Delayed Menstruation: Key Questions for Your Gynecologist

Hello, doctor. I am the inquirer with ID 145792?

Hello Dr.
Huang, I am the girlfriend of the inquirer with ID 145792.
My period was expected on April 30, but since it was late, I went to the obstetrics and gynecology department on May 2 (Thursday) for a check-up.
The gynecologist conducted a urine test (I’m not sure what they tested for, but they mentioned the delayed period and asked us to collect urine) and an ultrasound examination.
Afterward, the doctor informed us that there were no abnormalities and prescribed medication, advising us to start taking it if the period still hadn’t arrived after a week.
The medications are as follows: 1.
PROVERA 10mg (Wyeth M, three times a day for three days) 2.
Premarin 0.625 (three times a day for three days).
My girlfriend flew to Southeast Asia on May 3 for an internship and will return at the end of June.
I am a bit worried that she might not be able to seek medical care in Southeast Asia.
Additionally, she started experiencing premenstrual syndrome on the evening of May 2, with breast tenderness evolving into just breast fullness, and her lower abdomen is not as tight (accompanied by a very slight feeling of heaviness).
Therefore, I would like to ask Dr.
Huang the following questions:
1.
Is this medication a menstrual induction drug? I have looked up the side effects online, and there seem to be many, but I still can’t clarify the primary purpose of the medication.

2.
Clinically, does premenstrual syndrome tend to become milder as menstruation approaches? I am a bit worried that she might be pregnant (I found online that it seems only early pregnancy symptoms gradually become less noticeable, while premenstrual symptoms do not).

3.
My girlfriend returned to Taiwan from Southeast Asia on April 24 and went back to Southeast Asia on May 3.
Could the change in environment and dietary habits between the two places have caused her period to be delayed?
4.
Based on the gynecological examination on May 2 (urine test and ultrasound), can we reasonably conclude that she is not pregnant?
I apologize for the lengthy message and the many questions.
Thank you for your assistance, Doctor.

Nìmíng, 20~29 year old female. Ask Date: 2019/05/03

Dr. Huang Jianzhong reply Obstetrics and Gynecology

My girlfriend was scheduled to get her period on April 30, but since it was late, she went to the gynecologist on May 2 for a check-up.
The gynecologist performed a urine test (not sure what was tested, but since her period was late, we were asked to collect urine) and an ultrasound.
Afterward, the doctor informed us that there were no abnormalities and prescribed medication for us, advising that if her period still hadn't arrived after a week, she should start taking it.
The medications are as follows: 1.
PROVERA 10mg (three times a day for three days) 2.
Premarin 0.625 (three times a day for three days).
My girlfriend flew to Southeast Asia on May 3 for an internship and will return at the end of June.
I'm a bit worried that she won't be able to seek medical care in Southeast Asia.
Additionally, she started experiencing premenstrual syndrome on the night of May 2, with breast tenderness evolving into just breast fullness, and her lower abdomen is not as tight (accompanied by a very slight feeling of heaviness).
Therefore, I would like to ask Dr.
Huang the following questions:
1.
Is this medication a menstrual induction drug? I found many side effects online, but I'm still unclear about its primary function.

Answer: Yes, it is a menstrual induction drug.
2.
Clinically, does premenstrual syndrome become milder as menstruation approaches? I'm a bit worried that she might be pregnant (I found online that only early pregnancy symptoms gradually become less noticeable, while premenstrual symptoms do not).

Answer: Theoretically, premenstrual syndrome should become milder with the onset of menstruation.
3.
My girlfriend returned to Taiwan from Southeast Asia on April 24 and went back on May 3.
Could the change in environment and dietary habits between the two places have caused her period to be late?
Answer: It is possible.
4.
Based on the gynecological examination on May 2 (urine test and ultrasound), can we basically conclude that she is not pregnant?
Answer: Essentially, yes.

Reply Date: 2019/05/03

More Info

Understanding delayed menstruation can be a complex issue, especially when considering the various factors that can influence menstrual cycles and overall reproductive health. Based on the information provided, I will address your questions and offer additional insights into the implications of delayed menstruation, the medications prescribed, and the potential effects on fertility and menstrual health.

1. Is the medication a menstrual induction drug? What are its primary effects?
The medications prescribed, Provera (medroxyprogesterone acetate) and Premarin (conjugated estrogens), are indeed used to help regulate menstrual cycles. Provera is a synthetic form of progesterone, which can help induce a menstrual period in women who have irregular cycles or have missed their periods. It works by mimicking the natural hormone progesterone, which plays a crucial role in regulating the menstrual cycle. Premarin, on the other hand, is a form of estrogen that can help alleviate symptoms associated with low estrogen levels and is often used in hormone replacement therapy. While both medications can be effective in managing menstrual irregularities, they may have side effects, including mood changes, headaches, and gastrointestinal disturbances. It is essential to discuss any concerns about side effects with your healthcare provider.

2. Does premenstrual syndrome (PMS) symptoms lessen as menstruation approaches?
Yes, it is common for PMS symptoms to fluctuate as menstruation approaches. Many women experience an increase in symptoms in the days leading up to their period, followed by a decrease once menstruation begins. However, the experience can vary significantly from person to person. If your girlfriend is experiencing changes in her PMS symptoms, it could indicate that her body is preparing for menstruation. However, it is also important to consider the possibility of pregnancy, especially if there has been unprotected intercourse. Early pregnancy symptoms can sometimes mimic PMS, leading to confusion.

3. Could environmental factors and dietary changes contribute to delayed menstruation?
Absolutely. Changes in environment, stress levels, and dietary habits can significantly impact menstrual cycles. Traveling, especially across time zones, can disrupt the body's circadian rhythms, potentially leading to delayed menstruation. Additionally, changes in diet—such as increased intake of certain foods or changes in physical activity—can also affect hormonal balance and menstrual regularity. If your girlfriend has recently experienced significant changes in her routine, it could be a contributing factor to her delayed period.

4. Can the results of the gynecological examination (urine test and ultrasound) rule out pregnancy?
Generally, a urine pregnancy test conducted in a clinical setting is a reliable method for detecting pregnancy. If the test was negative and the ultrasound did not reveal any abnormalities, it is likely that pregnancy can be ruled out. However, it is important to note that very early pregnancies may not always be detected by urine tests, especially if the test is taken too soon after a missed period. If menstruation does not occur after taking the prescribed medications, it would be advisable for your girlfriend to follow up with her healthcare provider for further evaluation.

In summary, delayed menstruation can be influenced by a variety of factors, including hormonal imbalances, lifestyle changes, and stress. The medications prescribed are intended to help regulate her cycle, but it is crucial to monitor her symptoms and maintain open communication with her healthcare provider. If her period does not resume after the treatment, further investigation may be necessary to identify any underlying issues. It is also important for her to be aware of her body and any changes she experiences, as this can provide valuable information for her healthcare team.

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