Delayed Menstruation: Common Concerns and Next Steps

Menstruation is delayed by 13 days?

Hello, Dr.
Wu.
My menstrual cycle is approximately 29 to 33 days.
My last period started on June 3 and ended on June 9, lasting a total of 7 days.
I had protected sexual intercourse on June 21 and July 2.
On June 21, ejaculation occurred inside the condom, and on July 2, there was no ejaculation, but the intercourse ended with the penis softening (the condom did not come off, and it was removed immediately).
On July 3, I noticed discharge with brownish blood streaks and thought my period was starting, but the streaks only lasted for two days, with no normal menstrual flow.
I visited a gynecologist on July 8 for an ultrasound and a urine pregnancy test, and the doctor ruled out pregnancy and prescribed a 3-day course of medication to induce menstruation.
I completed the medication on time, but my period has not yet arrived three days later.
I would like to ask the doctor: 1.
On July 8, the most recent sexual intercourse was only 6 days prior.
Would the accuracy of the ultrasound and urine pregnancy test be low? If I want to test for pregnancy again, when should I do it for reliable results? 2.
Can the discharge with blood streaks be interpreted as menstrual blood or implantation bleeding? 3.
Since I have completed the medication to induce menstruation and my period has not yet arrived after three days, should I wait a few more days before seeking medical attention, or should I return to the clinic immediately? I am a bit worried as this is my first time encountering such a situation.
Thank you for your guidance.

Niming, 10~19 year old female. Ask Date: 2021/07/14

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
For pregnancy concerns, please take a home pregnancy test or visit a gynecologist for examination and evaluation four weeks after your most recent sexual intercourse.
2.
The menstrual cycle can be influenced by various psychological and physiological factors.
If your period is more than two months late, it is recommended to see a gynecologist for examination and evaluation.

Reply Date: 2021/07/14

More Info

Understanding delayed menstruation can be a source of concern for many individuals, especially when accompanied by unusual symptoms. In your case, you have provided a detailed account of your menstrual cycle, sexual activity, and subsequent medical evaluations. Let’s address your questions one by one, while also providing some context regarding menstrual irregularities.

1. Accuracy of Pregnancy Tests: You mentioned that you had sexual intercourse on June 21 and July 2, with the last encounter being just six days before your visit to the gynecologist on July 8. Generally, urine pregnancy tests can detect pregnancy about one week after a missed period, which means that testing too early may lead to false negatives. Since your last menstrual period started on June 3 and ended on June 9, a missed period would typically be expected around July 3. Given that you tested on July 8, the accuracy of the test could be somewhat reliable, but it may not be definitive. If you wish to retest, it is advisable to wait at least one week after your last test, which would be around July 15, to ensure a more accurate result.

2. Interpretation of Brown Discharge: The brown discharge you experienced on July 3 could be attributed to several factors. It is common for some women to experience spotting or brown discharge at the onset of their menstrual cycle, which can be old blood being expelled from the uterus. However, it could also be indicative of implantation bleeding if pregnancy were a possibility. Since your pregnancy test was negative and your doctor ruled out pregnancy, it is more likely that this was related to hormonal fluctuations or the onset of your period, albeit an atypical one.

3. Response to Menstrual Induction Medication: You mentioned taking medication to induce menstruation, and it has been three days since completing the course without any menstrual flow. It is not uncommon for hormonal medications to take some time to affect your cycle, and individual responses can vary. If you have not experienced any bleeding within a week of completing the medication, it would be prudent to follow up with your healthcare provider. They may want to conduct further evaluations, such as additional blood tests or imaging, to rule out any underlying issues that could be affecting your menstrual cycle.

In summary, menstrual irregularities can stem from a variety of factors, including stress, hormonal imbalances, and changes in lifestyle. It is essential to maintain open communication with your healthcare provider, especially if you continue to experience delays or other concerning symptoms. Keeping track of your menstrual cycle, any symptoms you experience, and any medications you take can provide valuable information for your doctor.

If you have further concerns or if your situation changes, do not hesitate to seek medical advice promptly. Your health and peace of mind are paramount, and understanding your body is an essential part of managing your reproductive health.

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