This means menstrual periods coming at unpredictable intervals, rather than the normal once-a-month cycles.

If the flows, whenever they come, are normal in character and length, this is not a dangerous condition and no treatment or evaluation is required. If the patient finds the irregular character of her periods to be troublesome, then starting low dose BCPs will be very effective in giving her quite normal, once-a-month menstrual flows.

If the flows, whenever they come, are not consistent; are sometimes heavy, are sometimes light, are sometimes only spotting, then they are likely not true menstrual cycles, but are anovulatory bleeding (uterine bleeding occurring in the absence of ovulation).

This condition should be treated with re-establishment of normal, regular periods, usually with BCPs. Unresolved anovulatory bleeding may, over many months to years, lead to cosmetic problems (unwanted hair growth due to relative excess of male hormones) and uterine lining problems (endometrial hyperplasia due to a lack of the protective hormone progesterone).

Patients with infrequent periods, particularly if associated with overweight status, acne, and multiple follicles on the ovary when visualized with ultrasound, usually have “polycystic ovary syndrome.” This condition may be effectively treated with OCPs, but also responds well to the use of Metformin.

Patients with hypothyroidism may also have this type of menstrual cycle, and screening for thyroid disease with a TSH is helpful.