Medical Management of Irregular Periods

Initial Evaluation

The American College of Neurology recommends assessing for polycystic ovary syndrome (PCOS), which affects 4-6% of women and is the most common cause of irregular periods, by checking testosterone, LH/FSH ratio, and mid-luteal progesterone levels, and considering pelvic ultrasound findings 1
The assessment of PCOS should include checking testosterone (abnormal if >2.5 nmol/l), LH/FSH ratio (abnormal if >2), and mid-luteal progesterone (<6 nmol/l indicates anovulation), and considering pelvic ultrasound showing >10 peripheral cysts (2-8 mm diameter) 1

The Centers for Disease Control and Prevention recommends using NSAIDs for 5-7 days during bleeding as first-line treatment for heavy menstrual bleeding, with options including mefenamic acid (500 mg three times daily for 5 days) or celecoxib (200 mg daily for 5 days) 2
The MMWR Recommendations and Reports suggest that multiple NSAIDs (indomethacin, flufenamic acid, diclofenac) demonstrate statistically significant reductions in menstrual blood loss, and that aspirin should be avoided as it may increase blood loss in some women 4
The guideline recommends using tranexamic acid to significantly reduce menstrual blood loss, but notes that it is contraindicated in women with thromboembolic disease or thrombosis risk 4
The guideline also recommends using levonorgestrel-releasing IUD (LNG-IUD) as the most effective long-term approach, reducing menstrual blood loss by 71-95% 2

The American Heart Association recommends that women with cardiovascular disease should avoid tranexamic acid and NSAIDs due to increased thrombosis and MI risk 2
The guideline suggests that certain antiepileptic drugs (valproate, carbamazepine, phenytoin) can worsen menstrual irregularities and should be considered in the medication history 1