Prolonged PMS and Delayed Menstruation: When to Seek Help

Lower abdominal and lower back pain for more than two weeks, but menstruation has not yet arrived and is delayed?

Hello Doctor, I am a girl with irregular menstrual cycles.
I have tried both Western and Chinese medicine for regulating my period, as well as dietary methods, but none have been effective.
(My daily routine is generally regular, except that I often have to work late due to my job.) My premenstrual syndrome (PMS) often lasts for two weeks, and while it sometimes gets delayed by a few days, my period usually starts immediately after PMS ends.
However, this time, I have been experiencing symptoms for over two weeks, including menstrual acne, dull pain in my lower abdomen and lower back, and excessive sleepiness.
Additionally, my period is already ten days late compared to my usual cycle.
I originally planned to take a day off to visit the hospital for a consultation and possibly receive a menstrual induction injection, but due to work commitments, it is difficult for me to see a gynecologist (scheduling conflicts and limited time off).
Moreover, I have felt quite uncomfortable after previous injections.
Therefore, I would like to ask for your advice: is it really urgent for me to see a doctor for an injection, or can I observe my symptoms for a few more days? Thank you for taking the time to respond to my question, and I appreciate your help.
Wishing you good health.

Tang Ning, 20~29 year old female. Ask Date: 2020/05/08

Dr. Wu Xianghui reply Obstetrics and Gynecology

Premenstrual syndrome and menstrual cycle irregularities have various influencing factors.
It is recommended to seek evaluation from a specialist in obstetrics and gynecology at an outpatient clinic.

Reply Date: 2020/05/08

More Info

Understanding prolonged premenstrual syndrome (PMS) and delayed menstruation can be quite complex, especially when you have already tried various treatments without success. It’s important to recognize that while some degree of irregularity in menstrual cycles can be normal, prolonged PMS symptoms and significant delays in menstruation can indicate underlying health issues that may require medical attention.

PMS typically occurs in the luteal phase of the menstrual cycle, which is the time between ovulation and the start of menstruation. Symptoms can include mood swings, bloating, breast tenderness, fatigue, and physical discomfort. For many women, these symptoms resolve with the onset of menstruation. However, when PMS symptoms extend beyond the typical timeframe, as you’ve described—lasting for two weeks or more—it can be concerning.

In your case, the combination of prolonged PMS symptoms, such as lower abdominal and back pain, acne flare-ups, and excessive sleepiness, along with a delay in your menstrual cycle of ten days, suggests that it may be time to seek medical advice. While lifestyle factors, such as stress from work and irregular sleep patterns, can contribute to menstrual irregularities, persistent symptoms warrant further investigation.

Here are some considerations regarding when to seek help:
1. Duration of Symptoms: Since your PMS symptoms have lasted longer than usual and are accompanied by a significant delay in menstruation, it is advisable to consult a healthcare provider. Prolonged symptoms can sometimes indicate hormonal imbalances, polycystic ovary syndrome (PCOS), thyroid issues, or other reproductive health concerns.

2. Severity of Symptoms: If your symptoms are severe enough to interfere with your daily life or cause significant discomfort, it is essential to seek medical attention. Pain that is debilitating or symptoms that affect your mental health should not be ignored.

3. Previous Treatment Efficacy: You mentioned trying both Western and traditional Chinese medicine without success. If previous treatments have not alleviated your symptoms, it may be time to explore other options with a healthcare professional who can provide a tailored approach based on your specific situation.

4. Underlying Health Conditions: If you have a history of irregular cycles or other reproductive health issues, it is crucial to address these with a healthcare provider. They may recommend tests such as blood work to check hormone levels or an ultrasound to assess your reproductive organs.

5. Work and Health Balance: While it can be challenging to find time to visit a doctor due to work commitments, prioritizing your health is vital. Consider scheduling an appointment during a time that works best for you, even if it means taking a short leave from work. Your health should come first, and addressing these symptoms early can prevent more significant issues down the line.

In conclusion, while it may be tempting to wait and see if your symptoms resolve on their own, given the duration and severity of your symptoms, it is advisable to seek medical attention sooner rather than later. A healthcare provider can help determine the cause of your prolonged PMS and delayed menstruation and recommend appropriate treatment options. Remember, taking care of your health is essential, and seeking help is a proactive step toward finding relief and improving your overall well-being.

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