Menstruation (irregular)

Our daughter’s periods can be regular, but she can go over 70 days between. This often causes her great stress or pain (we’re not sure) and she has uncontrollable behaviors such as bad self-injury and contortion-like movements. We have Lorazepam for her use during these crises. We give her an absolute minimum but are terrified she will become addicted. We are reluctant to give her yet more drugs but wonder if the pill might help. Our GP is against it. Our daughter cannot tell us of any side effects.

We certainly have seen irregular menstrual periods in females with CdLS, although we do not know why. Hormone studies and other work-ups have not yet been performed on a number of women with CdLS. It sounds as if you are describing some symptoms related to pre-menstrual syndrome, with pain and cramping and behavioral changes that many other families have reported.

There are several options in terms of treatment. Hormone replacement therapy is the best and likely safest option. This could be the pill, giving as low a dose of estrogen as well as progesterone (all in one pill), which will regulate her periods better. You could also use a Depoprovera shot (progesterone only) that also regulates the periods, and often causes them to stop altogether; the shot is given every 3 to 4 months. I think in her case using the pill to initially regulate the periods would be the best option. Her doctor will have to monitor her blood pressure.

We’ve had many, many families whose daughters have been on the pill.

TK 7-13-10

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Answer Published On: October 19th, 2018 3:08 PM

Menstruation (irregular)

My adult patient used to have menses however for the past 6 months has not had one. Should one pursue other medical testing to find the underlying cause. And if so, what tests should be prescribed?

Menstruation stopping after having been present (secondary amenorrhea) can have a number of causes. Both Olanazapine and Metoclopramide can stop menstrual cycles by causing elevated Prolactin levels, a hormone involving in breast milk production. Even Omeprazole has been cited as causing amenorrhea, but it also is reported to help menses restart in patients taking loanazapine. Significant weight loss can stop menstruation. Pregnancy is of course the most common cause for amenorrhea, but I assume that is not under consideration. I would recommend checking Prolactin and Thyroid hormone levels. If the Prolactin level is elevated, she may need to have her medication adjusted or changed. If both hormone levels are normal, then your patient should be given a progesterone drug (medroxyprogesterone 10 mg po for ten days) to see if she has a withdrawal bleed. If she does bleed, then the likely etiology for the amenorrhea is lack of ovulation. Treatment could be Progesterone every 3 months (depo provera) to bring on a cycle, to avoid the lining of the uterus from building up too much. If there is no bleeding after the progesterone medication, an FSH level should be checked. A high level would indicate that your patient has entered menopause. Hopefully your patient is getting a gynecological exam as part of her medical care (under anesthesia along with dental or other treatment is always an option).

NB – TK 3/25/11

Answer Published On: October 19th, 2018 3:05 PM