Abnormal Bleeding: Possible Causes and Concerns in Women

Bleeding issues

Hello Doctor: My menstrual period has been absent for two months (from March 10 to March 17, it hasn't come since then).
I have a history of polycystic ovary syndrome and insulin resistance.
I had intercourse between March 22 and 23.
At the end of April and beginning of May, I experienced abdominal discomfort, occasional cramping in the lower abdomen, occasional palpitations, a feeling of heat in my body, but my oral temperature did not exceed 37 degrees Celsius.
I also had discomfort and soreness in my lower back.
On May 13, I visited a doctor at Chung Shan Hospital, where a transvaginal ultrasound was performed, and no abnormalities were found; the doctor also said I was not pregnant.
On May 14, in the afternoon and evening, I noticed dark brown discharge that resembled blood and was somewhat thick after wiping twice after using the restroom, but it did not appear again afterward.
I would like to ask what my situation might indicate.
Is there a possibility of pregnancy?

Ami, 30~39 year old female. Ask Date: 2020/05/15

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, a pregnancy test can confirm if you are pregnant.
If you are not pregnant, it is advisable to consult a gynecologist to ask if you need to take medication to induce menstruation.
Wishing you good health.

Reply Date: 2020/05/15

More Info

Abnormal bleeding in women can be a concerning issue, especially when it deviates from the normal menstrual cycle. In your case, you mentioned that your last menstrual period was from March 10 to March 17, and you have not had a period since then. You also have a history of polycystic ovary syndrome (PCOS) and insulin resistance, which can complicate your menstrual regularity.
Given the timeline you provided, it is important to consider several potential causes for your symptoms. The absence of menstruation for over two months, coupled with the occurrence of deep brown discharge that resembles blood, could indicate several possibilities.
1. Hormonal Imbalance: Women with PCOS often experience irregular menstrual cycles due to hormonal imbalances, particularly involving estrogen and progesterone. This can lead to anovulation (lack of ovulation), which may result in prolonged amenorrhea (absence of menstruation) and abnormal bleeding patterns. The brown discharge you observed could be old blood that is being expelled from the uterus, which is not uncommon when the menstrual cycle is disrupted.

2. Pregnancy: Although you mentioned that a transvaginal ultrasound did not reveal any signs of pregnancy, it is still essential to consider this possibility, especially since you had unprotected intercourse on March 22 and 23. If there is any chance of pregnancy, a home pregnancy test could provide additional clarity. It is worth noting that some women experience light spotting or brown discharge in early pregnancy, which can sometimes be mistaken for a menstrual period.

3. Stress and Lifestyle Factors: Stress can significantly impact menstrual cycles. You mentioned experiencing abdominal discomfort, palpitations, and a feeling of heat, which could be related to stress or anxiety. Lifestyle factors such as irregular sleep patterns, changes in diet, and physical activity can also contribute to hormonal fluctuations and menstrual irregularities.

4. Other Medical Conditions: Conditions such as thyroid disorders, uterine fibroids, or endometrial hyperplasia can also lead to abnormal bleeding. Given your symptoms, it may be prudent to follow up with your healthcare provider for further evaluation, including blood tests to check hormone levels and possibly additional imaging studies if necessary.

5. Infection or Inflammation: Although less likely given your ultrasound results, infections or inflammatory conditions of the reproductive tract can sometimes cause abnormal bleeding. If you experience any additional symptoms such as fever, unusual discharge, or pelvic pain, it would be essential to seek medical attention promptly.

In summary, your symptoms could be attributed to a combination of factors, including hormonal imbalances due to PCOS, potential pregnancy, stress, and lifestyle changes. It is crucial to maintain open communication with your healthcare provider and consider further evaluation if your symptoms persist or worsen. Regular follow-ups and monitoring can help manage your condition effectively and provide peace of mind. If you have any concerns about your health, do not hesitate to seek medical advice.

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