Dear DoctorI have an irregular menstruation cycle and it is really starting to worry me. Is it a health complication or are my hormones simply at work? I know my days well and sometimes, I get my period twice a month. Is there something wrong with me?Sonia-------------------------Dear Sonia, You have not mentioned your age and how long you have been menstruating. Normally after menarche(beginning of menstruation), the cycles are irregular for a few months, but usually after 4 to 6 months, a regular flow pattern is established. Women above 40 years can also have irregular bleeding, before actual menopause occurs. You also have not mentioned any associated symptoms during or after menses like abdominal pain, leg cramps or vaginal discharge.In normal women, the cycle is variable occurring 24-34 days apart. The vaginal blood flow is variable between different women and can last from 4 -7 days.Having periods twice in a month, when previously the cycle was normal could be due to a large number of hormonal / systemic medical causes. Bleeding disorders can lead to abnormal bleeding from any site in the body, including the vagina. Long time use of drugs like aspirin or warfarin can induce abnormal bleeding. Use of hormonal contraceptives can also lead to prolonged bleeding. Endocrine diseases of thyroid or pituitary glands are also known to cause increased frequency of menstrual bleeding. Any infection, trauma or malignancy of the uterus, other pelvic parts or cervix can lead to abnormal vaginal bleeding. Excess bleeding in turn increases susceptibility of acquiring pelvic infections, thus aggravating the problem. Some problems in the uterus like myomas or endometriosis are also known to cause heavy and intermittent vaginal bleeding. If you started bleeding twice a month recently, i.e. after previously normal cycles, if the cycles involve very heavy bleeding, the bleeding continues for more than a week, if you have severe pain during menses and even after intercourse, some bleeding or spotting occurs after intercourse, if vaginal bleeding occurs 6 months after menopause, all these are common signs of pelvic infection and or malignancy, necessitating medical/surgical interventions. As such the hormones involved in menstruation, i.e. follicular stimulating hormone, luteinizing hormone, estrogens and progesterone have different roles to play. The net result of the action and balance of these hormones is that ovulation occurs from ovary; the inner lining of the uterus gets thickened to receive the fertilised ovum. Failing fertilisation, this lining breaks down causing cyclical vaginal bleeding. To know the level of these hormones and whether they are functioning normally or not, their blood levels can be estimated. Another simple test is a diagnostic curettage where a small part of the inner lining or uterus is scraped and examined under a microscope. Changes observed have to be compatible with the stage of the menstrual cycle. Treatment depends on any abnormality detected.
