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How can irregular menstrual cycles be treated?

Q: My 25 years old wife has been having delayed menstrual cycles by 10 days, means she has been getting her periods every 40 days for the last 6 months. The doctor asked for some hormones tests (FSH, LH, Prolactin). The results are: FSH: 5.64 mIU/ml, LH: 6.2 mIU/ml, prolactin: 26.38 ng/dl. Are these results normal? The doctor said that prolactin reference value should be below 20 ng/dl. Please advise.

A:You must have the reference values of the normal range of the lab where the tests were done. As such this value is slightly high. Few more points: Testing for Prolactin should be done first thing in the morning without doing any work, and there should have been no sex nor breast stimulation the previous night (which could give an elevated level). The TSH should also have been tested simultaneously; hypothyroidism is commonly associated with menstrual problems, and if TSH is high, that could give rise to an elevated prolactin level. In such a case, treating the hypothyroidism will help in treating the menstrual problem. FSH and LH should be tested on day 2 or day 3 of the menses. If these tests were done on these days, I note the LH is slightly higher than FSH, but not very much higher. A transvaginal scan of the pelvis should be done on Day 2 or Day 3 of menses by an experienced ultrasonologist to rule out PCO. Also, if the cycles are becoming infrequent, irregular, and the flow is decreasing, please ensure tuberculosis is ruled out (another very common cause of menstrual problems in India).

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