Irregular Menstrual Cycles: What to Do Next?

What should I do if it keeps happening?

Hello, doctor.
I apologize for the interruption.
I am currently 49 years old.
When I was younger, my menstrual cycle was regular, occurring every 30 days.
However, after turning 40, my cycle changed to every 21-25 days.
This year, after my menstrual period started on August 12, it lasted for 5 days, and I did not have another period until September 27.
After that, my next period did not arrive until December 2.
On December 3, the flow was heavy, but over the next few days, it reduced to just a few drops, leading me to believe it was ending.
Unexpectedly, on December 12, the flow increased again.
On the 13th and 14th, the volume was similar to my usual menstrual flow.
On December 16, I went to the gynecologist for an ultrasound, and the doctor informed me that I have several uterine fibroids, with the largest being less than 3 cm, and that observation was sufficient.
I was given an injection of PROGESTERONE 50MG 1CC (luteal injection).
The gynecologist mentioned that I would likely have my period in 2 or 3 days, and that my next cycle would be normal.
After the injection, my menstrual flow did indeed clear up, and I thought my period had ended.
However, on the morning of December 18, I felt like my period was returning, and sure enough, it started again around noon that day (with small blood clots).
I would like to ask the doctor: 1.
Why is this happening? 2.
Should I return to the original hospital, or should I seek care at a different hospital? (Since I am unmarried and have never had sexual experience, I only had an abdominal ultrasound that day.)

CAT, 40~49 year old female. Ask Date: 2017/12/19

Dr. Cai Yonglong reply Obstetrics and Gynecology

Approaching menopause, menstrual irregularities may occur.
Small fibroids will gradually shrink during menopause, so there is no need to worry.
However, it is advised to limit soy milk intake.
Please visit a gynecology clinic and follow the medical advice provided.

Reply Date: 2017/12/19

More Info

Irregular menstrual cycles can be a source of concern for many women, especially as they approach perimenopause, which typically occurs in their late 30s to early 50s. At 49 years old, you are at an age where hormonal fluctuations can lead to changes in menstrual patterns. Your experience of having regular cycles in your younger years, followed by increasingly irregular cycles as you entered your 40s, is not uncommon.

From your description, it seems that your menstrual cycle has become quite erratic. You noted that after a relatively normal cycle in August, your periods became less predictable, with intervals ranging from 21 to 25 days, and then significant variations in flow and duration. The presence of uterine fibroids, as identified during your ultrasound, can contribute to heavy bleeding and irregular cycles. Fibroids are benign tumors of the uterus that can cause symptoms such as heavy menstrual bleeding, prolonged periods, and pelvic pain.

The injection of progesterone you received was likely intended to help regulate your menstrual cycle and manage the bleeding. Progesterone can help stabilize the endometrial lining and may assist in controlling heavy bleeding. However, it is not unusual for the body to take some time to adjust, and the irregular bleeding you experienced after the injection could be a result of your body responding to hormonal changes.

1. Why is this happening? The irregularities in your menstrual cycle can be attributed to several factors:
- Hormonal Changes: As women approach menopause, estrogen and progesterone levels fluctuate, leading to irregular cycles.

- Uterine Fibroids: These can cause changes in menstrual flow and cycle regularity. Even small fibroids can lead to significant symptoms.

- Age: At 49, you are likely in perimenopause, which can cause unpredictable menstrual patterns.

2. Should you return to the original hospital or seek another opinion? If you feel that your concerns are not being adequately addressed, or if you continue to experience significant changes in your menstrual cycle, it may be beneficial to seek a second opinion. A gynecologist specializing in menopause or fibroid management could provide additional insights and treatment options. It’s important to have a healthcare provider who listens to your concerns and provides a treatment plan that aligns with your needs.

In the meantime, here are some steps you can take:
- Track Your Cycle: Keep a detailed record of your menstrual cycles, including the start and end dates, flow intensity, and any symptoms you experience. This information can be helpful for your doctor.

- Discuss Treatment Options: If the irregular bleeding continues, discuss potential treatment options with your healthcare provider. These may include hormonal therapies, non-hormonal medications, or procedures to manage fibroids.

- Lifestyle Modifications: Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help manage symptoms associated with hormonal changes.

In conclusion, while irregular menstrual cycles can be concerning, they are often a normal part of the transition to menopause. However, given your symptoms and the presence of fibroids, it is essential to stay in close communication with your healthcare provider and seek further evaluation if necessary. Your health and comfort are paramount, and you deserve a treatment plan that works for you.

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