Hello Mr. XXXXXXX
Thanks a lot for trusting me with your health query.
I would do my best to assist you in this matter.

1. Firstly, heavy pain during periods is called dysmenorrhoea, and Meftal Spas is a safe drug to take for treating dysmenorrhoea. For relief, she can take maximum upto three tablets a day, that is, 8 hourly. If the dysmenorrhoea is not relieved even at this dosage, she can take injectable Meftal Spas, as that provides instant relief.

2. For the heavy bleeding , she can use Tablet Trapic MF also three times a day , that is 8 hourly dosage. This can be used for the first 2 - 3 days of the heavy period.

3. However, your main concern should not be menstrual pain or heavy periods, as the main problem here is irregular menstrual cycles, and that will ultimately affect her general well being and also future fertility.

I would like to give you a few guidelines on causes of irregular cycles .

- Stress, anxiety, emotional upheavals, frequent travelling, recent illness, rapid fluctuations in weight - all can present with irregular menstrual bleeding. Please rule out all these factors in your case. Your wife has a BMI of 29. 7, and she is definitely overweight, and borderline obese too ( Obesity is defined as BMI > 30 ). She definitely needs to reduce her weight and achieve an ideal BMI. ( between 19 - 25 ). For this, she requires regular physical exercise ( for starting, brisk walking covering atleast 4 km in 45 minutes 5 days a week ) , and proper diet chart after consultation with a Dietician and counting the right calories. A diet XXXXXXX in XXXXXXX leafy vegetables and fresh fruits, and with almost nil intake of sugar, starch, fat, oils and processed food is ideal. Also, yoga and meditation will help her become stress free, and stress is a major cause of irregular cycles.

- Thyroid hormone disorders need to be ruled out by getting a free T3, T4 and TSH levels done on empty stomach.

- Polycystic ovarian syndrome is a condition where females have multiple eggs in the ovaries, but ovulation and menses is highly irregular. This causes irregular, generally delayed cycles, and then whenever there is a period, it is extremely heavy and painful. It is commonly seen in overweight women. Please investigate your wife thoroughly for polycystic ovaries. A proper pelvic ( vaginal ) ultrasound, FSH, LH, SHBG, DHEAS , fasting serum insulin, oral glucose tolerance test, free androgen index - these are the tests done to diagnose PCOS ( polycystic ovarian syndrome ). Treatment lies in weight loss and lifestyle modifications along with drugs like Metformin to regulate cycles. PCOS patients might need medication to aid fertility also.

- Endometrial hyperplasia ( thickening of the lining of the uterus ) or endometrial polyps might cause such irregular cycles and heavy bleeding. A pelvic ultrasound will show the diagnosis.

- Endometriosis ( functioning uterine lining outside the uterus ) also causes irregular and extremely painful cycles. This is a clinical diagnosis as well as sometimes diagnosed by ultrasound or laparoscopy.

- Ovarian cysts, uterine fibroids, cervical polyps might cause such bleeding pattern.

For the time being, take the following steps :

1. Consult a reputed gynecologist , and have a complete pelvic and bodily check up.
2. Go for the blood tests mentioned above after discussing with your gynecologist.
3. Aim for lifestyle modifications as detailed above.
4. Have a positive approach, as she is young, and will definitely respond to the right medication and diet and exercise.

Please take care, and feel free anytime to ask me further questions.

Hope I have been able to help you a bit.

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