{ "schema_version": 1, "kind": "condition", "id": "irregular-menstrual-periods", "name": "Irregular Periods", "category": "acute", "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)", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 1024, "generic": "Ethinyl estradiol + Levonorgestrel", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 0.03, "adult_dose": "1 tablet (30 mcg EE / 150 mcg LNG) PO daily for 21 days, followed by 7-day pill-free interval.", "adult_duration": null, "dose_source": "SmPC sections 4.1 and 4.2, https://www.medicines.org.uk/emc/product/1130/smpc", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable before menarche.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MICROCEPT 21 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 0.76, "pack_count": 21, "unit_price": 0.04, "strength_mg": null, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MICRODETTE 3* 21 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 7.5, "pack_count": 21, "unit_price": 0.36, "strength_mg": null, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NORDETTE 5*21 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE. > PFIZER", "price_egp": 15.0, "pack_count": 21, "unit_price": 0.71, "strength_mg": null, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MICROGENEST 30/150 MCG 21 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ACDIMA INTERNATIONAL TRADING", "price_egp": 23.0, "pack_count": 21, "unit_price": 1.1, "strength_mg": 0.15, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 120.0, "pack_count": 21, "unit_price": 5.71, "strength_mg": null, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "irregular-menstrual-periods" }, { "id": 1025, "generic": "Norethisterone", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 5.0, "adult_dose": "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).", "adult_duration": "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", "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)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary gives adult dosing only; no paediatric or adolescent dose is stated in this monograph.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CIDOLUT NOR 5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 36.0, "pack_count": 20, "unit_price": 1.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CIDOLUT NOR 5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 57.0, "pack_count": 30, "unit_price": 1.9, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "STERONATE 5 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 56.0, "pack_count": 20, "unit_price": 2.8, "strength_mg": 5.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "irregular-menstrual-periods" }, { "id": 1026, "generic": "Tranexamic acid", "line": 3, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1000 mg (2 tabs) PO TID during menstruation (max 4 g/day, up to 4 days).", "adult_duration": "up to 4 days per cycle; continue cycle-to-cycle for as long as it remains beneficial", "dose_source": "Egyptian National Drug Formulary - Blood Disorders 2025, tranexamic acid monograph, Menorrhagia (blood-2025.pdf page index 95, printed p86)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "25 mg/kg per dose", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "TREXAM 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRANEX 500 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > ABBOTT", "price_egp": 117.0, "pack_count": 30, "unit_price": 3.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KAPRON 500 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 110.0, "pack_count": 20, "unit_price": 5.5, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SAVIBLEED 500 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)", "price_egp": 110.0, "pack_count": 20, "unit_price": 5.5, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "irregular-menstrual-periods" } ] }