Abnormal Menstrual Bleeding: Causes and Concerns

Q: Abnormal Menstrual Bleeding: Causes and Concerns

Ms. <br>Hsiao-Yuan： Hello, if there are no organic issues (such as uterine fibroids, ovarian cysts, etc.), it may be due to recent irregularities in your ovulation cycle. <br>It is recommended to maintain a regular lifestyle, avoid staying up late, and work on weight loss. <br>If

Abnormal menstrual bleeding

Hello Dr.
Lin, my menstrual cycle is usually around 30 days, but sometimes it comes 4 to 5 days early or is delayed by 3 to 4 days.
The menstrual flow is usually heavy on the second day, requiring me to change 4 to 5 sanitary pads, and I often pass blood clots, with a significant drop in flow.
By the third day, the flow decreases, and the overall duration lasts about 15 to 17 days.
This change occurred after my cesarean section five years ago.
However, on February 19, my menstrual flow noticeably decreased, and the blood clots were fewer, with the period ending by the 10th day.
Additionally, from before the Lunar New Year until now, I have experienced occasional itching and discomfort in my skin and muscles, making me feel generally unwell, though I'm unsure of the cause.
My period, which was due on March 19, did not arrive, but I felt a heaviness and bloating in my abdomen, similar to premenstrual symptoms.
During this time, I also experienced significant abdominal pain akin to menstrual cramps.
After being 12 days late, I visited a gynecologist, who performed a urine test and ultrasound, confirming that I was not pregnant.
The doctor mentioned that my period would likely come soon and prescribed a three-day course of medication to induce menstruation.
After taking the medication, my period started on the fourth day, but the flow was very light and different from before.
On the second day, the flow remained minimal, and I experienced headaches and abdominal discomfort.
Is there a problem with this situation? Thank you.

Xiao Yuan, 40~49 year old female. Ask Date: 2019/04/08

Dr. Lin Manying reply Obstetrics and Gynecology

Ms.
Hsiao-Yuan: Hello, if there are no organic issues (such as uterine fibroids, ovarian cysts, etc.), it may be due to recent irregularities in your ovulation cycle.
It is recommended to maintain a regular lifestyle, avoid staying up late, and work on weight loss.
If this persists for 2-3 consecutive cycles, it is advisable to seek medical treatment.
The Hualien Hospital of the Ministry of Health and Welfare cares about your health.

Reply Date: 2019/04/08

More Info

Abnormal menstrual bleeding can be a source of concern for many women, and understanding its causes and implications is crucial for maintaining reproductive health. Based on your description, it seems that you have experienced significant changes in your menstrual cycle since your cesarean section five years ago. These changes include variations in cycle length, changes in blood flow, and the presence of blood clots, which can all be indicative of underlying issues.

Firstly, let's break down the symptoms you've described. A menstrual cycle typically lasts between 21 to 35 days, and variations within this range can be normal. However, if you notice that your cycle is consistently irregular—such as being early or late by several days—it may warrant further investigation. The fact that you experience heavy bleeding on the second day, requiring multiple sanitary pads, suggests that you may be experiencing menorrhagia, which is defined as excessive menstrual bleeding.

The presence of blood clots during menstruation can also be a sign of heavy bleeding. Blood clots are typically formed when blood pools in the uterus and thickens before being expelled. While small clots can be normal, larger clots or an increase in clot size can indicate a problem, such as uterine fibroids or hormonal imbalances.

The changes you've noted in your menstrual flow, particularly the decrease in blood volume and clot size during your most recent cycle, could be attributed to several factors. Hormonal fluctuations, particularly involving estrogen and progesterone, can significantly impact menstrual bleeding. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or even stress can lead to irregularities in hormone levels, affecting your menstrual cycle.

Additionally, the discomfort and pain you mentioned, along with the itching sensation, could be related to various conditions, including infections or skin irritations. It's essential to consider that systemic issues, such as anemia or thyroid dysfunction, can also manifest as changes in menstrual patterns and general discomfort.

Given that you have already consulted with a gynecologist and undergone tests to rule out pregnancy, it is advisable to follow up with them regarding your ongoing symptoms. They may recommend further evaluations, such as blood tests to check hormone levels, a pelvic ultrasound to assess for structural abnormalities (like fibroids or polyps), or even a hysteroscopy if necessary.

In summary, while some variations in menstrual cycles can be normal, the significant changes you are experiencing—especially following a surgical procedure—should be closely monitored. Keeping a detailed record of your menstrual cycles, including flow, duration, and any accompanying symptoms, will be beneficial for your healthcare provider in diagnosing any potential issues. If your symptoms persist or worsen, do not hesitate to seek further medical advice. Your health and comfort are paramount, and addressing these concerns early can lead to better outcomes.

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