Should I Get Checked? Irregular Menstrual Cycles

Should I get checked?

Hello Doctor: I have been experiencing irregular menstrual cycles since I first got my period.
In high school, my flow was heavy and painful, but it has gradually decreased since college.
My periods have always been irregular, sometimes arriving on time, but most of the time they are spaced two to three months apart (the longest being six months).
Recently, I have not had a period since December of last year.
In the past two to three days, I suddenly experienced abdominal bloating, nausea, and some discharge (I have had discharge before, which varies in frequency).
I have had a few sexual experiences, but they have been infrequent, and it has been a long time since my last encounter.

Doctor, I have several questions:
1.
What could be causing my consistently irregular menstrual cycles? I have always had irregular periods, but it has become significantly worse in recent years.
I was diagnosed with depression during college and took medications like Prozac and Lexapro.
After receiving treatment for depression, my menstrual flow began to decrease.
Could this be related, or is it due to having had sexual intercourse?
2.
If my period continues to be absent, what impact could this have on my body? I feel generally well and do not experience any particular discomfort, but it has been a long time since my last period.

3.
Is the sudden abdominal bloating and nausea related to the discharge? If I go to the hospital to check on the discharge, will it definitely indicate that I have had sexual intercourse?
4.
What negative effects could my current situation have on my body? Should I seek to identify the cause of my irregular menstruation? Will this affect my ability to have children in the future?
I have many questions, and I appreciate your patience in answering them.
:)

Ben Niao, 20~29 year old female. Ask Date: 2004/04/19

Dr. Chen Changfu reply Obstetrics and Gynecology

Dear readers,
1.
The menstrual period in women is due to the cyclical ovulation process of the ovaries, which involves the secretion of estrogen and progesterone that affect the endometrium, leading to periodic bleeding.
Many women may experience irregular menstrual cycles due to various factors or unknown reasons, resulting in irregular bleeding.
Psychiatric medications that act on the central nervous system (the brain) may disrupt the normal stimulation of the ovaries, causing anovulation and resulting in irregular menstrual periods or even decreased menstrual flow.
Young women in their developmental stage may also experience irregular menstrual cycles as their ovaries may not yet be capable of regular ovulation.
The regularity of a woman's menstrual cycle is not related to whether she has engaged in sexual intercourse.
2.
If a woman has had sexual intercourse and her period has not arrived, the primary concern is the possibility of pregnancy, which she may not be aware of.
As long as pregnancy is ruled out, the absence of menstruation is not immediately life-threatening; however, it may lead to continuous endometrial hyperplasia, resulting in abnormal uterine bleeding, irregular menstrual cycles, or symptoms of heavy menstrual flow.
3.
Engaging in sexual intercourse increases the risk of female reproductive tract infections and pelvic inflammatory disease (PID).
If there is an increase in vaginal discharge, abdominal pain, or bloating resembling symptoms of PID, it is crucial to visit a healthcare provider and openly acknowledge past sexual activity to enable accurate examination, diagnosis, and treatment.
Clinical experience shows that women who have not engaged in sexual intercourse are unlikely to develop pelvic inflammatory disease.
Providing false information to the physician may hinder accurate diagnosis and treatment.
4.
Some cases of irregular menstrual cycles are of unknown origin.
Women who frequently experience irregular menstrual cycles may have ovulatory dysfunction, leading to difficulties in conceiving and requiring medication to stimulate ovulation.

Reply Date: 2004/04/19

More Info

Irregular menstrual cycles can be a source of concern for many women, and your situation certainly warrants a thorough evaluation. Let's break down your questions and concerns regarding your menstrual irregularities, potential underlying causes, and implications for your health.

1. Causes of Irregular Menstrual Cycles: Irregular periods can stem from various factors, including hormonal imbalances, stress, significant weight changes, excessive exercise, and underlying medical conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders. Given your history of depression and the medications you mentioned (like SSRIs), it’s possible that these factors could be influencing your menstrual cycle. Antidepressants can sometimes affect hormonal regulation, leading to changes in menstrual patterns. Additionally, the stress associated with mental health issues can also impact your menstrual cycle.

2. Impact of Missing Periods: Not having a menstrual period for an extended time (amenorrhea) can have several implications. It can lead to a decrease in bone density over time, increasing the risk of osteoporosis, especially if you are not menstruating due to low estrogen levels. Moreover, prolonged amenorrhea can indicate underlying health issues that may need to be addressed, such as hormonal imbalances or other reproductive health concerns.

3. Recent Symptoms of Bloating and Nausea: The symptoms of abdominal bloating and nausea you are experiencing could be related to hormonal changes or other gastrointestinal issues. It’s essential to consider that these symptoms could also be linked to ovulation or even pregnancy, especially if you have had unprotected sexual encounters. The discharge you mentioned could be normal cervical mucus or could indicate an infection, especially if it has changed in color or consistency. If you are concerned about the possibility of pregnancy, a home pregnancy test could provide clarity.

4. Health Implications and Future Fertility: Irregular menstrual cycles can affect your fertility, as regular ovulation is crucial for conception. If you are planning to have children in the future, it is advisable to seek medical advice to understand the underlying causes of your irregular cycles. A healthcare provider can perform tests to evaluate your hormone levels, check for conditions like PCOS, and assess your overall reproductive health.

5. Seeking Medical Attention: Given your history of irregular cycles, the recent absence of menstruation, and the new symptoms you are experiencing, it would be wise to consult with a healthcare provider. They can conduct a comprehensive evaluation, which may include a physical examination, blood tests to check hormone levels, and possibly imaging studies if necessary. This will help determine the cause of your symptoms and guide appropriate treatment options.

In conclusion, while it’s understandable to feel anxious about your menstrual irregularities, seeking medical advice is the best course of action. A healthcare professional can provide personalized insights and treatment options based on your specific situation. Early intervention can help address any underlying issues and support your reproductive health moving forward.

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