acute

Irregular Periods

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources6 sources

Egyptian National Drug Formulary - Endocrine System Drugs 2024, norethisterone (norethindrone) monograph (endocrine.pdf page index 125, printed p112) · Microgynon 30 (ethinylestradiol 30 mcg + levonorgestrel 150 mcg) SmPC sections 4.2-4.4 (eMC product 1130) · SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/1130/smpc · Tranexamic Acid 500 mg Tablets SmPC section 4.2 (eMC product 14622) · Mikes BA, Vadakekut ES, Sparzak PB. Abnormal Uterine Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Feb 21. Bookshelf ID: NBK532913; PMID: 30422508. · Egyptian National Drug Formulary - Blood Disorders 2025, tranexamic acid monograph, Menorrhagia (blood-2025.pdf page index 95, printed p86)

Verified against5 documents

Egyptian National Drug Formulary - Endocrine System Drugs 2024, norethisterone (norethindrone) monograph (endocrine.pdf page index 125, printed p112)
SmPC section 4.2, https://www.medicines.org.uk/emc/product/14622/smpc
SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/1130/smpc
Mikes BA, Vadakekut ES, Sparzak PB. Abnormal Uterine Bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Updated 2025 Feb 21. Bookshelf ID: NBK532913; PMID: 30422508.
Egyptian National Drug Formulary - Blood Disorders 2025, tranexamic acid monograph, Menorrhagia (blood-2025.pdf page index 95, printed p86)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (10)

Cycles arriving closer than <24 days apart count as frequent
A normal cycle interval is 24 to 38 days
Cycles >38 days apart count as infrequent; none at all is amenorrhoea [absent periods]
Regular means a variation of +/- 2 to 7 days; irregular means variation >20 days
Bleeding lasting >8 days is prolonged; ≤8 days is normal [bleeding]
Flow >80 mL is heavy, 5 to 80 mL normal, <5 mL light
Ask about pad changes each day, clots and their size, changes needed overnight, and how much it disrupts activity
Ask separately about bleeding between periods and after sex [abnormal uterine bleeding]
Also ask about loss of weight, pain, discharge, bowel or bladder trouble, and features of anaemia [anaemia]
Ask for features or a past diagnosis of a clotting problem or a hormonal disorder

Signs — what you find (9)

Check first for instability - a postural drop in pressure or a fast pulse
Record vital signs, blood pressure and body mass index
Skin clues: pallor, petechiae, bruising [bruising · pallor · petechiae]
In a teenager, Tanner stage should fit with the fact she is bleeding [bleeding]
Feel the thyroid for swelling or tenderness
Extra hair growth, an enlarged clitoris and acne suggest excess androgen [acne]
Round face, odd fat distribution and striae raise Cushing syndrome [stretch marks]
Feel the abdomen for a pelvic or abdominal mass [abdominal mass · pelvic mass]
Carry out a speculum and bimanual examination

Tests (12)

In any woman of reproductive age, exclude pregnancy with hCG and send a blood count for anaemia and low platelets
Check thyroid function where thyroid disease is suspected, or where no cause has emerged
Prolactin, androgens and oestrogen only where an endocrine problem is suspected, such as anovulation
First-line clotting screen is platelets, PT and APTT - all can read normal in von Willebrand disease, so ask haematology
Screen for a bleeding disorder when periods run ≥7 days with gushes, or soak through protection in 2 hours or less
Screen too after treated anaemia, a family bleeding disorder, or heavy loss at dental work, delivery, miscarriage or surgery
Send ferritin for iron stores; a low value means iron deficiency, but a normal one does not exclude anaemia where there is inflammation
Image when the bimanual is abnormal or symptoms persist on treatment; in teenagers only after first-line management fails
Ultrasound, transvaginal or transabdominal, comes first and finds polyps, adenomyosis and fibroids
MRI is kept for when ultrasound falls short - complex anatomy, fibroids, adenomyosis
Sample the endometrium from 45 years old, and in younger women with persistent bleeding, unopposed oestrogen or failed treatment
If symptoms carry on after a normal biopsy, go to hysteroscopy - blind sampling can miss focal lesions

If not this — what else fits (9)

Bleeding from the urinary or bowel tract can pass for bleeding from the womb
Vulval growths, benign or cancerous
Vaginal causes: growths, sexually transmitted infection, vaginitis, cancer, trauma, a foreign body
Cervical causes: growths, sexually transmitted infection or cancer
From tubes and ovaries: pelvic inflammatory disease or cancer
From the urinary tract: infection or cancer
From the gut: inflammatory bowel disease or Behcet syndrome
Pregnancy itself: intrauterine pregnancy, miscarriage, ectopic, placenta praevia
Causes arising in the body of the womb are grouped under PALM-COEIN

SourceStatPearls "Abnormal Uterine Bleeding" - disease-level clinical article

Presentation findings are traced to the source above.

ETHINYL ESTRADIOL + LEVONORGESTREL

1st line

Strength0.03 mg

Formoral.solid

Adult dose and duration

1 tablet (30 mcg EE / 150 mcg LNG) PO daily for 21 days, followed by 7-day pill-free interval.

Paediatric dose

Not applicable before menarche.

Dose source

SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/1130/smpc

Why

Standard first-line hormonal option to regulate an unpredictable cycle once pregnancy and other causes are excluded, and it doubles as contraception.

Cautions

Exclude pregnancy, thyroid disease, hyperprolactinaemia, and structural causes (fibroids, polyps) before starting.
Contraindicated with a history of VTE/PE, migraine with aura, severe hypertension, or smoking after age 35.
Also provides contraception - confirm this is wanted; if not, norethisterone is the alternative.
Clot risk is highest in the first year on it and resets after any gap of 4 or more weeks off the pill.
RED FLAG - Postmenopausal bleeding, bleeding between periods with pelvic pain or heavy loss, signs of anemia from heavy or prolonged bleeding, or suspected pregnancy or ectopic pregnancy.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
MICROCEPT 21 TAB.? strength differs	CID	0.76 EGP (0.04/unit)
MICRODETTE 3* 21 TAB.? strength differs	EL NILE.	7.50 EGP (0.36/unit)
NORDETTE 5*21 TAB.? strength differs	EL NILE. > PFIZER	15.00 EGP (0.71/unit)
MICROGENEST 30/150 MCG 21 TABS.? strength differs	ACDIMA INTERNATIONAL TRADING	23.00 EGP (1.10/unit)
TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC)? strength differs	CID	120.00 EGP (5.71/unit)

NORETHISTERONE

2nd line

Strength5 mg

Formoral.solid

Adult dose and duration

Acute bleed: 20 mg by mouth three times daily for 7 days (StatPearls, Abnormal Uterine Bleeding NBK532913, acute AUB progestin-only option). The Egyptian National Drug Formulary gives 5 mg by mouth three times daily for 10 days for the same indication, with bleeding usually stopping within 48 hours. Then, to prevent recurrence: 5 mg by mouth twice daily from day 19 to day 26 of each of the next two cycles (Egyptian National Drug Formulary). x 7 days for the acute course (StatPearls) or 10 days (Egyptian formulary), then the day 19 to day 26 course in each of the two following cycles

Paediatric dose

The formulary gives adult dosing only; no paediatric or adolescent dose is stated in this monograph.

Dose source

StatPearls, Abnormal Uterine Bleeding (NBK532913), acute AUB progestin-only option (lead); Egyptian National Drug Formulary - Endocrine System Drugs 2024, norethisterone (norethindrone) monograph (endocrine.pdf page index 125, printed p112)

Why

Cyclical progestogen on days 19 to 26 of the cycle, the regimen the formulary's norethisterone monograph gives, is a standard way to impose a regular withdrawal bleed on an irregular cycle.

Cautions

The two sources disagree four-fold on the acute dose: StatPearls gives 20 mg three times daily for 7 days, the Egyptian formulary 5 mg three times daily for 10 days. The international figure leads here per the app's source policy; both are printed.
Evaluate abnormal bleeding that persists or is severe before repeating courses.
Contraindicated in pregnancy, in current or past deep vein thrombosis or pulmonary embolism, in hepatic impairment or disease, and in undiagnosed abnormal genital bleeding.
Alternative when a combined pill is contraindicated or contraception is not wanted; this cyclical regimen is NOT reliably contraceptive.
Never combine with tranexamic acid - listed as a contraindicated (Risk X) combination in the Egyptian formulary.
Side effects include bloating, weight gain, mood change, and breast tenderness.
Refer to gynaecology if the cycle has not regularised after 3 cycles, or if intermenstrual/postcoital/postmenopausal bleeding appears.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
CIDOLUT NOR 5 MG 20 TABS.	CID	36.00 EGP (1.80/unit)
CIDOLUT NOR 5 MG 30 TABS.	CID	57.00 EGP (1.90/unit)
STERONATE 5 MG 20 TABS.	HI-PHARM	56.00 EGP (2.80/unit)

TRANEXAMIC ACID

3rd line

Strength500 mg

Formoral.solid

Adult dose and duration

1000 mg (2 tabs) PO TID during menstruation (max 4 g/day, up to 4 days). x up to 4 days per cycle; continue cycle-to-cycle for as long as it remains beneficial

Paediatric dose

25 mg/kg per dose

Dose source

Egyptian National Drug Formulary - Blood Disorders 2025, tranexamic acid monograph, Menorrhagia (blood-2025.pdf page index 95, printed p86)

Why

Reduces blood loss during the heavy episodes that can accompany irregular cycles; treats the bleeding itself, not the irregularity.

Cautions

Only needed if the irregular cycle also brings heavy flow - it does not regulate timing, only reduces blood loss during a bleed.
Contraindicated in active or past venous/arterial thromboembolism.
Any postmenopausal bleeding needs urgent referral, not this drug.
Check a full blood count if bleeding is heavy or prolonged; treat confirmed iron deficiency separately.
Do not use for irregular menstrual bleeding until the cause has been established.
Do not start until menstrual bleeding has started, and do not exceed 4 g in 24 hours.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
TREXAM 500 MG 20 TABS.	MEMPHIS	24.00 EGP (1.20/unit)
TRANEX 500 MG 30 TABS.	EGPI > ABBOTT	117.00 EGP (3.90/unit)
KAPRON 500 MG 20 F.C.TABS.	AMOUN	110.00 EGP (5.50/unit)
SAVIBLEED 500 MG 20 F.C.TABS.	MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)	110.00 EGP (5.50/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.