Menstrual Irregularities After Pregnancy: A Comprehensive Guide

Menstrual issues

Hello Doctor, I recently gave birth about nine and a half months ago.
I stopped breastfeeding around two months postpartum.
Approximately at three months, I had a tooth extraction, and since then, I've been experiencing discomfort in my oral cavity.
I have a burning pain on the left side of my oral mucosa, and my tongue has an abnormal taste sensation.
I have seen many specialists, but no one has been able to identify the underlying cause.
Since March, my menstrual cycle has become irregular.
In April, I had two periods, and in early May, I experienced abnormal bleeding.
I then visited a gynecologist and took the medication prescribed for regulation.
After taking the medication for three weeks, my period returned for seven days, but the flow was very light and the duration was short.
I felt this was unusual, so I went to a large hospital for further examination.
The doctor performed a transvaginal ultrasound and stated that there were no significant abnormalities in my ovaries or uterus, but the endometrium was thinner than normal, suggesting anovulation.
I was advised to take hormonal treatment for three months to help regulate my menstrual cycle.
I have completed the first 21-day treatment cycle, and the flow during that period was slightly heavier, lasting about three days.
After completing the second treatment cycle, my period was only heavier on the first day, and by the second day, it felt like it had stopped.
I previously consulted a metabolic specialist who conducted blood tests, a 24-hour urine test, and an MRI of my brain with contrast, all of which showed no abnormalities in the brain.
However, some blood test results were slightly off, leading the doctor to suspect ovarian dysfunction or issues with the ovaries.
On June 4th, I had another transvaginal ultrasound, which showed no abnormalities, and the doctor advised me to continue the hormonal treatment and return for blood tests in six months.
Additionally, in June, I shaved my underarm hair, and it has not grown back since.
I am unsure what the underlying issue might be.
Could you help analyze whether I might be experiencing early menopause, hormonal issues, or deficiencies in my body? Is it possible that my oral symptoms are related to these issues, or could there be a gynecological condition? I have already undergone a CT scan of my head and neck with contrast, which showed no oral abnormalities, and I also had an MRI of my brain, which also showed no issues.
The only thing that seems to potentially affect my oral symptoms is a neurological problem.
Currently, my main concern is the irregular menstrual cycle.
What further tests should I consider? I had a Pap smear earlier this year, which was normal, and I have a follow-up gynecological appointment in early September for the third hormonal treatment cycle, which I just started on July 31.
I have undergone many tests, including those for prolactin, which seemed normal, but I am still puzzled about the irregular menstrual cycle.
Could the untreated oral symptoms be a result of stress, or could there be issues with my uterus or ovaries? I apologize for the lengthy message, and I appreciate your patience in reading it.
Thank you for your compassion and care.

Miss Lin, 40~49 year old female. Ask Date: 2019/07/31

Dr. Huang Jianzhong reply Obstetrics and Gynecology

After giving birth nine and a half months ago, I stopped breastfeeding about two months later.
Around three months postpartum, I had a tooth extraction, and since then, I have experienced discomfort in my oral cavity.
I have a burning pain in the left side of my oral mucosa, and my tongue has an abnormal taste sensation.
I have seen many specialists, but no one has been able to identify the underlying cause.
Since March, my menstrual cycle has become irregular; in April, I had two periods, and in early May, I experienced abnormal bleeding.
I visited a gynecologist and took the medication prescribed for regulation.
After three weeks of treatment, my period returned for seven days, but the flow was very light and the duration was short.
Concerned about this, I went to a major hospital for further examination.
The doctor performed a transvaginal ultrasound and reported no significant abnormalities in my ovaries or uterus, but noted that my endometrium was thinner than normal, suggesting a lack of ovulation.
I was advised to take hormonal therapy for three months to help regulate my menstrual cycle.
I have completed the first 21-day treatment cycle, and my subsequent period had a slightly heavier flow, lasting about three days.
After finishing the second treatment cycle, my menstrual flow was only substantial on the first day, with little to no flow on the second day.
I previously consulted a metabolic specialist who conducted blood tests, a 24-hour urine test, and an MRI of my brain with contrast, all of which showed no abnormalities in the brain.
However, some blood markers were slightly off, leading the doctor to suspect ovarian dysfunction or issues with the ovaries.
On June 4, I underwent another transvaginal ultrasound, which showed no abnormalities, and the doctor recommended continuing the hormonal therapy and re-evaluating with blood tests in six months.
Additionally, in June, I shaved my underarm hair, and it has not grown back since, which raises further concerns.
I am unsure what the underlying issue might be.
Could I be experiencing early menopause, hormonal imbalances, or deficiencies in certain bodily substances? Is it possible that my oral symptoms are related to these issues, or could there be an undiagnosed gynecological condition? I have had a CT scan of my head with contrast, which showed no abnormalities, and an MRI of my brain, which also revealed no issues.
The only potential link to my oral symptoms seems to be a neurological problem.
Currently, my main concern is the irregular menstrual cycle and what further tests I should pursue.
I had a Pap smear earlier this year, which was normal, and I have a follow-up gynecological appointment in early September for my third hormonal treatment cycle, which I started on July 31.
I have undergone numerous tests, including for prolactin levels, which also appeared normal.
I am puzzled as to why my menstrual cycle is irregular, whether the untreated oral symptoms are a result of stress, or if there are underlying issues with my uterus or ovaries.

Reply Date: 2019/07/31

More Info

Understanding menstrual irregularities after pregnancy can be quite complex, especially when compounded by other health issues. It’s important to consider various factors that may contribute to these irregularities, including hormonal changes, stress, and potential underlying medical conditions.

Firstly, after childbirth, it is common for women to experience changes in their menstrual cycles. The body undergoes significant hormonal shifts as it transitions from pregnancy back to a non-pregnant state. If you stopped breastfeeding around two months postpartum, this could also influence your menstrual cycle. Breastfeeding typically suppresses ovulation due to elevated levels of prolactin, the hormone responsible for milk production. Once breastfeeding ceases, the body may take some time to resume normal ovulatory cycles.

In your case, the irregularities began after a dental procedure, which raises the question of whether stress or anxiety related to that experience could have impacted your hormonal balance. Stress is known to affect the hypothalamus, which plays a crucial role in regulating the menstrual cycle. Additionally, the discomfort and symptoms you are experiencing in your oral cavity could also contribute to overall stress levels, potentially exacerbating hormonal imbalances.

The thin endometrial lining noted during your ultrasound may indicate that your body is not ovulating regularly, which can lead to lighter periods or even missed cycles. Hormonal treatments prescribed by your doctor are a common approach to help regulate your menstrual cycle by promoting a thicker endometrial lining and encouraging ovulation. It is essential to follow through with these treatments and monitor your response, as it may take time for your body to adjust.

Regarding the potential for early menopause, while it is a concern, it is typically diagnosed based on specific criteria, including age and hormonal levels. Since you are relatively young and have had a recent pregnancy, it is less likely that you are experiencing premature ovarian insufficiency. However, hormonal testing can provide more clarity on your ovarian function.

Your mention of hair loss in the underarm area is also noteworthy. This could be related to hormonal changes, but it may also indicate other conditions such as polycystic ovary syndrome (PCOS) or thyroid dysfunction. Given that you have undergone various tests, it may be beneficial to specifically evaluate your thyroid function and androgen levels, as these can significantly impact menstrual regularity and hair growth.

As for the oral symptoms you are experiencing, while they may seem unrelated, there is a possibility that systemic issues could manifest in both your menstrual cycle and oral health. Conditions such as autoimmune disorders can affect multiple systems in the body, including hormonal regulation and oral mucosa. If you have not yet consulted with a specialist in oral medicine or a rheumatologist, it may be worth considering.

In summary, the irregularities in your menstrual cycle post-pregnancy could be attributed to a combination of hormonal changes, stress, and possibly underlying health conditions. Continuing with the hormonal treatment as prescribed, maintaining regular follow-ups with your healthcare providers, and exploring further evaluations for thyroid function and potential autoimmune issues may provide more insights into your symptoms. It is essential to communicate openly with your healthcare team about all your concerns, including the oral symptoms, as they may be interconnected.

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