Q: I am 32 years old and got married recently. I weigh 42 kg and I am anaemic. My periods cycle is for 21 days only. Is it normal? Earlier my cycle lasted for just 15 days. For this I took an ayurvedic medicine, which was effective. Why does my cycle vary with changes in the life? What diet should I take to increase my haemoglobin? I also have dark circles around my eyes and I get very tired by the end of the day. I am a working lady. Please advise.

A:The menstrual cycle in women ranges, on an average, from 21-35 days and occurs in response to a complex interplay of hormones (oestrogen, progesterone, follicle stimulating hormone and leutinising hormone) and organs (including the hypothalamus & the pituitary gland located in the brain, and the ovary). Nearly 1/5th women experience cycles that are irregular. If your cycles are occasionally irregular, it should not worry you too much but in case they are consistently irregular, you need to be evaluated by your doctor. The cycle can be influenced by stress; thoughts and emotions; a break in routine; anxiety about pregnancy; sexual activity; dietary problems like poor diet, anorexia, bulimia; too much exercise, medicines; and illness (thyroid disease) etc. An irregular cycle suggests a problem with the hypothalamus, pituitary, ovary, or uterus and by carefully and systematically examining each level, a doctor can figure out what is going on. If your cycles are regular, but you are experiencing irregular bleeding in between, you are probably ovulating, but may be having bleeding associated with ovulation, a polyp, a fibroid, a cervical lesion, infection, or bleeding from a source outside the uterus (non-uterine bleeding - from the urinary tract, vagina, or cervix). If your cycles are not coming at regular intervals, chances are that you are not ovulating regularly. This may be caused by a problem with the hypothalamus, pituitary, or the ovary. Conditions that can affect the hypothalamus include, stress, dieting, anorexia etc. Conditions that can affect the pituitary include increased levels of prolactin from a prolactinoma (a benign pituitary tumour) and certain drugs. The most common condition that can affect the ovary is polycystic ovarian syndrome (PCOD). Being very young or perimenopausal can also affect your cycles. The thyroid gland (hyperthyroidism or hypothyroidism) can also affect menstruation. It is helpful to keep a “menstrual diary” in which you record the pattern and amount of the bleeding. Anaemia is a condition in which the number of red blood cells or the amount of haemoglobin is below normal for age and sex of the individual. It is defined as a decrease in red blood cell (RBC) mass and is usually discovered and quantified by measurement of the RBC count, haemoglobin (Hb) concentration, and haematocrit (Hct). Anaemia is suggested in males with Hb levels less than 13.0 g/dl and in females with Hb levels less than 12.0 g/dl (less than 11.5 g/dl in pregnant women). It may be due to decreased production of red blood cells, blood loss (haemorrhage) or red cell breakdown (haemolysis). Anaemia is a symptom of disease that requires investigation to determine the underlying cause. It is twice as common in women than in men, especially during the childbearing years due to menstrual blood loss and pregnancies. One of the commonest cause of anaemia in our country is nutritional deficiency - iron deficiency &/or folic acid/vitamin B12 deficiency. Your symptoms are likely due to the anaemia possibly caused by heavy and unpredictable bleeding due to irregular cycles. Please get yourself examined by a physician and a gynaecologist and get a complete blood count done (which includes red cell indices) along with a reticulocyte count and a peripheral smear examination. This will give an idea of the underlying cause on which the treatment depends.