Irregular Periods: Menstruation or Early Miscarriage?

It's difficult to determine whether it's menstruation or a miscarriage?

In May, I took medication to delay my period due to traveling abroad.
My period started two days after stopping the medication.
My menstrual cycle is usually very regular, but in June, my period was delayed by 9 days.
I took a home pregnancy test, which showed one dark line and one faint line.
The next day, I went to the obstetrics and gynecology department, where the doctor performed an ultrasound and found nothing; the uterine lining was also not thickened.
The doctor confirmed the pregnancy test results, which showed two lines, but the second line was very faint.
The doctor instructed me to receive a medication to induce menstruation.
Four days later, I experienced bleeding, which was different from my usual periods as I felt very anemic and had abdominal pain.
I would like to know if this is a normal period or if it could be considered a miscarriage?

Ty, 20~29 year old female. Ask Date: 2018/07/05

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In May, I took medication to delay my period due to traveling abroad.
My period started two days after stopping the medication.
I usually have a regular menstrual cycle, but in June, my period was delayed by 9 days.
After taking a home pregnancy test, which showed one dark line and one faint line, I went to see a gynecologist the next day.
The doctor performed an ultrasound and found nothing; the uterine lining was also not thickened.
The doctor confirmed the pregnancy test was positive, but the second line was very faint, and instructed me to receive a medication to induce menstruation.
Four days later, I experienced bleeding, which was different from my usual periods as I felt very anemic and had abdominal pain.
I would like to know if this is a normal period or if it could be a miscarriage.

Answer: The medication to induce menstruation does not cause a miscarriage; you should repeat the pregnancy test.

Reply Date: 2018/07/05

More Info

Understanding irregular menstrual cycles can be quite challenging, especially when there are factors like medication, potential pregnancy, and symptoms of discomfort involved. In your case, it seems that you have experienced a significant change in your menstrual cycle following the use of medication to delay your period, and now you are facing uncertainty regarding whether your recent bleeding is a normal menstrual period or an early miscarriage.

Firstly, it's important to clarify the role of the medication you took to delay your period. These medications, often hormonal in nature, can disrupt your normal menstrual cycle. After stopping the medication, it is not uncommon for your body to take some time to readjust, which can lead to irregularities in your cycle, including delayed periods or unexpected bleeding.

In June, when your period was delayed by nine days, you took a pregnancy test that showed faint lines, indicating a possible early pregnancy. However, the ultrasound performed by your doctor did not show any signs of a developing pregnancy, such as a gestational sac or thickened uterine lining. This could suggest that either the pregnancy was very early and not yet detectable or that it may not be a viable pregnancy.

The administration of a medication to induce menstruation (often referred to as a "progestin challenge") is a common practice in such situations. The fact that you experienced bleeding four days after receiving the injection indicates that your body responded to the medication, which is a positive sign that your hormonal levels are adjusting.

Now, regarding your symptoms of feeling very anemic and experiencing abdominal pain, these can be concerning. While some cramping and discomfort can accompany a normal menstrual period, severe pain and feelings of anemia (such as dizziness, fatigue, or weakness) may indicate that something more serious is occurring. In the context of a potential miscarriage, it is not uncommon to experience heavier bleeding and more intense cramping than a typical menstrual cycle.
To differentiate between a normal menstrual period and a miscarriage, consider the following:
1. Bleeding Characteristics: A miscarriage may involve heavier bleeding, passing of tissue, and more severe cramping compared to a regular period. If you notice any tissue or clots that seem unusual, it is important to seek medical attention.

2. Duration and Intensity of Pain: If the abdominal pain is severe and persistent, or if it worsens over time, this could be a sign of complications that require immediate medical evaluation.

3. Follow-Up Care: It is crucial to follow up with your healthcare provider, especially given your symptoms of anemia and abdominal pain. They may recommend further evaluation, such as blood tests to check your hemoglobin levels, or additional imaging to ensure there are no complications.

4. Emotional Support: Regardless of the outcome, experiencing irregular periods and potential pregnancy loss can be emotionally taxing. It is important to seek support from friends, family, or professionals who can help you navigate this experience.

In conclusion, while the bleeding you experienced could be a normal response to the medication and a return to your menstrual cycle, the presence of severe pain and feelings of anemia necessitates further evaluation by a healthcare professional. They can provide a more definitive diagnosis and ensure that you receive the appropriate care and support during this time.

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