Response to reader - Confused about irregular cycle

Monique Rainford, HER HEALTH

Dear Doctor,

I am a 26-year-old female and, since my high school years, I have had irregular periods. I have been to doctors on several occasions and I have been given provera, proglyluton and Diane-35 to regularise the cycle.

The last time I took the pill was last October, and since then I have not seen my period. I went to a doctor and he sent me to do some blood tests which I haven't done because I went to another doctor and he said I cannot take the tests unless I am in my period. I should have returned to him for a prescription to start the flow if my period does not return. I am confused. Every year I do an ultrasound and the results are always okay. What do I do from here? Awaiting your response.

Dear Reader,

I do appreciate your question. Irregular periods are a problem faced by many women and can cause stress. When women have irregular cycles like you do, they are often treated with hormones. You mentioned you were on provera which is a progestin; proglyluton, an oestrogen; and Diane-35, a birth-control pill that contains both an oestrogen and a progestin.

Women who have normal menses produce both oestrogen and progesterone in different amounts during the month. The cycling of these hormones allows a woman to have regular menses. If she has an imbalance of these hormones, she may either miss her periods or have prolonged bleeding. The same woman can experience both of these problems at different times in her reproductive life.

Induce a period

If a woman does not have a period for six months, this is known as amenorrhoea and this problem should be investigated. One of the most common causes of amenorrhoea is pregnancy and, therefore, a test should be done. If she is not pregnant, a progestin like provera can be prescribed to induce a period. Whether a woman has a period with a progestin is helpful in determining the likely cause of her amenorrhoea.

Women who have bleeding after using a progestin more likely did not ovulate. However, certain blood tests can be helpful in determining the reason for your lack of periods, and some of these tests can be done whether or not you had a period. However, since I am not aware of the specific tests ordered for you, I cannot comment if a period was required in your case. If your doctor is a gynaecologist, it is likely he or she will be able to diagnose the cause of your irregular periods if you keep your follow-up visits. Finally, it is not unusual for ultrasounds to be normal in women with your problem since the cause is often hormonal.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.