Hello XXXXXXX

Thanks for your query on this portal.

Irregular menstrual cycles generally occur at the extremes of reproductive life for a woman, that is, around puberty or menopause, but at 28, this is not the case for you.

I will highlight a few important causes of irregular periods :

1. Stress, anxiety, sudden or severe weight loss, or emotional upheavals

2. Anemia or other nutritional deficiencies

3. Endocrine disorders such as disorders of the thyroid gland, adrenal gland, prolactin

4. Polycystic ovarian disease, characterized by multiple small cysts on ultrasound in both ovaries, features of hirsutism, raised blood sugars and delayed cycles. Polycystic ovarian disease is a leading cause of irregular menses in reproductive age women.

5. Local causes such as damage to the uterine lining, endometriosis, or ovarian cysts.

6. Certain medications interfere with the menstrual cycle, however, you have not mentioned any other than Duphaston or folic acid, and these do not have such side effects.

In order to evaluate cause of irregular periods, as well as to have proper treatment direction for fertility, you should consult a proper infertility specialist, as you have been trying to conceive for almost 3 years now.

I will broadly outline the investigations you need to get done

1. Proper physical examination - breast, neck, thyroid, per abdomen, per speculum and per vaginum to rule out any abnormalities

2. Thorough pelvic ultrasound to rule out pathology in the uterus, tubes or ovaries

3. Semen analysis of your husband after 3 days of abstinence

4. Routine tests such as complete blood count, viral markers, blood grouping etc.

5. Tests for thyroid disorder, adrenal disorders and tests for polycystic ovarian disease - Day 2 FSH, LH, Glucose tolerance test, fasting serum insulin, SHBG ( sex hormone binding globulin ), free testosterone, DHEAS, serum prolactin.

6. Tests for ovarian reserve - to rule out tendency for premature menopause - AMH ( anti mullerian hormone ) and AFC ( antral follicular count ) on ultrasound on day 2 of periods

7. Follicular monitoring - serial ultrasound of your uterus and ovaries to detect disorders of endometrium or ovulation.

8. If none of these tests are conclusive, you should go in for tests of tubal patency - which test your fallopian tubes, if they are open or not - hysterosalpingogram ( HSG ), sono salpingogram or diagnostic hysteroscopy and laparoscopy.

Each disorder is treatable - ovulation disorders are treated by ovulation induction drugs combined with IUI - this seems to be the likely option in your case, as your periods are irregular.

Also, at 28 , please do not panic, as there is a whole spectrum of treatment options for any problem you might have in conceiving.
But do not waste more time, and consult an infertility specialist at the earliest.


Feel free to ask for any further clarifications.

Take care

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