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What is the treatment for irregular periods?

Q: My wife, age 27 years is having problem of irregular periods. We got married in 1997 and the problem started when we stopped using contraceptives (we used condoms). What I had observed was that after having unprotected intercourse, my wife used to have some bleeding during 15th to 20th days and whenever we were either not having intercourse during 10th to 20th day or having protected intercourse she was having normal periods. We went to doctor at Ahmedabad and I told her the same observation and she prescribed Tab Dubogen for 10 days and after the period Tab Siphene 50 mg (one a day from 4th day to 8th day) and Tab Nidagest (twice a day from 17th to 27th day) for three months. After this dose in the second month wife got pregnant and we had a child in Oct 2000. After that now again we wanted second child and so I went to a doctor in Bhopal and told her the same story, she then prescribed Tab Duphostone for 14 days (from 12th day of MC) for 2 months for regularisation of MC. She took the medicines for 2 months, but again after that the same thing happened, after that we went to another doctor - she gave m2tone for two months but after that she had more irregular bleeding. What I feel is that these doctors are doubting hormonal problems, which I think is not there; problem is after having intercourse during 12th to 16th day she get some problem resulting in bleeding? Now what to do? Wife is asking to take the same medicines prescribed by doctor at Ahmedabad for conceiving child. Kindly advise?

A:After going through this rather exhaustive and confusing history, my suggestions are: 1. Estimation of fasting blood for serum follicle stimulating hormone (FSH), leuteinising hormone (LH), estradiol (E2) and prolactin on the second day of the menstrual cycle (day 2). 2. Regularise her menstrual cycle with a progestin in the luteal phase of the menstrual cycle, eg: Cap MICROGEST (100 mg), 1 capsule twice daily from day 16-25 (a total of 10 days) for a period of three consecutive cycles. The couple can try for conception in any of these three cycles by noting the fertile period. 3. Perform a transvaginal sonography (TVS) from day 11 of the menstrual cycle till the day of follicular rupture to ascertain her ovulatory status and endometrial response. 4. Once her ovulatory status is ascertained, the couple should be counselled for timed intercourse during the fertile period, or more preferably following administration of human chorionic gonadotropin (hCG) injection, for better chance of conception. A speculum examination of the cervix by a gynaecologist should easily rule out the presence of an erosion/polyp on the cervix, which in the presence of vaginitis, could well be the cause of the post-coital bleed that this couple seem to be having every now and then.

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