Having Two Periods a Month: Potential Causes and When to Consult a Doctor
A normal menstrual cycle ranges 21–35 days (mean 28). Two episodes of bleeding per month (<21 days apart) is abnormal (polymenorrhea).
Possible Causes
- Hormonal Dysregulation: PCOS, thyroid disorders, hyperprolactinemia, perimenopause.
- Structural Lesions: Endometrial polyps, submucosal fibroids, adenomyosis.
- Infection/Inflammation: Endometritis, PID, cervicitis.
- Iatrogenic: Hormonal contraception (breakthrough bleeding), anticoagulants.
- Stress: HPA axis disruption of GnRH pulsatility.
Evaluation
Pelvic ultrasound, hormonal panel (FSH, LH, estradiol, progesterone, TSH, prolactin), endometrial biopsy if indicated. Treatment targets the underlying etiology.
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