acute

Polymenorrhea (Frequent Periods)

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

Evidence status

Checked against the sources named below

Sources5 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.

Verified against4 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.

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (8)

Bleeding is called frequent when the cycle interval is <24 days [bleeding]
Cycle timing counts as irregular once it varies >20 days
A period lasting >8 days is prolonged
Heavy loss is >80 mL and light is <5 mL of blood loss
Since volume cannot be measured, ask how often pads are changed by day and by night, and about clot size
Ask separately about bleeding between periods and after sex [abnormal uterine bleeding]
Ask too about weight loss, pain, discharge and bowel or bladder trouble [weight loss]
Ask what contraception is in use and about any past sexually transmitted infection

Signs — what you find (8)

Look first for instability: a postural drop in pressure, or a fast pulse
Skin clues to anaemia or a clotting disorder are pallor, petechiae and bruising [anaemia · bruising · pallor · petechiae]
Feel the thyroid for swelling or tenderness
Excess hair growth, clitoromegaly or acne point to androgen excess [acne · excess hair]
Moon face, odd fat distribution and striae raise Cushing syndrome [stretch marks]
Palpate the abdomen for a pelvic or an abdominal mass [abdominal mass]
Both a speculum and a bimanual examination belong in the pelvic assessment
In an adolescent, check the bleeding fits her sexual maturity by Tanner stage [bleeding]

Tests (12)

Exclude pregnancy by urine or serum hCG and send a full blood count for anaemia and low platelets
Test thyroid function where there are thyroid features, or where nothing else explains the bleeding
Keep prolactin, androgen and oestrogen assays for a suspected endocrine cause such as anovulation
First-line clotting screen is a platelet count with prothrombin and partial thromboplastin times
A normal clotting screen does not exclude von Willebrand disease, so haematology input is often needed
Screen for a bleeding disorder when menses run ≥7 days with gushes, or soaking a tampon in 2 hours or less
Screen also after anaemia needing treatment, a relative with a bleeding disorder, or heavy loss at extraction, delivery or surgery
Ferritin measures iron stores, and inflammation can hold it normal despite anaemia
Ultrasound, transvaginal or transabdominal, is the first imaging and finds polyps, adenomyosis or fibroids
Sample the endometrium from 45 years or older, because cancer risk climbs with age
Sample younger women too when bleeding persists, oestrogen was unopposed, or drug treatment failed
Symptoms persisting after a normal biopsy call for hysteroscopy, as blind sampling misses focal lesions

If not this — what else fits (9)

Blood from the urinary or the bowel tract can be mistaken for menstrual loss
Vulval growth, benign or malignant
Vaginal growth, infection, vaginitis, cancer, trauma or a retained foreign body
Cervical growth, a sexually transmitted infection, or cervical cancer
Pelvic inflammatory disease or malignancy of the tubes and ovaries
Urinary tract infection or urinary tract cancer
Inflammatory bowel disease, or Behcet syndrome
Pregnancy itself, miscarriage, ectopic pregnancy or placenta praevia
Causes arising in the uterine body are grouped by the PALM-COEIN acronym

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

Presentation findings are traced to the source above.

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 imposes a normal-length cycle on frequent periods; a standard alternative when the combined pill is unsuitable.

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

This should be calculated according to body weight at 25 mg /kg per dose.

Dose source

SmPC section 4.2, https://www.medicines.org.uk/emc/product/14622/smpc

Why

Reduces blood loss if the frequent cycles are also heavy; does not lengthen the cycle interval itself.

Cautions

Only needed if the frequent cycles are also heavy - it does not lengthen the cycle interval, 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.

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.