Irregular Menstrual Bleeding: Causes and Treatment Options

Q: Irregular Menstrual Bleeding: Causes and Treatment Options

Hello, Mumu： Question 1： Condition is normal. Question 2： Please stop the medication. Question 3： It is not recommended to purchase emergency contraceptive pills on your own; please return for a follow-up on the fifth day of your menstrual cycle. Q

Irregular menstrual bleeding?

Hello Doctor: My menstruation started on April 4th and has not stopped since, with varying flow.
I visited a clinic on April 26th, and since I have no sexual experience, only an abdominal ultrasound was performed, which showed no issues.
I was prescribed a hemostatic medication (TRANSAMINE) for three days, but menstruation did not cease.
Therefore, I visited a larger hospital on May 3rd, where another ultrasound was performed, and again, both the uterus and ovaries appeared normal.
I was prescribed "Peili" (Progesterone) soft capsules at 100 mg and "Shengda" (Dydrogesterone) film-coated tablets at 0.625 mg, to be taken twice a day for a total of four pills, and blood tests were conducted for further examination.
During my follow-up on May 8th, all values were normal, and I did not have menstruation that day, so the doctor prescribed the same medications for another seven days, advising me to wait for my period to return.
However, in the following days, I experienced some light bleeding (after researching, I learned that taking progesterone can sometimes cause slight bleeding).
Then, yesterday (May 16th), I woke up to find menstrual blood in my underwear, with a significant amount (approximately 23 cm), and I continued to bleed throughout the day (even dripping after using the restroom).
I would like to ask: 1.
Given that I have not missed any doses, is this normal? 2.
Should I continue taking the remaining medication for one more day, or should I stop and observe? Should I consider purchasing emergency contraceptive pills to stop the bleeding after five days? 3.
If I buy emergency contraceptive pills, do I need to take any estrogen medications? 4.
How should I calculate my menstrual cycle? Does it start from May 8th? 5.
If I go to a larger hospital, are there any specific tests I can request for blood work? 6.
Is there a possibility of "endometrial cancer"? Can an abdominal ultrasound detect "endometrial cancer"? 7.
Can taking myo & D-chiro inositol help? Can it be taken together with the emergency contraceptive pills? Thank you for addressing these questions.

Mu Mu, 20~29 year old female. Ask Date: 2023/05/17

Dr. Lin Manying reply Obstetrics and Gynecology

Hello, Mumu:
Question 1: Condition is normal.

Question 2: Please stop the medication.

Question 3: It is not recommended to purchase emergency contraceptive pills on your own; please return for a follow-up on the fifth day of your menstrual cycle.

Question 4: Calculation should start from May 16.

Question 5: This needs to be determined by a physician.

Question 6: This needs to be assessed by a physician.

Question 7: Self-medication is not recommended; please allow a physician to make the assessment.

The Ministry of Health and Welfare cares about your health.

Reply Date: 2023/05/17

More Info

Irregular menstrual bleeding can be a concerning issue for many women, and it’s important to understand the potential causes and treatment options available. Based on your description, it appears that you have been experiencing prolonged menstrual bleeding since April 4th, with varying flow and subsequent medical evaluations indicating no immediate structural issues with your uterus or ovaries.

Understanding Irregular Menstrual Bleeding
Irregular menstrual bleeding can be caused by a variety of factors, including hormonal imbalances, stress, changes in weight, certain medications, or underlying health conditions. In your case, the prolonged bleeding and the medications you have been prescribed, such as Tranexamic acid (TRANSAMINE) and hormonal treatments, suggest that your healthcare provider is addressing a potential hormonal imbalance or clotting issue.

Addressing Your Questions
1. Is it normal to have ongoing bleeding while on medication?
It is not uncommon for some women to experience breakthrough bleeding while taking hormonal medications, especially during the initial adjustment period. Since you have been consistent with your medication, it is advisable to continue taking the remaining doses as prescribed unless instructed otherwise by your healthcare provider.

2. Should you continue the medication or stop?
It is generally recommended to complete the course of medication unless you experience severe side effects or are advised by your doctor to stop. After finishing the medication, monitor your bleeding pattern and consult your doctor if it continues or worsens.

3. Regarding the use of contraceptive pills:
If you are considering starting birth control pills to regulate your cycle, it is important to consult with your healthcare provider first. They can guide you on whether you need to take estrogen-containing pills or if a progestin-only pill would be more appropriate based on your medical history.

4. How to calculate your menstrual cycle:
The menstrual cycle is typically calculated from the first day of your period (in this case, April 4th) to the first day of your next period. However, since you are experiencing irregular bleeding, it may be more challenging to determine a consistent cycle length at this time.

5. Further evaluations at a hospital:
If you return to a hospital for further evaluation, your doctor may consider additional tests such as blood tests to check hormone levels, a pelvic exam, or possibly a hysteroscopy to examine the uterine lining more closely if there are concerns about conditions like endometrial hyperplasia or cancer.

6. Concerns about endometrial cancer:
While your ultrasound results were normal, it is essential to discuss any concerns about endometrial cancer with your doctor, especially if you have risk factors such as obesity, a family history of cancer, or prolonged unopposed estrogen exposure. Ultrasound can help identify abnormalities, but a definitive diagnosis may require a biopsy.

7. Use of myo-inositol:
Myo-inositol is often used to support ovarian function and may help with menstrual regularity, particularly in women with polycystic ovary syndrome (PCOS). It is generally considered safe to take alongside hormonal medications, but you should discuss this with your healthcare provider to ensure it fits into your overall treatment plan.

Conclusion
Irregular menstrual bleeding can be complex and multifactorial. It is crucial to maintain open communication with your healthcare provider, adhere to prescribed treatments, and report any changes in your symptoms. Regular follow-ups will help ensure that any underlying issues are addressed promptly, and your menstrual health is managed effectively. If you have any further concerns or if your symptoms change, do not hesitate to seek medical advice.

Similar Q&A

Understanding Irregular Menstrual Cycles: Causes, Treatments, and Costs

1. Irregular menstruation with prolonged bleeding lasting for a year and presenting with brown discharge could indicate the presence of a tumor. 2. Treatment options may include surgery or medication, depending on the diagnosis. 3. There are various types of surgical procedure...

Dr. Lin Manying reply Obstetrics and Gynecology
Abnormal menstruation requires a visit to the outpatient clinic to determine whether it is due to organic lesions or functional issues. Initially, medication treatment should be the primary approach, and one should not panic unnecessarily.

Understanding Irregular Menstruation: Causes, Treatment, and Fertility Concerns

Hello Dr. Jan, I would like to ask you about my menstrual cycle. Since high school and now while studying in a vocational program, my menstrual cycle has been irregular. My periods either come early or I experience prolonged bleeding for a month. What could be the underlying ca...

Dr. Zhan Deqin reply Obstetrics and Gynecology
There are many reasons for irregular menstruation in young women, such as abnormal lifestyle and diet, weight loss, and medications. Sometimes it can be due to anovulation or hormonal imbalances. If anovulation is the case, it may affect the chances of conception. It is recommend...

Understanding Irregular Periods: Treatment Options and Surgical Considerations

In the past, my menstrual cycles were normal, but three months ago, after trying to regulate my cycle, I suddenly experienced bleeding that lasted for a month. I visited a local hospital where the physician prescribed hormones to help gradually stop the bleeding. An ultrasound wa...

Dr. Wu Xianghui reply Obstetrics and Gynecology
1. Observation for 2-3 months or performing a hysteroscopy for biopsy. 2. Hormonal therapy without the addition of uterotonics may lead to excessive menstrual bleeding and prolonged menstrual periods.

Understanding Irregular Menstrual Cycles: Causes and Solutions

Hello Doctor, I started taking oral contraceptives for menstrual regulation in August of last year, and my menstrual cycle was stable until March of this year when I began experiencing abnormalities. Initially, I had a Pap smear that indicated vaginal inflammation, which has been...

Dr. Zhang Kunmin reply Obstetrics and Gynecology
Hello, the factors that can affect the menstrual cycle or cause irregular bleeding include age, environment, lifestyle, stress, emotional instability, weight changes, medications, emergency contraceptive pills, diet, polycystic ovary syndrome, uterine or cervical lesions, infecti...