# Irregular Periods - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## 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) ## Treatment metadata - Ethinyl estradiol + Levonorgestrel — 0.03 mg — oral.solid - Norethisterone — 5 mg — oral.solid - Tranexamic acid — 500 mg — oral.solid ## Complete treatment card ```text IRREGULAR PERIODS 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 against 5 sources listed above (2026-08) 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 Source StatPearls "Abnormal Uterine Bleeding" - disease-level clinical article Status traced to the source above 1. ETHINYL ESTRADIOL + LEVONORGESTREL [1st line] Adult 1 tablet (30 mcg EE / 150 mcg LNG) PO daily for 21 days, followed by 7-day pill-free interval. Peds Not applicable before menarche. 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. Caution 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. Egypt MICROCEPT 21 TAB. CID 0.76 EGP (0.04/unit) -> ? strength differs MICRODETTE 3* 21 TAB. EL NILE. 7.50 EGP (0.36/unit) -> ? strength differs NORDETTE 5*21 TAB. EL NILE. > PF... 15.00 EGP (0.71/unit) -> ? strength differs MICROGENEST 30/150 MCG 21 TABS. ACDIMA INTERN... 23.00 EGP (1.10/unit) -> ? strength differs TRIOCEPT 21 TAB. X 6 STRIP (TRIPHASIC) CID 120.00 EGP (5.71/unit) -> ? strength differs 2. NORETHISTERONE [2nd line] Adult 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 Peds The formulary gives adult dosing only; no paediatric or adolescent dose is stated in this monograph. 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. Caution 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. Egypt 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) 3. TRANEXAMIC ACID [3rd line] Adult 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 Peds 25 mg/kg per 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. Caution 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. Egypt 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 PHARM... 110.00 EGP (5.50/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)