Irregular Menstrual Cycles: When to Seek Medical Advice

How many days after the end of the menstrual period does it start again?

Hello Dr.
Chen! I have been experiencing irregular menstrual cycles recently.
My last period started on December 19 and ended on December 25, with a generally heavier flow.
The duration was about five to six days, with lighter bleeding on the fifth and sixth days, and sometimes a little on the seventh day.
There were no large blood clots.
However, my period returned on December 29, with the first two days having brown or black blood, followed by three days of red blood.
The flow was not heavy, about one to two sanitary pads per day.
At night, there was almost no bleeding, and I only noticed bleeding during the day.
It has been five days now, and there is still a small amount of blood.
My menstrual cycle has not been stable over the past couple of years.
Previously, my cycle was about 27 days, but recently it has been around 25 days, sometimes as short as 21 or 18 days, and there have been instances of having two periods in one month.
The last three months have been consistently around 25 days.
The bleeding is usually heavy on the first, second, and third days, then gradually decreases, but the duration has lengthened, with occasional light bleeding on the seventh day.
I have also been experiencing significant hair loss.
This past year, I have been staying up late due to the pandemic, with my sleep schedule being reversed, sometimes sleeping in the morning and only having dinner throughout the day.
I also experience occasional anxiety.
Dr.
Chen, I would like to know if my period returning four days after it ended is due to incomplete shedding from the previous cycle, an endocrine issue, or a result of my irregular sleep schedule? Or could it be an indication of perimenopause? (I am 45 years old, so I don't think I am in menopause yet.) I have also read online about the possibility of uterine fibroids.
Should I see a gynecologist regarding my situation? If I need to see a doctor, should I wait until my period ends, or can I see a doctor while still experiencing bleeding? I apologize for the many questions and for my somewhat disorganized expression.
Thank you, Dr.
Chen!

Nuli, 40~49 year old female. Ask Date: 2023/01/02

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Hello! Lifestyle, dietary habits, work stress, or illnesses can all affect the menstrual cycle.
It is advisable to seek medical evaluation.
Thank you!

Reply Date: 2023/01/02

More Info

Irregular menstrual cycles can be a source of concern for many women, and your symptoms certainly warrant a closer look. Based on the information you've provided, it seems that you are experiencing significant changes in your menstrual cycle, including shorter cycles, varying blood flow, and prolonged bleeding. Let's break down your concerns and discuss when it might be appropriate to seek medical advice.

1. Irregular Menstrual Cycles: Your cycles have shifted from a more regular pattern of approximately 27 days to cycles that range from 18 to 25 days, with some months experiencing two periods. This irregularity can be attributed to various factors, including hormonal imbalances, lifestyle changes, stress, and underlying health conditions.

2. Menstrual Flow Changes: The changes in your menstrual flow, such as heavier bleeding in the first few days followed by lighter flow and the presence of brown or dark blood, can be normal variations. However, if you notice significant changes in your cycle or if the bleeding becomes excessively heavy (soaking through a pad or tampon every hour), it is essential to seek medical attention.

3. Potential Causes: Several factors could contribute to your irregular cycles:
- Hormonal Imbalances: Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can lead to irregular periods.

- Lifestyle Factors: Stress, poor diet, lack of sleep, and significant weight changes can all impact your menstrual cycle. You mentioned that your sleep schedule has been irregular and that you have been experiencing anxiety, which could certainly play a role.

- Age-Related Changes: At 45, you are approaching perimenopause, which is the transitional phase before menopause. This can lead to irregular cycles and changes in menstrual flow.

- Uterine Conditions: Conditions such as fibroids or polyps can also cause changes in menstrual patterns and should be evaluated by a healthcare provider.

4. When to Seek Medical Advice: Given your symptoms, it would be wise to consult with a gynecologist. You do not necessarily need to wait until your period ends to seek help. If you are experiencing prolonged bleeding or any other concerning symptoms, it is appropriate to make an appointment. A healthcare provider can perform a thorough evaluation, which may include a physical examination, blood tests to check hormone levels, and possibly imaging studies like an ultrasound to assess for any structural issues in the uterus.

5. Preparing for Your Appointment: When you see a doctor, it can be helpful to keep a menstrual diary for a few months leading up to your visit. Note the start and end dates of your periods, the flow (light, medium, heavy), any associated symptoms (cramping, mood changes), and any lifestyle factors that may be affecting your health. This information can provide valuable insights for your healthcare provider.

In conclusion, while some irregularities in menstrual cycles can be normal, your symptoms suggest that a medical evaluation is warranted. Addressing lifestyle factors, such as improving your sleep hygiene and managing stress, can also be beneficial. However, it is essential to rule out any underlying health issues that may require treatment. Don't hesitate to reach out to a healthcare professional for guidance and support.

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