For a young lady with a history of irregular menses, we will always consider polycystic ovaries as a possible cause.
Other possible causes include severe stress, hormonal disorders such as thyroid problems, prolactin producing tumours (prolactin is a hormone necessary for production of breast milk), sudden weight fluctuations, vigorous intensity of exercise, or even a deficient production of the female hormones.
Of course, in someone who is sexually active, it is important to exclude pregnancy. The urine pregnancy tests kits are quite sensitive and hence the result is reliable enough. However, if sex has occurred over a period of time, then sometimes it is necessary to repeat the pregnancy test due to a possibility of late ovulation.
A clinical examination and ultrasound scan would be important to exclude local genital tract causes such as polyps for the reason of the bleeding/spotting.
Hope this helps.
Dr Fong Yoke Fai
