Miscarriage or Menstruation: Irregular Cycles and Pregnancy Tests

Miscarriage or menstruation?

Due to polycystic ovary syndrome (PCOS), my menstrual cycle has been irregular.
I only get my period on time when I take medication; otherwise, it can be six months to over a year between periods.
A few months ago, I consulted a reproductive specialist, and it was found that my husband's sperm count was so low that the doctor classified it as azoospermia, so we decided to stop medical treatment and try to conceive naturally.
After stopping the medication, my period ended on September 3, and it has not returned since.
Therefore, after a negative pregnancy test the Friday before last, I sought traditional Chinese medicine to regulate my cycle.
After taking the medicine for three days, my period still did not come, but I experienced breast tenderness, fatigue, and diarrhea.
On Saturday, I visited the Chinese medicine practitioner again and received another three days' worth of medication.
After taking the medicine for one day on Sunday, I collected a urine sample for a health check at work on Monday morning and took a pregnancy test, which showed two lines, although the lines were not very clear.
I tested again with another strip, and it also showed two lines, but they were fainter than the first test.
I planned to visit the obstetrician-gynecologist after work for confirmation, but around noon, I experienced some bleeding.
Initially, it was a small amount of brown discharge, and when I went to the bathroom at noon, there was no bleeding, but later it started to resemble menstrual bleeding with bright red blood and clots.
After work, around 5 PM, I immediately went to the obstetrician-gynecologist for an examination.
The doctor performed an ultrasound and said there was nothing visible, and the pregnancy test showed only one line.
I anxiously asked the doctor about my situation, but he told me that it was likely just a normal menstrual period and that home pregnancy tests are not very accurate.
However, I have tested multiple times, and this is the first time I saw two lines.
Could it really just be a false positive, or is there something else wrong?

Shan, 30~39 year old female. Ask Date: 2017/10/31

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Due to polycystic ovary syndrome (PCOS), my menstrual cycle has been irregular.
I only have regular periods when I take medication; otherwise, my periods can be absent for six months or even over a year.
A few months ago, I consulted a reproductive endocrinologist, and my husband was diagnosed with oligospermia, which led us to abandon further medical treatment and try to conceive naturally.
Since stopping the medication, my period has not returned after it ended on September 3rd.
After a negative pregnancy test the Friday before last, I sought traditional Chinese medicine to regulate my cycle.
After taking the herbs for three days, my period still did not come, but I experienced breast tenderness, fatigue, and diarrhea.
On Saturday, I visited the Chinese medicine practitioner again and received another three days' worth of herbs.
After taking the herbs for one day on Sunday, I collected a urine sample for a health check at work on Monday morning and took a pregnancy test, which showed two lines, although the lines were not very clear.
I tested again with another strip, and it also showed two lines, but the second line was fainter than the first.
I planned to visit an obstetrician-gynecologist after work for confirmation, but around noon, I experienced some bleeding.
Initially, it was a small amount of brown discharge, and when I went to the restroom at noon, there was no bleeding, but later it started to resemble menstrual flow with bright red blood and clots.
After work, I immediately went to the obstetrician-gynecologist for an examination.
The doctor performed an ultrasound and said there was nothing visible, and the pregnancy test showed only one line.
I anxiously asked the doctor about my situation, but he told me that it was likely just a normal menstrual period and that home pregnancy tests are often inaccurate.
However, after so many tests, this was the first time I saw two lines.
Is it really just a false positive, or is there something wrong?

Reply Date: 2017/10/31

More Info

Miscarriage or menstruation can be a complex issue, especially for individuals with irregular menstrual cycles, such as those caused by polycystic ovary syndrome (PCOS). Your situation highlights the challenges of distinguishing between a miscarriage and a normal menstrual period, particularly when pregnancy tests yield ambiguous results.

Firstly, it is important to understand that irregular menstrual cycles can significantly complicate the interpretation of pregnancy tests. In women with PCOS, menstrual cycles can be unpredictable, leading to difficulties in determining the timing of ovulation and the expected onset of menstruation. This unpredictability can result in missed periods, which may lead to confusion when attempting to conceive.

In your case, the initial positive pregnancy tests, indicated by the faint lines, suggest that there may have been some level of hCG (human chorionic gonadotropin) present in your urine. However, the subsequent bleeding and the negative results from the ultrasound and additional pregnancy tests raise concerns about whether this was indeed a viable pregnancy or simply a false positive due to low hCG levels. False positives can occur, particularly if the test is taken too early or if there are remnants of hCG from a previous pregnancy.

The presence of bleeding, especially if it is accompanied by blood clots and resembles a typical menstrual flow, can indicate a miscarriage. However, it is also possible that this bleeding is simply a heavy menstrual period, especially in the context of your irregular cycles. The fact that you experienced a mix of brown and bright red blood is also characteristic of menstrual bleeding, as brown blood typically indicates older blood that has taken longer to exit the body.

It is crucial to consider the timing of your symptoms. If you had a positive pregnancy test followed by bleeding shortly thereafter, it could suggest a very early miscarriage, often referred to as a chemical pregnancy. This type of miscarriage occurs when a fertilized egg implants but does not develop properly, leading to a drop in hCG levels and the onset of bleeding.

Given your history of irregular cycles and the recent attempts to regulate them with traditional Chinese medicine, it is also possible that your body is adjusting to these changes, which could contribute to the irregular bleeding patterns. Stress, hormonal imbalances, and changes in lifestyle can all impact menstrual cycles and the body’s ability to maintain a pregnancy.

In light of these factors, it is advisable to follow up with a healthcare provider for further evaluation. A blood test to measure hCG levels can provide more definitive information about whether you are pregnant and if the pregnancy is progressing normally. Additionally, monitoring your symptoms and any further bleeding is essential, as it can help your healthcare provider determine the appropriate course of action.

In summary, distinguishing between a miscarriage and menstruation in the context of irregular cycles can be challenging. The faint lines on your pregnancy tests suggest the possibility of pregnancy, but the subsequent bleeding and negative ultrasound findings indicate that it may not be viable. Consulting with a healthcare professional for further testing and evaluation is the best course of action to clarify your situation and address any underlying issues related to your menstrual irregularities.

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