Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Recurrent Inter-menstrual Bleeding After Attaining Puberty?
Question: my daughter is 11 yrs and got periods for the first time on 19/10/15 which stopped after 6 days and then again after completion she started bleeding on 8th day i.e 26/10/15. our doctor advised to take traneya mf and gynac cvp for 3 days, it was helpful and bleeding stopped. But again on 06/11/15 her bleeding has started. now doctor has advised to take hormonal treat of deviry 10 mg for 21 days. is it okay? and what are the possible side effects?
Brief Answer:
She is on the right lines of treatment
Detailed Answer:
Dear Mrs. XXXXXXX
Your daughter has got her first menses (menarche) at an appropriate age, though lower limits of appropriate age. Before I discuss the matter with you, I would like to know certain aspects of her phenotype (body type). This will help me to guess her hormonal balance.
1. What is her height, weight and BMI? Does she appear rather plumpy?
2. Is her (may be your family) breast development rather gorgeous?
3. Is she worrying type of the girl?
If you understand the mechanism of menstruation, probably it would be easier for you to understand and appreciate our discussion.
There is a complete quota of the eggs present in the ovaries of a girl. Every month some of them are maturing and one of them gets released. As the egg is maturing, the follicle in which it is sitting releases a hormone Oestrogen which grows the lining of the uterus (endometrium). Endometrium needs Oestrogen and/or Progesterone for its survival. When the egg is released, the remaining follicle undergoes some changes, now called as corpus luteum starts producing Progesterone hormone in addition which causes secretory changes in the endometrium. This corpus luteum has got a life of 10 days. If pregnancy does not take place, this corpus luteum dies out; thus Oestogen and Progesterone levels come down and the endometrium starts dying out and in four days time it is thrown out with some blood. This is menstruation.
Now in girls immediately after her menarche do not produce eggs for some period which may vary from few months to few years. Hence there is only Oestrogen in varying levels. Therefore the bleeding may be irregular during first few years. The bleeding due to oestrogen is rather heavy. If your daughter is having Oestrogen dominance, she will have heavy bleeding. This hormonal dominance can be guessed by phenotype.
Probably your daughter (may I know your and her name?) is oestrogen dominant personality and hence is having heavy frequent bleeding. Tab. Tranexa is tranexamic acid which helps to control any type of bleeding while Gynae CVP are vitamins and iron to build up the blood lost during menstruation. Since in spite of Tranexa she is having repeated bleeding, your doctor has thought of adding progesterone to her system so the endometrium will become secretory and bleed lesser. Deviry is a progesterone preparation. Probably he/she may consider continuing her on Progesterone for three months cyclically to regularize her menses and control the bleeding.
Due to progesterone, she may put on some weight, may have heaviness & some pain in breasts and may be some constipation. If she feels so, minimizing salt intake may give her some relief. However, these are not longer lasting side effects and will go away soon. In the initial phase of the treatment, she may have nausea and vomiting which will go away as she gets used to the tablets. It is better to take these tablets after dinner to minimize the nausea and vomiting.
In married girl, one would have thought of studying her endometrium by some invasive techniques like endometrial biopsy or hysteroscopy which at this stage is not indicated for your daughter. If the irregularity continues with heavy bleeding in spite of Deviry, one may opt for studying her endometrium by ultrasonography. However, let us not consider it at this stage.
I feel, Mrs. XXXXXXX your Gynaecologist is on the correct path in treating your daughter's menstrual problem. Mostly with few months hormonal treatment, she will resume her normal menses. You need not take much of stress at this stage. As a mother, your duty is firstly to assure your daughter (for which you may make her read this message) and to keep a close watch on her menstruation. Please keep her well equipped with hygienic sanitary napkins handy.
I hope this will take away your much concern about your daughter's menstrual irregularity. Please furnish me with the required information for update in the case. If you want to have any more information, I am always available for you, Mers. XXXXXXX If you are impressed with this information, you may post the review with 5 starts rating for me.
She is on the right lines of treatment
Detailed Answer:
Dear Mrs. XXXXXXX
Your daughter has got her first menses (menarche) at an appropriate age, though lower limits of appropriate age. Before I discuss the matter with you, I would like to know certain aspects of her phenotype (body type). This will help me to guess her hormonal balance.
1. What is her height, weight and BMI? Does she appear rather plumpy?
2. Is her (may be your family) breast development rather gorgeous?
3. Is she worrying type of the girl?
If you understand the mechanism of menstruation, probably it would be easier for you to understand and appreciate our discussion.
There is a complete quota of the eggs present in the ovaries of a girl. Every month some of them are maturing and one of them gets released. As the egg is maturing, the follicle in which it is sitting releases a hormone Oestrogen which grows the lining of the uterus (endometrium). Endometrium needs Oestrogen and/or Progesterone for its survival. When the egg is released, the remaining follicle undergoes some changes, now called as corpus luteum starts producing Progesterone hormone in addition which causes secretory changes in the endometrium. This corpus luteum has got a life of 10 days. If pregnancy does not take place, this corpus luteum dies out; thus Oestogen and Progesterone levels come down and the endometrium starts dying out and in four days time it is thrown out with some blood. This is menstruation.
Now in girls immediately after her menarche do not produce eggs for some period which may vary from few months to few years. Hence there is only Oestrogen in varying levels. Therefore the bleeding may be irregular during first few years. The bleeding due to oestrogen is rather heavy. If your daughter is having Oestrogen dominance, she will have heavy bleeding. This hormonal dominance can be guessed by phenotype.
Probably your daughter (may I know your and her name?) is oestrogen dominant personality and hence is having heavy frequent bleeding. Tab. Tranexa is tranexamic acid which helps to control any type of bleeding while Gynae CVP are vitamins and iron to build up the blood lost during menstruation. Since in spite of Tranexa she is having repeated bleeding, your doctor has thought of adding progesterone to her system so the endometrium will become secretory and bleed lesser. Deviry is a progesterone preparation. Probably he/she may consider continuing her on Progesterone for three months cyclically to regularize her menses and control the bleeding.
Due to progesterone, she may put on some weight, may have heaviness & some pain in breasts and may be some constipation. If she feels so, minimizing salt intake may give her some relief. However, these are not longer lasting side effects and will go away soon. In the initial phase of the treatment, she may have nausea and vomiting which will go away as she gets used to the tablets. It is better to take these tablets after dinner to minimize the nausea and vomiting.
In married girl, one would have thought of studying her endometrium by some invasive techniques like endometrial biopsy or hysteroscopy which at this stage is not indicated for your daughter. If the irregularity continues with heavy bleeding in spite of Deviry, one may opt for studying her endometrium by ultrasonography. However, let us not consider it at this stage.
I feel, Mrs. XXXXXXX your Gynaecologist is on the correct path in treating your daughter's menstrual problem. Mostly with few months hormonal treatment, she will resume her normal menses. You need not take much of stress at this stage. As a mother, your duty is firstly to assure your daughter (for which you may make her read this message) and to keep a close watch on her menstruation. Please keep her well equipped with hygienic sanitary napkins handy.
I hope this will take away your much concern about your daughter's menstrual irregularity. Please furnish me with the required information for update in the case. If you want to have any more information, I am always available for you, Mers. XXXXXXX If you are impressed with this information, you may post the review with 5 starts rating for me.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Hi Dr. Shrotri
Thanks for your prompt reply and it was really helpful for us and we are much relaxed now.
As regards your questions, the answer is as below
1) My daughter is very slim, her height is around 5.4 and weight is mere 28-29 (and i understand she is underweight by some 3-4 kgs). She is as such since her childhood. However she is very active, tall , good in studies and badminton.
2) There is no such breast history in the family and neither she has developed any substantial breast till date (very minor development has occured.
3) Yes as regards her worrying nature, little bit, but nothing serious as such.
As regards your detailed answer to my query i would further like to ask you few more things if the site permits me to
a) You have said that after few months of hormonal treatment-while doctor has perscribed us 21 days of hormonal treatment. Do you think this treatment might get prolonged?? and why?
b) In case of any side effects as you have mentioned they would be temporary. Does this side effect such as weight gain or other remain for years or they would disappear in course of time. Does this effect the normal routine of the girl such as going to school, tutions, sports etc?
c) Last and most important. Do we need to get stressed due to my childs underweight. Should we try to give her supplements for weight increase. Her diet is normal. we are non vegetarian and she enjoys and eats whatever is served to her. But she seldom feels lot of hunger, only she follows normal routine time for meals. Also she is prone to stomach infection (if she eats 2-3 times non veg in hotel she gets loose motions). Also this year after summer she has suffered 2-3 times throat infection and 2-3 times cold (viral fever) accompanied with cough and cold. Can i ask you how to increase her resistance power and should we give anything for her weight increase???
d) Most important when she started bleeding for the second time in 20 days this month she was under treatment for viral fever (coldman and chericoff) does this suggest anything, can this be the reason for this problem??
I think i am taking too much XXXXXXX in asking you, but these were the things we cannot ask our doctors (because of time restraint). We are already very thankful to you for your time and guidance. Thank you once again.
p.s Today is third day for second dose of initial two tablets gynac and traneya. and she has hardly had any flow today (just 2-3 drops). should we go for hormonal treatment from tomorrow, or should we wait for another few days???
Eagerly waiting for your reply.
XXXXXXX XXXXXXX XXXXXXX XXXXXXX
Thanks for your prompt reply and it was really helpful for us and we are much relaxed now.
As regards your questions, the answer is as below
1) My daughter is very slim, her height is around 5.4 and weight is mere 28-29 (and i understand she is underweight by some 3-4 kgs). She is as such since her childhood. However she is very active, tall , good in studies and badminton.
2) There is no such breast history in the family and neither she has developed any substantial breast till date (very minor development has occured.
3) Yes as regards her worrying nature, little bit, but nothing serious as such.
As regards your detailed answer to my query i would further like to ask you few more things if the site permits me to
a) You have said that after few months of hormonal treatment-while doctor has perscribed us 21 days of hormonal treatment. Do you think this treatment might get prolonged?? and why?
b) In case of any side effects as you have mentioned they would be temporary. Does this side effect such as weight gain or other remain for years or they would disappear in course of time. Does this effect the normal routine of the girl such as going to school, tutions, sports etc?
c) Last and most important. Do we need to get stressed due to my childs underweight. Should we try to give her supplements for weight increase. Her diet is normal. we are non vegetarian and she enjoys and eats whatever is served to her. But she seldom feels lot of hunger, only she follows normal routine time for meals. Also she is prone to stomach infection (if she eats 2-3 times non veg in hotel she gets loose motions). Also this year after summer she has suffered 2-3 times throat infection and 2-3 times cold (viral fever) accompanied with cough and cold. Can i ask you how to increase her resistance power and should we give anything for her weight increase???
d) Most important when she started bleeding for the second time in 20 days this month she was under treatment for viral fever (coldman and chericoff) does this suggest anything, can this be the reason for this problem??
I think i am taking too much XXXXXXX in asking you, but these were the things we cannot ask our doctors (because of time restraint). We are already very thankful to you for your time and guidance. Thank you once again.
p.s Today is third day for second dose of initial two tablets gynac and traneya. and she has hardly had any flow today (just 2-3 drops). should we go for hormonal treatment from tomorrow, or should we wait for another few days???
Eagerly waiting for your reply.
XXXXXXX XXXXXXX XXXXXXX XXXXXXX
Brief Answer:
Concerned about her BMI. Rule out certain things
Detailed Answer:
Dear XXXXXXX
I had thought that her mother is asking the query. It is indeed heartening and proud to note that a father is looking after the daughter's health.
You have all the right to ask me any number of questions regarding her (what is her name?) health. Even after closing this query, any time you feel, you may ask me a Direct question.
I shall answer your queries one by one:
a. She may require up to 3 months treatment initially; however, after first 21 days course, the Gynaecologist may revise the decision of continuing for more period cyclically or to wait for the bleeding and assess at that juncture. Any decision is fair. If she continues to bleed heavily (chances are very low after Progesterone course) she may be further continued on Deviry. Cyclical treatment of Deviry is mainly for regularizing her cycles.
b. The side effects of Progesterone that I mentioned are temporary. Some times they go away after few days. They will not remain after discontinuing the pills.
c. Yes; her BMI is too low - barely 5. It has to be between 18.5 and 24.9. (I am providing you a link which will help you calculating BMI : http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.) You have to take it seriously. Please get her Thyroid function tests done (T3, T4, TSH). Considering her menstrual problem, let us have a look at her Thyroid function. Girls are known to land into Thyroid dysfunction at pubertal age due to increased metabolism. Usually it is Hypothyroidism; your daughter's picture suggests Hyperthyroidism. However, heavy bleeding fits into Hypothyroidism. Also, please get her complete haemogramme with ESR done. Tuberculosis is very rampened in XXXXXXX (India). Let us rule it out. ESR will give us some clue regarding the necessity of any further investigations. Please concentrate on her diet. You are non-vegetarian. High protein-low carbohydrate diet can keep the person lean. You may think of increasing her carbohydrates. Rice is a good source of carbohydrates. You may take a dietician's advice for the same. I would like to rule out tuberculosis as she is having low immune response. To increase her immunity, please give her fresh lemon, amla and citrous fruits which have plenty of Vitamin C. Green leafy vegetables, Vitamin A, B-complex also help increasing immunity. Make her eat balanced vegetarian diet also.
d. Yes, any acute illness can cause menstrual irregularity or heavy bleeding. However, let us rule out the other organic causes first before blaming influenza.
ps: Tranexemic acid does bring down the bleeding due to any cause from any site. Whether to wait and see the results or to start Deviry tablets is your informed choice. Considering the irregularity in the menses, I would have opted for Deviry in spite of control over the bleeding.
I hope I have answered all your queries with appropriate information. If you wish to have any more information, please go ahead and ask me without any hesitation, XXXXXXX
And finally XXXXXXX worrying will not help her. Take proper care. Sympathy never helps, you have to be empathetic.
Always for you,
Dr. Nishikant Shrotri
Concerned about her BMI. Rule out certain things
Detailed Answer:
Dear XXXXXXX
I had thought that her mother is asking the query. It is indeed heartening and proud to note that a father is looking after the daughter's health.
You have all the right to ask me any number of questions regarding her (what is her name?) health. Even after closing this query, any time you feel, you may ask me a Direct question.
I shall answer your queries one by one:
a. She may require up to 3 months treatment initially; however, after first 21 days course, the Gynaecologist may revise the decision of continuing for more period cyclically or to wait for the bleeding and assess at that juncture. Any decision is fair. If she continues to bleed heavily (chances are very low after Progesterone course) she may be further continued on Deviry. Cyclical treatment of Deviry is mainly for regularizing her cycles.
b. The side effects of Progesterone that I mentioned are temporary. Some times they go away after few days. They will not remain after discontinuing the pills.
c. Yes; her BMI is too low - barely 5. It has to be between 18.5 and 24.9. (I am providing you a link which will help you calculating BMI : http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm.) You have to take it seriously. Please get her Thyroid function tests done (T3, T4, TSH). Considering her menstrual problem, let us have a look at her Thyroid function. Girls are known to land into Thyroid dysfunction at pubertal age due to increased metabolism. Usually it is Hypothyroidism; your daughter's picture suggests Hyperthyroidism. However, heavy bleeding fits into Hypothyroidism. Also, please get her complete haemogramme with ESR done. Tuberculosis is very rampened in XXXXXXX (India). Let us rule it out. ESR will give us some clue regarding the necessity of any further investigations. Please concentrate on her diet. You are non-vegetarian. High protein-low carbohydrate diet can keep the person lean. You may think of increasing her carbohydrates. Rice is a good source of carbohydrates. You may take a dietician's advice for the same. I would like to rule out tuberculosis as she is having low immune response. To increase her immunity, please give her fresh lemon, amla and citrous fruits which have plenty of Vitamin C. Green leafy vegetables, Vitamin A, B-complex also help increasing immunity. Make her eat balanced vegetarian diet also.
d. Yes, any acute illness can cause menstrual irregularity or heavy bleeding. However, let us rule out the other organic causes first before blaming influenza.
ps: Tranexemic acid does bring down the bleeding due to any cause from any site. Whether to wait and see the results or to start Deviry tablets is your informed choice. Considering the irregularity in the menses, I would have opted for Deviry in spite of control over the bleeding.
I hope I have answered all your queries with appropriate information. If you wish to have any more information, please go ahead and ask me without any hesitation, XXXXXXX
And finally XXXXXXX worrying will not help her. Take proper care. Sympathy never helps, you have to be empathetic.
Always for you,
Dr. Nishikant Shrotri
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hello again Doctor,
We had done Sanchi's tests, following is the report
haemoglobin 12.3
blood sugar 116.7
Sr. Free T4 1.6
Sr. Tsh 0.7
rbc Normocytic normochromic
wbc TLC 6900
DLC Neutro 55%
Lympho 42%
Eosino 02%
Monocytes 01%
Normal morphology
Platelets; Adequate
Malarial Palasites Not seen
There isnt any attachment provision in this reply column hence i am noting down the details.
We understand this is in normal range as normal figures are also mentioned in the report and we have shown this report to our doctor and she said its okay.
Regarding BMI, yes she is underweight, her actual height is 154 cms and weight is 29 kg, still she is underweight and our pediatrician says that this is her natural structure and that will remain so. We take care of her diet and would be more attentive now.
Got your contact details would defntly get in touch with you for further queries.
Thank you so much and i am surprised that how do you take time for such prompt replies.
Thanks and regards, XXXXXXX XXXXXXX Adv, XXXXXXX
We had done Sanchi's tests, following is the report
haemoglobin 12.3
blood sugar 116.7
Sr. Free T4 1.6
Sr. Tsh 0.7
rbc Normocytic normochromic
wbc TLC 6900
DLC Neutro 55%
Lympho 42%
Eosino 02%
Monocytes 01%
Normal morphology
Platelets; Adequate
Malarial Palasites Not seen
There isnt any attachment provision in this reply column hence i am noting down the details.
We understand this is in normal range as normal figures are also mentioned in the report and we have shown this report to our doctor and she said its okay.
Regarding BMI, yes she is underweight, her actual height is 154 cms and weight is 29 kg, still she is underweight and our pediatrician says that this is her natural structure and that will remain so. We take care of her diet and would be more attentive now.
Got your contact details would defntly get in touch with you for further queries.
Thank you so much and i am surprised that how do you take time for such prompt replies.
Thanks and regards, XXXXXXX XXXXXXX Adv, XXXXXXX
Brief Answer:
ESR please
Detailed Answer:
Dear XXXXXXX
I have gone through Sanchi's reports. Apparently they appear to be within normal range; however, I would like her haemoglobin to be raised by at least 1 gm%. This will help her in her future marital life. Her Lymphocytic count is on slightly higher side which may indicate some chronic infection. I had suggested you to have haemogramme with ESR. Considering her Lymphocyte count, I would further insist on ESR. Please let me know it.
Does she have any bowel problem? Worms or dysentery?
Please keep me informed about her menstrual regularization also.
Is her familial disposition (maternal and/or paternal) is towards such a low BMI? Otherwise I would be hesitant to label this low BMI as her phenotype.
You are most welcome to contact me personally on my contacts.
ESR please
Detailed Answer:
Dear XXXXXXX
I have gone through Sanchi's reports. Apparently they appear to be within normal range; however, I would like her haemoglobin to be raised by at least 1 gm%. This will help her in her future marital life. Her Lymphocytic count is on slightly higher side which may indicate some chronic infection. I had suggested you to have haemogramme with ESR. Considering her Lymphocyte count, I would further insist on ESR. Please let me know it.
Does she have any bowel problem? Worms or dysentery?
Please keep me informed about her menstrual regularization also.
Is her familial disposition (maternal and/or paternal) is towards such a low BMI? Otherwise I would be hesitant to label this low BMI as her phenotype.
You are most welcome to contact me personally on my contacts.
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
