Menstrual or Implantation Bleeding? Your Symptoms

Is it menstrual bleeding or pregnancy bleeding?

Hello, doctor.
My last menstrual period started on April 6, with an average cycle of about 30 days.
I had sexual intercourse on April 15, during which a condom was used, and ejaculation occurred inside the condom.
Afterward, it was immediately withdrawn.
In April, I sometimes experienced abdominal pain, with occasional sharp pain in the lower right abdomen.
Previously, I would experience breast tenderness before my period, but this time I did not.
However, a few days ago, I felt a slight stabbing pain in my nipples, which has since resolved.
From May 4 to May 7, I noticed brown or dark red blood when wiping after using the restroom.
Today (May 7), I took a pregnancy test, which showed a negative result.
My previous menstrual flow has been quite heavy and bright red, unlike this time, where there was only blood when wiping, so I'm uncertain if this is my period.
Could you please advise if the bleeding these past few days is my menstrual period or early pregnancy bleeding? Additionally, is it possible that I tested too early for pregnancy? Lastly, could the nipple pain be related to my upcoming period? Thank you, doctor.

Nìmíng, 20~29 year old female. Ask Date: 2019/05/07

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Last month, my menstrual period started on April 6, with an average cycle of about 30 days.
I engaged in sexual intercourse on April 15, during which a condom was used, and ejaculation occurred inside.
Afterward, I immediately withdrew.
In April, I sometimes experienced abdominal pain, with occasional sharp pain in the lower right abdomen.
Previously, I would experience breast tenderness before my period, but this time I did not.
However, a few days ago, I felt a slight sharp pain when touching my nipples, which has since subsided.
From May 4 to May 7, I noticed brown or dark red blood when wiping after using the restroom.
Today (May 7), I took a pregnancy test upon waking up, which showed a negative result.
My previous menstrual flow has been quite heavy and bright red, unlike this time, where I only noticed blood when wiping, so I'm uncertain if this is my period.

Could you please tell me if the bleeding these past few days is my period or early pregnancy bleeding? Answer: It should be menstruation.
Additionally, could it be that I tested for pregnancy too early, which is why it didn't show up? Answer: Test again on May 14.
Lastly, is the sharp pain in my nipples related to my period approaching? Answer: It should be.

Reply Date: 2019/05/07

More Info

When it comes to understanding whether the bleeding you are experiencing is menstrual or implantation bleeding, there are several factors to consider. Based on your description, it appears that you have a regular menstrual cycle averaging around 30 days, with your last period starting on April 6. You engaged in protected sexual intercourse on April 15, and you have noted some unusual symptoms leading up to the bleeding that began on May 4.

Understanding the Timing and Nature of Bleeding:
1. Implantation Bleeding: This type of bleeding typically occurs when a fertilized egg attaches itself to the lining of the uterus, which can happen about 6 to 12 days after conception. Given that you had intercourse on April 15 and your next expected period would be around May 6, the timing of your bleeding could potentially align with implantation bleeding. However, implantation bleeding is usually light and may appear as spotting rather than a heavier flow.

2. Menstrual Bleeding: Your usual menstrual bleeding is characterized by a heavier flow and bright red color. The bleeding you described from May 4 to May 7, which is coffee-colored or dark red and only appears when wiping, may not fit the typical profile of menstrual bleeding. However, it is important to note that menstrual bleeding can vary in color and flow from cycle to cycle.

Pregnancy Testing:
You mentioned that you took a pregnancy test on May 7, which came back negative. It is important to remember that home pregnancy tests are most accurate when taken after a missed period. Since your period was expected around May 6, testing on May 7 may have been too early to detect pregnancy, especially if implantation occurred later than expected. If your bleeding continues or if you miss your period, consider retesting in a few days or consulting with a healthcare provider for a blood test, which can detect pregnancy earlier than a urine test.

Breast Sensitivity:
The tenderness you experienced in your nipples could indeed be related to hormonal changes associated with your menstrual cycle. Hormonal fluctuations can cause breast tenderness both before and during menstruation. However, if this symptom persists or worsens, it may be worth discussing with a healthcare provider.

Conclusion:
In summary, the bleeding you are experiencing could be either implantation bleeding or an early sign of your menstrual cycle. Given the timing and nature of the bleeding, it is more likely to be related to your menstrual cycle, especially since you have a regular pattern. However, the possibility of early pregnancy cannot be completely ruled out, particularly if the bleeding is lighter than usual. If the bleeding continues or if you have any concerns about your symptoms, it is advisable to consult with a healthcare provider for further evaluation and guidance. They may recommend additional testing or examinations to provide clarity regarding your situation.

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