Irregular Menstrual Bleeding: Causes and Concerns

Regarding menstrual issues?

Hello doctor, I would like to ask about my situation.
On July 22, I had sexual intercourse (with a condom, and ejaculation was on my partner's hand, who then touched my genital area).
On July 31, I noticed some blood streaks and brown discharge.
The next morning, August 1, I experienced heavier bleeding and went for a consultation.
The doctor said it was ovulation bleeding (after researching, I found that it might be fine to let it finish, so I only took progesterone for two days).
On August 6, I noticed blood streaks again.
On August 7, the bleeding resembled the second day of my period but without menstrual cramps.
On August 8, I visited another gynecologist, who prescribed progesterone for seven days.

On the evening of August 18, I had brown discharge with a little bit of blood.
On the morning of August 19, a pregnancy test showed negative, and then my period started (with cramps), but on the evening of August 21, there was no blood at all, and it became very clean (my usual menstrual duration is five days).
On the morning of August 22, I started bleeding again, but the amount was not much (a home pregnancy test also showed negative).
During a follow-up visit, the doctor performed a transvaginal ultrasound and mentioned an irregular cyst on my right ovary, along with some menstrual blood, but this time the blood was mostly bright red, and there was some blackish mucous.
My previous menstrual blood was usually dark red or deep red.

Starting August 23, I began to feel a bit fatigued.
On the evening of August 26, my left nipple started to itch.
I'm uncertain if this recent bleeding is what is referred to as implantation bleeding, or if the bleeding on August 1 and August 7 was irregular bleeding.

Niming, 10~19 year old female. Ask Date: 2017/08/27

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, polycystic ovary syndrome, uterine or cervical lesions, infections, ovulation, pregnancy, and breastfeeding, among others.
It is also possible to conceive even if ejaculation does not occur, as pre-ejaculatory fluid may contain sperm.
If your symptoms persist or worsen, it is advisable to consult a gynecologist to check for hormonal imbalances or other underlying causes.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2017/08/27

More Info

Irregular menstrual bleeding can be concerning and may arise from various causes. Based on your detailed account, it seems you have experienced a series of unusual bleeding episodes following a sexual encounter, which has led to confusion regarding your menstrual cycle and potential pregnancy.
Firstly, let's clarify some terminology. "Ovulation bleeding" can occur around the time of ovulation, which typically happens about 14 days before your next expected period. This type of bleeding is usually light and may be accompanied by other ovulation symptoms. The blood you observed on July 31 could have been ovulation bleeding, especially since it was followed by more significant bleeding on August 1.

The subsequent bleeding episodes you described, particularly the one on August 7 that resembled a typical menstrual flow but without accompanying cramps, could indicate a few possibilities. It might be a continuation of your menstrual cycle, an irregular period, or even a sign of hormonal fluctuations. The fact that you experienced different colors of blood (bright red and dark brown) is also noteworthy. Bright red blood typically indicates fresh bleeding, while dark brown blood often signifies older blood that has taken longer to exit the body.

The ultrasound findings of an irregular cyst on your right ovary could also be relevant. Ovarian cysts are common and can sometimes cause irregular bleeding, especially if they rupture or if there is hormonal imbalance associated with them. It's essential to monitor these cysts, as they can sometimes lead to complications.

Regarding the pregnancy concerns, since you tested negative for pregnancy and experienced bleeding, it is less likely that you are experiencing a "pregnancy bleed" or implantation bleeding. However, hormonal fluctuations can sometimes mimic pregnancy symptoms, including breast tenderness or itching, which you mentioned experiencing.

The fatigue you felt on August 23 could be attributed to several factors, including hormonal changes, stress, or even the physical toll of irregular bleeding. It's essential to listen to your body and consult with a healthcare provider if you continue to feel fatigued or if your symptoms worsen.

In terms of management, it is crucial to maintain regular follow-ups with your healthcare provider. They may recommend further investigations, such as blood tests to check hormone levels, or additional imaging studies to monitor the ovarian cyst. If your bleeding continues to be irregular or if you experience significant changes in your menstrual cycle, further evaluation may be necessary to rule out conditions such as polycystic ovary syndrome (PCOS), fibroids, or other hormonal imbalances.

In summary, while some irregular bleeding can be normal, especially in the context of hormonal fluctuations or ovulation, persistent or concerning symptoms warrant further investigation. Keeping a detailed record of your menstrual cycle, symptoms, and any other changes can be beneficial for your healthcare provider in diagnosing and managing your condition effectively. Always prioritize your health and seek medical advice when in doubt.

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