Irregular periods

Irregular bleeding can be heavy or light and the term may represent several abnormal menstrual patterns. The definition includes too many periods, too few periods, bleeding between periods and postcoital bleeding. The main aim of the health-care professional is to exclude any genital tract malignancy and then improve quality of life. A careful history, including perhaps a menstrual calendar, followed by examination is essential. If the woman is over 40 or there are particular risk factors for hyperplasia or malignancy, it may be necessary to obtain a Pap smear. Management will depend on the underlying cause. Cervical lesions often only require simple outpatient treatment. Cyclical progestogens such as medroxyprogesterone acetate can be used to give cycle control if the combined oral contraceptive pill is not suitable.