Brief Answer: OUTLINED BELOW Detailed Answer: Hello Thanks for writing to us with your health concern. Yes, irregular menstrual cycles should be investigated, both from the health and fertility point of view. In general, there are some factors that lead to irregular menstrual bleeding. These are - stress of any kind in personal or professional life, weight loss or weight gain that is recent and rapid, ingestion of hormonal medications or drugs that affect the menstrual cycle ( birth control pills, injections, antidepressants, blood thinners etc ), late nights, erratic eating and sleeping schedules, travelling, changes in climate or altitude, smoking, drinking, excessive consumption of tea , coffee or caffeinated drinks etc. If any of those factors are present, then please eliminate them. Other than that, she should have formal gynaecological evaluation to arrive at the cause of irregular cycles. The most common cause for this is - Polycystic Ovarian Syndrome ( PCOS ). This is characterized by hormonal imbalance ( cause is unknown ) - the ovary gets studded with multiple small follicles ( cysts ) and ovulation and menstruation both are erratic and unpredictable. Women with PCOS are often overweight and have excessive hair growth on the face, chin, tummy, legs. Another possible reason could be imbalance of thyroid hormone levels. Presence of a cyst, polyp or fibroid in the uterus / ovaries can cause menstrual irregularity. Diminished ovarian reserve ( less capacity of ovaries to form eggs ) can be a reason, as can damage to the lining of the uterus due to infections. Please have the evaluation as I would outline below for a patient - 1. Internal evaluation by a gynaecologist - per speculum and per vaginum check up. 2. Pelvic ultrasound scan done transvaginally. 3. Hormonal levels - FSH, LH, TSH, Prolactin, OGTT, Serum free testosterone, Fasting serum insulin, DHEAS, Lipid profile. 4. Routine blood investigations - complete blood count, HIV, HBsAg, HCV, bleeding and clotting profile tests. Once this workup is done, a specific diagnosis will emerge. In general , - Avoid stress, late nights. - Eat regularly and sensibly. - Exercise for atleast 30 minutes 5 days a week. - Take daily folic acid supplements. - Also, get your semen analysis done , to rule out any problems on that front. - Be sexually active throughout the cycle, as with irregular cycles, ovulation is unpredictable. You can use follicular monitoring ( keeping track of the growth of egg by ultrasound scanning ). - If ovulation is a problem ( often found in PCOS ) - you can take ovulation inducing agents like Clomiphene citrate to induce ovulation. All the best. Please feel free to discuss further.

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