# Polymenorrhea (Frequent 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. - 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. ## Treatment metadata - Norethisterone — 5 mg — oral.solid - Tranexamic acid — 500 mg — oral.solid ## Complete treatment card ```text POLYMENORRHEA (FREQUENT 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. Review status: REVIEWED against 4 sources listed above (2026-08) 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 Source StatPearls "Abnormal Uterine Bleeding" - disease-level clinical article Status traced to the source above 1. 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 imposes a normal-length cycle on frequent periods; a standard alternative when the combined pill is unsuitable. 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) 2. 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 This should be calculated according to body weight at 25 mg /kg per 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. Caution 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. 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)