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Main article: Irregular Periods Overview

Updated: 14-September-2024

Diagnosis of Irregular Periods

Diagnosing the cause of irregular periods and subfertility is a thorough process. The Doctor will ask you about your recent cycles, carry out a physical examination and ask a list of questions to document your:

1. Menstrual history
   • Cycle characteristics and age menstruation began.
2. Obstetric history
   • Previous pregnancies, terminations, loss and infections (pelvic, puerperal sepsis).
3. Contraceptive history
   • When used last and any complications.
4. Sexual history
   • Frequency and timing, lubricants, douching, libido, dyspareunia, STDs.
5. Medical history
   • Ovarian cysts, diabetes, hypertension, thyroid disorder, cystic fibrosis, sickle cell disease, tuberculosis, vaccinations (rubella, varicella, hepatitis B & C, HIV), change in weight.
6. Surgical history
   • Appendicectomy, tubal or pelvic surgery, laparotomy, bowel surgery, caesarean sections, conization or loop excision.
7. Family history
   • Diabetes mellitus, hypertension, cancer, consanguinity, premature ovarian insufficiency.
8. Social history
   • Occupation, diet, drug history (prescription, non-prescription and recreational), smoking, alcohol, caffeine.

Following a comprehensive history and physical examination, the Doctor will recommend some tests to help identify or rule out known causes.

These tests are usually carried out in order of least invasive to most invasive:

• Blood test (Hormones)
• Non-invasive tests (Tubal and Uterine)
• Invasive tests (Tubal, Uterine and Pelvis)

Blood Test (Hormones)

The first test is a blood test, taken on cycle day 3-5 and later in the mid-luteal phase, to check a number of hormones.

This will include:

• LH, FSH, AMH and Estradiol (oestrogen).
• Progesterone (mid-luteal phase) to confirm ovulation.
• Androgen (total testosterone) to rule out PCOS.
• Thyroid-stimulating hormone and thyroxine to rule out Hypothyroidism.
• Prolactin to rule out Hyperprolactinaemia.
• Cortisol (or 17α-hydroxyprogesterone) and aldosterone followed by adrenocorticotropic to rule out an adrenal disorder.

The Doctor may also have your insulin levels and insulin resistance measured, along with your cholesterol levels, to obtain a complete picture of your condition.

References

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2. van Welie N, et al. (2022). Can hysterosalpingo-foam sonography replace hysterosalpingography as first-choice tubal patency test? A randomized non-inferiority trial. https://academic.oup.com/humrep/article/37/5/969/6537992 ↩︎
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9. Yanushpolsky E H, et al. (2003). Predictive usefulness of cycle day 10 follicle-stimulating hormone level in a clomiphene citrate challenge test for in vitro fertilization outcome in women younger than 40 years of age. https://www.fertstert.org/article/S0015-0282(03)00499-0/fulltext ↩︎
10. Licciardi F L, et al. (1995). Day 3 estradiol serum concentrations as prognosticators of ovarian stimulation response and pregnancy outcome in patients undergoing in vitro fertilization. https://www.sciencedirect.com/science/article/pii/S0015028216579163 ↩︎
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13. Hoek A, et al. (1997). Premature Ovarian Failure and Ovarian Autoimmunity. https://academic.oup.com/edrv/article/18/1/107/2530761 ↩︎
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