DEAR DOCTOR, My teenage daughter has had an irregular menstrual cycle since she got her first period two years ago. She’s 15 years old now. Sometimes, it skips a month, and sometimes even two. Even the days are irregular, sometimes 4, and other times a week. What is the cause of this? Should I be worried? HILDA DEAR HILDA, At what age did your daughter start having menses? Did she have regular periods for some time, i.e. having them in a fixed pattern? Menses begin in young girls after attaining puberty, due to change in balance of the two hormones, oestrogen and progesterone. The inner wall of the uterus is prepared to receive a fertilised egg. But when this does not occur, the build of tissues and blood vessels is broken down, causing blood and clots to pass out, in form of menstrual blood. Average age of menarche (beginning of menses) is about 12 to 13 years, though it can be as early as 9 to 10 years. Menses remain irregular for the first few months to about a year, till hormone balance is stabilised. After that, a pattern is established which remains same till around menopause. It is usually 28 to 30 days, plus, minus one week, but can be more variable. If your daughter has started menses, recently, wait for few months more to watch when regular cycles start. However, regular pattern of menses can be disturbed due to multiple reasons. Deficiency of blood (anaemia) can cause irregular periods. It can be due to poor dietary intake of iron, folic acid and vitamin B12, excess bleeding or some genetic disorders causing defective blood formation. Anaemia is easily diagnosed on physical examination and its type by a simple blood test, correction of anaemia by necessary supplements and dietary measures helps to regularise menstrual cycles as well. Recent weight loss or weight gain can also disrupt hormone balance resulting in irregular periods. Doing a lot of physical activity also affects hormone levels, causing irregular menses. Mental stress is also responsible for disrupting hormone balance, resulting in irregular menses. Alcohol is also incriminated in disrupting hormone balance, but your daughter is very young yet and I am sure, would not be taking alcohol. A healthy life style including balanced diet, exercise and adequate relaxation can help in regularising menstrual cycles. Irregular periods can occur in a young girl, due to hormonal disorders like those of thyroid, pituitary gland, even diabetes. Any one of this disorder, if present, can be detected easily by investigation and is treatable. Regular menstrual cycles, can become irregular due to drugs like aspirin, painkillers like NSAIDS (non-steroidal anti-inflammatory drugs), anti-thyroid, anti-depressant, anti-epilepsy, and some chemotherapy drugs used for cancer treatment. Polycystic Ovarian Syndrome (PCOS) is yet another cause for irregular periods in an adolescent girl, it becomes difficult to diagnose at this age. Dr. Rachna Pande, Specialist in internal medicine rachna212002@yahoo.co.uk
