Brown Discharge: Causes and Concerns in Women's Health

Brown discharge

Hello Doctor, I visited a gynecologist the day before yesterday because I haven't had my period this month.
The app predicted it would start on August 16.
I have polycystic ovary syndrome (PCOS), and my last menstrual periods were from June 1 to June 7 and from July 6 to July 13.
During the ultrasound examination, the doctor mentioned that I have over 20 follicles, but none are mature, and my endometrial thickness is around 5 cm.
Therefore, it seems that my period is unlikely to come this month, and I didn't take any medication to induce menstruation.
However, starting from August 18, I have been experiencing dark brown discharge, which varies in amount—sometimes resembling the end of a menstrual period and other times just a small amount on toilet paper.
It also has a faint fishy odor.
I would like to ask the doctor what the issue might be.

Lai Ya-Yuan, 20~29 year old female. Ask Date: 2017/08/24

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I visited a gynecologist the day before yesterday because I haven't had my period this month.
My app predicted that my period would start on August 16.
I have polycystic ovary syndrome (PCOS), and my last menstrual periods were from June 1 to June 7 and from July 6 to July 13.
During the ultrasound examination this time, the doctor said I have over 20 follicles, but none are mature, and my endometrial thickness is only about 5 cm.
Therefore, my period is not expected to come this month, and I did not take any medication to induce menstruation.
However, starting from August 18, I have been experiencing dark brown discharge, which varies in amount—sometimes resembling the end of a menstrual period and other times just a small amount on toilet paper.
It also has a faint fishy odor.
I would like to ask the doctor what this issue might be.
Answer: It is likely related to this month's menstrual cycle.

Reply Date: 2017/08/24

More Info

Brown discharge can be a source of concern for many women, especially when it appears outside of the regular menstrual cycle. In your case, the presence of brown discharge following a missed period, particularly with a history of polycystic ovary syndrome (PCOS), raises several important considerations.

First, it’s essential to understand that brown discharge typically indicates old blood that has taken longer to exit the body. This can happen for various reasons, including hormonal fluctuations, which are common in women with PCOS. In your situation, the ultrasound findings of multiple immature follicles and a thin endometrial lining (5 cm) suggest that your body may not be ovulating effectively. This lack of ovulation can lead to irregular menstrual cycles and can sometimes result in spotting or discharge that is not typical of a regular period.

The brown discharge you are experiencing could be due to several factors:
1. Hormonal Imbalance: Women with PCOS often experience hormonal imbalances that can lead to irregular periods and abnormal bleeding patterns. The fluctuation of estrogen and progesterone levels can cause the endometrial lining to shed irregularly, leading to brown discharge.

2. Anovulation: Since your ultrasound indicated that the follicles were not maturing, it is possible that you are experiencing anovulation (the absence of ovulation). This can lead to a buildup of the endometrial lining, which may eventually shed in a non-standard manner, resulting in brown discharge.

3. Implantation Bleeding: If there is a possibility of pregnancy, brown discharge can sometimes be associated with implantation bleeding, which occurs when a fertilized egg attaches to the uterine lining. However, given your history of missed periods and PCOS, this may be less likely unless you have had unprotected intercourse.

4. Infection: The faint odor you mentioned could indicate a possible infection, such as bacterial vaginosis or a sexually transmitted infection (STI). Infections can lead to abnormal discharge and should be evaluated by a healthcare provider.

5. Other Factors: Stress, significant weight changes, and lifestyle factors such as sleep disturbances can also affect your menstrual cycle and contribute to abnormal discharge.

Given your symptoms and the context of your PCOS, it is advisable to monitor the situation closely. If the brown discharge persists, increases in volume, or is accompanied by other symptoms such as pain, fever, or a strong odor, you should seek further evaluation from your healthcare provider. They may recommend additional tests, such as a pelvic exam or laboratory tests, to rule out infections or other underlying conditions.

In conclusion, while brown discharge can be concerning, it is often a result of hormonal changes, particularly in women with conditions like PCOS. Understanding the underlying causes can help in managing your symptoms effectively. If you have any further questions or concerns, do not hesitate to reach out to your healthcare provider for personalized advice and treatment options.

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