Pregnancy Chances with Irregular Menstrual Cycles and Symptoms

Probability of Pregnancy

Hello Dr.
Tsao: My menstrual cycle is irregular.
My last period started on March 20.
After that, I had unprotected sexual intercourse on April 18, but there was no penetration or ejaculation.
Since then, my period has not arrived.
I visited a gynecologist on April 30, and the pregnancy test was negative.
An ultrasound was performed, and the doctor diagnosed me with polycystic ovary syndrome (PCOS).
I was prescribed a three-day course of medication to induce menstruation.
After taking the medication, I experienced a small amount of dark brown discharge for three consecutive days.
I continued taking the medication, and on May 5, I had a heavier flow.
On May 7, I noticed something resembling a fleshy mass in my sanitary pad.
Could this be the shedding of the endometrium? From May 11, there was no bleeding at all.
Was the blood discharged between May 5 and May 11 considered my period? The amount was less than usual, and the color was darker.
On June 3, I experienced severe palpitations, abdominal bloating, and other discomforts.
I returned to the gynecologist on June 4, where I took another pregnancy test, which was also negative, but this time no ultrasound was performed.
On June 11, I expected my menstrual period to start, and the next morning, I had a large amount of blood with more clots, continuing until June 17.
The flow varied, but I did not expel anything resembling a fleshy mass like in May.
My abdominal bloating has not improved, and I occasionally feel pain in my lower right abdomen, lasting mostly under five minutes.
A few days after my period ended, I noticed watery discharge that made my underwear damp.
Should I go back to the gynecologist for an examination? I have taken pregnancy tests on days 10, 11, 30, 40, 46, 64, and 71 after the sexual intercourse, including home tests and two tests at the gynecologist's office, all of which were negative.
Is there still a possibility of pregnancy?

Tongxue, 20~29 year old female. Ask Date: 2020/07/07

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, everything seems to be within the normal range, and it is likely that you are not pregnant.
It is recommended to use contraceptive measures, especially if your menstrual cycle is irregular.
Wishing you good health.

Reply Date: 2020/07/07

More Info

Understanding the complexities of pregnancy, especially in the context of irregular menstrual cycles and various symptoms, can be quite challenging. Based on the information you've provided, it appears that you have been experiencing a range of symptoms and have undergone multiple tests, all of which have returned negative results for pregnancy. Let's break down your situation and address your concerns.

Firstly, irregular menstrual cycles can significantly complicate the understanding of your fertility and the timing of ovulation. In women with irregular cycles, ovulation may not occur consistently, making it difficult to predict fertile windows. This can lead to uncertainty about the chances of conception, especially if sexual intercourse occurs during a non-fertile period. The fact that you had unprotected intercourse on April 18, but have since received negative pregnancy tests, suggests that conception is unlikely, particularly if your menstrual cycle has not normalized.

The symptoms you describe, including the brown discharge and the passage of what you referred to as "meatball-like" tissue, could indicate a few possibilities. The brown discharge often signifies old blood, which can occur at the beginning or end of a menstrual period. The passage of tissue could be a sign of the uterine lining shedding, which is a normal part of menstruation, especially if you have been taking medication to induce your period.

Regarding your menstrual cycle, the bleeding you experienced from May 5 to May 11, which was less than usual and darker in color, could indeed represent a menstrual period, albeit a lighter one. Variations in menstrual flow can occur for many reasons, including hormonal fluctuations, stress, or underlying conditions such as polycystic ovary syndrome (PCOS), which you mentioned having.
Your subsequent symptoms of severe palpitations, abdominal bloating, and discomfort could be attributed to a variety of factors, including hormonal imbalances, anxiety, or even gastrointestinal issues. It is essential to monitor these symptoms closely. If they persist or worsen, it would be prudent to consult with your healthcare provider for further evaluation.

As for the possibility of pregnancy, given that you have taken multiple pregnancy tests over the course of several weeks, all returning negative results, the likelihood of being pregnant is low. Home pregnancy tests are generally very reliable, especially when taken after a missed period. However, if you continue to experience symptoms that concern you, such as persistent abdominal pain or unusual discharge, it would be advisable to return to your gynecologist for further investigation. This may include a pelvic exam, additional blood tests, or imaging studies to rule out any other underlying conditions.

In summary, while the chances of pregnancy appear low given your negative tests and irregular cycles, it is crucial to remain vigilant about your symptoms. Regular follow-ups with your healthcare provider can help ensure that any potential issues are addressed promptly. Additionally, maintaining a healthy lifestyle, managing stress, and keeping track of your menstrual cycle can help improve your reproductive health moving forward.

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