mellitus. It can be successfully treated by weight loss, the use of metformin and in some cases oral contraceptive pills.
In your case, if you are of normal weight for your height and have no other problems, then the use of a low-dose oral contraceptive pill can be helpful in establishing regular menstrual cycles. Prior to the use of the contraceptive pills you should get a baseline hormone profile done to see if you have polycystic ovarian disease. A pelvic ultrasound will also be helpful in ruling out ovarian problems such as ovarian cysts and also to establish that the uterus is normal.
Consult your doctor who will advise you further. If you have not done so already you should also ask your doctor about the cervical cancer vaccine. This is a vaccine against the human papilloma virus (HPV) which causes cervical cancer, throat cancer, vulval and vaginal cancer and also anal cancer. It is a course of three vaccines over a six- month period. You will still need to have your pap smear done starting at age 21 for screening for cervical cancer.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.
The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.