My teen daughter gets her period once every two months or so. And when it comes, it so heavy, lasts about eight days with severe cramps.  I’ve never heard anyone in my family talk about irregular menstruation. Is this normal? Is there medical assistance I can get her? Jackie

Dear Jackie,

How long has your daughter had her menstrual cycle? Has the pattern been once in two months or so, or did it start recently?

Menstrual cycles start with onset of puberty around 13 to 15 years of age. In some girls it may start early, whereas in some, it may start at 16 to 17. Menstruation occurs due to balance of the two hormones, estrogen and progesterone in the body. Few times after menarche (beginning of menstruation), the cycles are irregular. After six months or so, a pattern is set for each woman, which usually lasts till menopause. The cycles occur periodically from 28 to 30 days, plus or minus, one week. In some it is very regular and fixed, i.e. occurring on a fixed date every month. Whereas for some, it varies, being a week before or after the date of last menstrual period. When late, it may also be prolonged to almost two months. The duration of bleeding lasts from three to five days to a week even, varying in different women.

The blood flow pattern also varies from person to person. It may be heavy for first two, three days and then scant flow may occur from third to fifth day.

However, heavy physical exercise, being overweight or underweight (as due to crash dieting) can affect the menstrual cycle pattern in a teenager. It can be due to physical or mental stress or lack of adequate sleep.

Hormonal disorders like hypo or hyperthyroidism, can also cause irregular cycles with heavy flow.  Polycystic ovarian syndrome causes altered cycles, but there would be other manifestations like weight gain and excess facial hair. Use of drugs like corticoids in a young woman can cause irregular menses as a side effect. Regular menstrual cycles can also be altered due to use of hormonal contraceptive pills, and, chronic anaemia can affect menstruation and flow. Infections of the inner lining of the uterus, like tuberculosis, may affect menstrual cycles as well.

Uterine fibroids can cause irregular cycles with heavy flow, but there may be other symptoms like pain in the lower abdomen or heaviness over lower abdomen, with or without backache and muscular cramps. Endometriosis, (where uterine tissue grows outside uterus), is yet another underlying cause for altered menstrual cycles. But it would be accompanied by heavy flow with pain in lower abdomen, backache and cramps in legs.

If the menstrual cycle of your daughter has been consistent since beginning menses, or if she just started menstruating recently, there is nothing to worry about. You can wait patiently and observe. However, if there has been a recent change in the periodicity, duration of blood flow and or amount of blood flow, she needs to be investigated for some underlying disorder. Blood tests and ultrasound examination of the uterus can help to identify a cause for the altered cycles and heavy flow. Almost all the causes in a teenager are treatable.

  Dr. Rachna  Pande is a specialist in internal medicine.