Irregular Menstrual Cycles: Causes and Health Checks

Irregular menstrual periods?

In my younger years, my menstrual flow was heavy enough that I needed to use overnight pads.
However, in recent years, I have noticed a significant decrease in the amount of menstrual blood, to the point where I no longer need overnight pads, and the next day the flow is so light that I hardly need to change my pad—only on the first day do I need to change it.
This month, two weeks before my period, I noticed light red blood when wiping after using the restroom, so I sought medical attention.
An ultrasound examination was normal, and a cervical polyp was removed and found to be benign.
A few days before my menstrual cycle, I began to notice brown discharge when wiping, and it took about four days for bright red blood to appear.
I consider the first day of my period to be when I noticed the bright red blood (this month it started 2-3 days earlier than usual).
On the first day, the bleeding was bright red and somewhat thick, while on the second day, there was hardly any blood on the pad—just a little on the surface or only when wiping.
By the third and fourth days, there was no bleeding at all (it felt like it was ending).
On the fifth day, I noticed brown discharge again and light red discharge when wiping (not sure if it was menstrual blood).
This pattern has been consistent for the past two years: 1-2 days of thick menstrual blood with clots, followed by 3-4 days of feeling like there is nothing, and then 5-6 days of some discharge (brown, light red, or red).
Overall, the bleeding lasts about 7-9 days, and it is intermittent.
Since my ultrasound examinations have all been normal and the transvaginal ultrasound indicated that my uterus and ovaries are normal, what kind of tests can I undergo? Is this situation abnormal? I have given birth once and had three miscarriages (medically induced).
What could be the cause of the intermittent bleeding (with a 2-day gap) and the thick consistency (not flowing directly, feeling like mucus that stretches, and only coming out when I urinate)? What tests can ensure my health? Thank you, doctor.

Aa, 30~39 year old female. Ask Date: 2023/09/04

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Based on your description, everything has been checked and is normal, so there is no need to worry too much.
However, if you are still feeling very troubled, it is recommended to visit a gynecology outpatient clinic at a regional hospital or higher for further evaluation.
Thank you.

Reply Date: 2023/09/04

More Info

Irregular menstrual cycles can be concerning and may indicate underlying health issues. Based on your description, it seems you are experiencing changes in your menstrual flow, including lighter bleeding, intermittent spotting, and variations in the consistency of menstrual blood. These changes can be influenced by various factors, including hormonal fluctuations, structural abnormalities, and previous reproductive health issues.

Possible Causes of Irregular Menstrual Cycles
1. Hormonal Imbalances: Hormonal fluctuations are one of the most common causes of irregular menstrual cycles. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and perimenopause can lead to changes in menstrual flow and cycle length.

2. Structural Abnormalities: You mentioned having a cervical polyp that was removed and found to be benign. Other structural issues, such as uterine fibroids or endometrial polyps, can also cause changes in menstrual bleeding patterns.

3. Previous Pregnancy Complications: Having had multiple pregnancies, including miscarriages, can affect your menstrual cycle. The body may take time to regulate itself after such events, leading to irregularities.

4. Lifestyle Factors: Stress, significant weight changes, excessive exercise, and dietary changes can all impact menstrual cycles.
5. Infections or Inflammation: Pelvic inflammatory disease (PID) or other infections can lead to abnormal bleeding patterns.

Recommended Health Checks
Given your symptoms and history, it is essential to conduct further evaluations to rule out any serious conditions and to understand the underlying causes of your irregular menstrual cycles. Here are some recommended checks:
1. Hormonal Testing: Blood tests to check hormone levels, including estrogen, progesterone, thyroid hormones, and androgens, can help identify any hormonal imbalances.

2. Pelvic Ultrasound: While you have already had an ultrasound, it may be beneficial to have a follow-up ultrasound to check for any new developments in the uterus or ovaries, such as fibroids or cysts.

3. Endometrial Biopsy: If there are concerns about the endometrial lining, especially given your history of irregular bleeding, a biopsy may be recommended to rule out hyperplasia or other abnormalities.

4. Hysteroscopy: This procedure allows for direct visualization of the uterine cavity and can help identify any structural issues that may not have been visible on ultrasound.

5. Blood Tests for Infections: Testing for sexually transmitted infections (STIs) or other infections that could affect menstrual health may also be warranted.

Conclusion
Your symptoms of intermittent bleeding, changes in flow, and the presence of thick, mucous-like discharge can be indicative of several underlying issues. It is crucial to work closely with your healthcare provider to determine the best course of action. Keeping a detailed menstrual diary, noting the flow, consistency, and any accompanying symptoms, can also be helpful for your healthcare provider in diagnosing the issue.

In summary, while some variations in menstrual cycles can be normal, especially after significant reproductive events, persistent irregularities warrant further investigation. By undergoing the recommended tests, you can gain a clearer understanding of your reproductive health and address any potential issues effectively.

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