Anovulatory Cycles: When to Seek Medical Advice

Anovulatory menstrual cycle questions?

Hello Doctor, my menstrual period was a week late in March.
This month in April, I had my period for a total of 21 days (23 days), but for the first three days, there was only a very small amount of spotting.
From days 4 to 6, the flow was very light, only two to three pads a day (including overnight).
I have never experienced this situation before.
I went to the hospital for an examination and an ultrasound showed no pregnancy.
By yesterday, which was the 7th or 8th day of my period, the flow had decreased even more (appearing dark brown).
I went for a jog, but the next day I suddenly felt very uncomfortable in my abdomen (similar to the heaviness at the start of a period), and the menstrual flow suddenly increased, but today is already the 10th day, and the increased flow is still very light but has turned red (it feels like it won't stop anytime soon).
Could this be considered an anovulatory cycle? What kind of tests should I undergo at the hospital, or should I just continue to observe? This is the only time I've had this issue since I started menstruating, but I'm very worried as my period has been ongoing.
I would appreciate your assistance in answering my concerns.
Thank you.

Niming, 20~29 year old female. Ask Date: 2017/04/20

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In March, my period was a week late.
This month in April, I had my period for 21 days (23 days), but for the first three days, there was only a very small amount of spotting.
By days 4, 5, and 6, the overall flow was very light, only two to three pads a day (including overnight).
I have never experienced this situation before.
Later, I went to the hospital for an examination and an ultrasound showed no pregnancy.
By yesterday, which was the 7th or 8th day of my period, the flow had decreased even more (appearing dark brown).
I went for a jog, but the next day I suddenly felt very uncomfortable in my abdomen (similar to the heaviness when my period first starts).
The menstrual flow suddenly increased, but today marks the 10th day, and the increased flow is still very light but has turned red (it feels like it won't stop anytime soon).

1.
Does this count as an anovulatory cycle?
Answer: What is anovulatory bleeding? The menstrual cycle is regulated by the interaction between the hypothalamus, pituitary gland, and ovaries, controlled by the cerebral cortex.
The formation of a menstrual cycle begins with a phase known as the "follicular phase," followed by ovulation, and then enters the "luteal phase" for about two weeks.
If there is no pregnancy, the endometrium sheds, resulting in menstruation.
Some women with irregular periods have unstable ovulatory function, leading to abnormal menstrual patterns.
Their bleeding may be very short, lasting only one or two days with a darker color, or they may experience a sudden heavy flow after a period of amenorrhea, with menstruation often being unpredictable.
This situation is often due to anovulation, resulting in an extended follicular phase.
Therefore, under continuous estrogen secretion, the endometrium only undergoes proliferative changes.
When estrogen levels drop to a certain point, it can cause the endometrium to shed, leading to menstruation.
However, this type of menstrual flow is usually very light, sometimes requiring only one pad or panty liner per day, but it can also occasionally feel heavy and uncontrollable.
The most common cause of anovulatory menstruation is polycystic ovary syndrome (PCOS), while other causes may include hypothyroidism, elevated prolactin levels, or ovarian function decline.
2.
What tests should I undergo at the hospital? Should I just observe for now? I am worried because this is the only time I have experienced such an issue since I started menstruating.

Answer: You can start by observing for now.
If it continues for six months, then consider testing for thyroid function, prolactin levels, or ovarian function.

Reply Date: 2017/04/20

More Info

Understanding anovulatory cycles and when to seek medical advice is crucial for maintaining reproductive health. Anovulatory cycles occur when the ovaries do not release an egg, which can lead to irregular menstrual cycles and abnormal bleeding patterns. Your experience of having a late period, followed by a significantly lighter flow and then a sudden change in bleeding patterns, raises some important considerations.

Based on your description, it seems you may be experiencing anovulatory bleeding. The fact that your menstrual cycle was delayed and then presented with very light bleeding, followed by a change in color and flow, can be indicative of hormonal imbalances. Anovulatory cycles are often characterized by irregularities in the menstrual cycle, including missed periods, prolonged bleeding, or very light periods.
The initial light bleeding you experienced could be due to a lack of ovulation, which means that the hormonal changes that typically prepare the uterine lining for menstruation may not have occurred properly. The subsequent increase in bleeding, even if it remains light, can be a sign that your body is attempting to shed the uterine lining, albeit in a less typical manner.

Given that you have not experienced this type of menstrual irregularity before, it is advisable to seek medical attention. Here are some steps you can consider:
1. Consult a Healthcare Provider: Since this is an unusual occurrence for you, it would be prudent to schedule an appointment with your gynecologist or healthcare provider. They can perform a thorough evaluation, including a physical examination and a review of your medical history.

2. Diagnostic Tests: Your healthcare provider may recommend several tests to assess your hormonal levels and rule out any underlying conditions. These tests may include:
- Blood Tests: To check hormone levels, including estrogen, progesterone, and thyroid hormones, which can affect menstrual cycles.

- Ultrasound: To examine the ovaries and uterus for any abnormalities, such as cysts or fibroids that could be contributing to your symptoms.

- Endometrial Biopsy: In some cases, a biopsy may be performed to evaluate the uterine lining for any abnormalities.

3. Monitor Symptoms: Keep a detailed record of your menstrual cycle, including the duration, flow, and any accompanying symptoms such as pain or discomfort. This information can be valuable for your healthcare provider in diagnosing the issue.

4. Lifestyle Considerations: Stress, significant weight changes, excessive exercise, and certain medical conditions can contribute to anovulatory cycles. Consider evaluating your lifestyle and discussing any potential changes with your healthcare provider.

5. Follow-Up: If your symptoms persist or worsen, or if you experience severe pain, it is important to follow up with your healthcare provider promptly.

In summary, while occasional irregularities in menstrual cycles can occur, the changes you are experiencing warrant further investigation. Seeking medical advice will help ensure that any potential issues are addressed early and appropriately. Your health and well-being are paramount, and understanding the underlying causes of your symptoms is essential for effective management.

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