My irregular periods
Dear Dr Mitchell,
I would like to know if there is a problem with me. I am having irregular menstrual cycles and doctors say I am OK. But if I see my period this month sometimes I don’t see it for two months after or sometimes one month after. Can you give me a solution to my problem please?
The problem with your menstrual period being irregular may be due to infrequent ovulation (release of eggs from the ovaries) or complete failure to ovulate. This is a fairly common problem in women and may be due to several factors. Irregular menstruation may be due to problems at the level of the brain, ovary or problems with the thyroid gland.
Failure to release an egg monthly may also be due to a condition called polycystic ovarian disease. This condition is associated with increased weight gain, increased risk of developing diabetes mellitus and increased production of the male hormone, testosterone.
The excess testosterone results in acne, excessive hair growth on the face, chest and abdomen and loss of scalp hair sometimes to simulate a male pattern type. There is also an associated insulin resistance, so despite high levels in the body, the ability to control the blood sugar level is impaired resulting in diabetes mellitus. This condition can be controlled by embarking on a weight loss programme with a plan to achieve your ideal weight for height. In addition the use of Metformin daily will help in reducing the insulin resistance and helps to control the weight gain and restore regular menstrual cycles.
Women with polycystic ovarian disease also have difficulty becoming pregnant. The use of a drug called Clomid (Clomiphene citrate) in conjunction with the Metformin and weight loss helps to restore ovulation and fertility in most women. This condition may be confirmed by doing a pelvic ultrasound to look at the ovaries and also doing blood tests to check the testosterone levels and measure the hormones follicular stimulating hormone (FSH) and luteinizing hormone (LH). These are produced by the pituitary gland in the brain.
Rigorous or overzealous exercise programmes with drastic weight loss can also cause irregular menstruation because of failure to ovulate. Athletes suffer from this problem in a lot of instances. Extreme dieting as is seen in women with anorexia nervosa can also cause irregular menstruation. This can be easily reversed by increasing your dietary intake and of course counselling will be required since these women usually have significant emotional problems. In all cases of irregular menstruation it is a good idea to check for abnormalities in the thyroid gland since this may be the source of the problem.
Increased stress levels such as change in job, migration or other domestic problems can cause problems with ovulation and result in irregular menstruation.
If fertility is not desired then you can achieve regular predictable cycles by using a low dose birth control pill. It is important, however, for you to be thoroughly evaluated by your doctor to ensure that there are no contraindications to the use of the pills. The pill will also work well in women who have polycystic ovarian disease especially if a preparation containing cyproterone acetate is used. This helps to reverse the effect of testosterone and reduces the excessive hair growth on the body and the acne.
Diane 35 or Cypress are readily available and will work well in this regard. The important thing though is to have some basic investigations done to determine the underlying cause so that appropriate treatment can be undertaken.
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.
DISCLAIMER:
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 or other professional health care provider.
