Irregular Periods: When to Seek Further Medical Evaluation

The menstrual cycle has been 62 days, and menstruation has not yet occurred?

Hello Doctor, on June 12th, I had brown discharge for the entire day, intermittently.
On June 13th and 14th, the discharge changed from brown to a little bit of bright red menstrual blood in the morning.
By the afternoon, the menstrual flow disappeared again.
On June 17th, I returned for a follow-up, and the doctor suggested administering a medication to induce menstruation, but my period still did not come.
On July 1st, during another follow-up, the doctor performed an abdominal ultrasound and noted that the endometrial thickness was 1.2 cm.
I received another injection to induce menstruation, but as of today, my period still has not arrived.
In April, I had blood tests done, and the results were normal.
The ultrasound indicated some polycystic tendencies.
My last menstrual cycle was 35 days long, and it lasted for 7 days.
However, this cycle has now exceeded 60 days, and I am unsure what further evaluations I should pursue.
Doctor, what kind of tests do I need to undergo? Thank you.

A Nian, 20~29 year old female. Ask Date: 2017/07/04

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the factors that can affect the menstrual cycle or cause intermenstrual bleeding are numerous, including age, environment, lifestyle, stress, emotional instability, weight changes, medications, emergency contraceptive pills, diet, uterine or cervical lesions, infections, pregnancy, and breastfeeding, among others.
It is advisable to consult a gynecologist if symptoms persist or worsen to determine whether it is due to hormonal imbalance or other causes, so that appropriate treatment can be arranged.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2017/07/04

More Info

Irregular menstrual periods can be a source of concern for many women, and understanding when to seek further medical evaluation is crucial for maintaining reproductive health. Based on your description, it appears that you have experienced a significant change in your menstrual cycle, with a delay exceeding 60 days, which is notably longer than your previous cycle of 35 days. This situation warrants further investigation.

Firstly, it is essential to recognize that menstrual irregularities can stem from various factors, including hormonal imbalances, stress, weight changes, underlying medical conditions, or lifestyle factors. In your case, the presence of brown discharge followed by a brief episode of bright red bleeding, and then the absence of menstruation for an extended period, suggests that your body may be experiencing some form of hormonal disruption. The fact that you have a history of polycystic ovarian syndrome (PCOS) can also contribute to irregular cycles, as PCOS is known to cause hormonal imbalances that can lead to missed periods.

Given that you have already undergone blood tests that returned normal results and have had an ultrasound showing a thickened endometrial lining (1.2 cm), it is advisable to consider the following steps:
1. Follow-Up with Your Healthcare Provider: Since you have already consulted with your doctor and received hormonal injections to induce menstruation without success, it is important to schedule a follow-up appointment. Your healthcare provider may want to reassess your hormonal levels, particularly focusing on estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). These tests can help determine if there is an underlying hormonal imbalance contributing to your irregular periods.

2. Consider Additional Imaging: If your menstrual irregularities persist, your doctor may recommend further imaging studies, such as a transvaginal ultrasound, to evaluate the ovaries and uterus more closely. This can help identify any structural abnormalities, such as ovarian cysts or uterine fibroids, that could be affecting your menstrual cycle.

3. Evaluate Lifestyle Factors: Sometimes, lifestyle factors such as stress, significant weight loss or gain, excessive exercise, or changes in diet can impact menstrual regularity. Reflecting on any recent changes in your lifestyle may provide insight into potential causes of your irregular periods.

4. Explore Treatment Options: If hormonal imbalances are confirmed, your healthcare provider may discuss treatment options, which could include hormonal contraceptives to regulate your cycle, lifestyle modifications, or other medications to address specific issues related to PCOS or other underlying conditions.

5. Monitor Symptoms: Keep a detailed record of your menstrual cycle, including any additional symptoms you may experience, such as pain, mood changes, or other physical symptoms. This information can be valuable for your healthcare provider in determining the best course of action.

In summary, while occasional irregularities in menstrual cycles can be normal, a cycle exceeding 60 days, especially with a history of PCOS, should prompt further evaluation. Regular communication with your healthcare provider is key to addressing your concerns and ensuring that any underlying issues are identified and managed appropriately. If you experience any additional symptoms, such as severe pain, unusual discharge, or other concerning signs, do not hesitate to seek immediate medical attention. Your health and well-being are paramount, and proactive management can help restore your menstrual regularity and overall reproductive health.

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