Dear Doctor, 

I am 22 and my periods are irregular. My cycle is more than 40 days and sometimes I miss periods for over two months. I have never used any contraception. Will I be able to give birth?

Angel

Dear Angel,

A menstrual period occurs due to changes in the hormone balance of estrogen and progesterone. It is counted from the first day of passing blood of one month to beginning of another period. Normally it can vary from 30 days to plus/minus one week. In some women the dates are fixed, whereas in some it is variable. But missing periods for 2 months together warrants attention.

Disorders of the pituitary, adrenal and thyroid gland can cause irregular menses. Diseases of the ovary, like ovarian cyst or tumor can also have irregular menses as one of the manifestations.

Increased levels of prolactin present during feeding a baby or due to prolactin producing tumors leads to irregular menses. One can have irregular menses due to stress and obesity as well. Alcohol use is also responsible for irregular periods. Strenuous exercise done on a regular basis may affect hormonal levels disturbing menstrual cycle.

Eating disorders like anorexia nervosa, malnutrition in young women disturb the menstrual cycle as well as causing irregular periods. Drugs like corticoids when used for a long time can cause absence or irregularities of menses.

Sometimes one may be pregnant but continue to have scanty periods for some months.

Conception depends on the ovulation and subsequent union of the egg with sperm resulting in fertilization.

Ovulation usually occurs anywhere between the 14th to the 21st day of a cycle. One can conceive with irregular periods, provided ovulation is occurring. It is advisable to get investigations done for hormonal disorders, any disorder detected is treatable. Tests like basal body temperature, serial ultrasound examination can help pinpoint the day of ovulation. That day is most suitable to try for conception.

Eating a balanced nutritious diet including fresh vegetables and fruits and whole grains is useful for improving fertility. Regular light exercise is also useful. Abusive substances like alcohol should be avoided.

Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital