Irregular Periods: Causes, Treatments, and Concerns

Irregular menstruation

On January 9, my menstrual period started and continued until January 17, although the flow was not heavy.
Sometimes it was bright red, and other times it was brown.
On January 17, I went to Cathay for an ultrasound, and the doctor said it was a hormonal issue.
He prescribed progesterone and estrogen, one pill each, to be taken three times a day for a week.
After taking the medication twice a day for the second and third weeks, I stopped bleeding after two days.
However, I still had two days of medication left (until February 7) when my period returned.
This time, I had some bleeding until February 19, without a single day of complete cessation, although the flow decreased after the sixth day.
However, it was never completely clear, and by the twelfth day, I still had some blood clots, although the bleeding was minimal.
Since it was the weekend, I had to visit a nearby clinic.
During the pelvic examination, the doctor said everything seemed fine and that it should just be a matter of regulating my cycle.
However, during the ultrasound (performed by the doctor personally), he noted that the endometrium looked fine and was not thick, but there was something resembling a polyp or a blood clot measuring about 0.7 x 1.7 cm.
The doctor prescribed a medication that combined progesterone and estrogen (estradiol ethinyl) for me to take for 14 days, one pill a day.
He mentioned that if the bleeding did not stop after finishing the medication, I would need a dilation and curettage (D&C).
After taking the medication for two days, I stopped bleeding, but for some reason, on the third day, before taking the fourth day's pill, I experienced fresh bleeding along with blood clots.
This is really frustrating! Why would a polyp develop in the uterus within a month? Could the ultrasound have been inaccurate? What do you suggest for this situation? Why am I still bleeding after taking the medication? Is one pill a day insufficient? If a D&C is necessary, considering my endometrium was not very thick (7-8 mm on January 17 and the doctor said it was not thick on February 18), can it be performed safely? Is there a risk of uterine perforation? Should this procedure be done in a hospital, or is it acceptable to do it in a clinic? I have heard that anesthesia is required.
Additionally, I have a benign cyst in my left breast.
If I need to take hormones long-term, what should I do? Do you have any suggestions for managing this without medication? I look forward to your advice.
This is very frustrating.

An An, 40~49 year old female. Ask Date: 2005/02/24

Dr. Mao Yikun reply Obstetrics and Gynecology

1.
Please go to the outpatient clinic for an ultrasound examination.

2.
A dilation and curettage (D&C) can be performed at either the hospital or a clinic.

3.
If there are benign breast cysts, regular check-ups are sufficient.

Reply Date: 2005/02/24

More Info

Understanding irregular menstrual cycles can be quite complex, as they can stem from a variety of causes, including hormonal imbalances, structural abnormalities in the uterus, and lifestyle factors. In your case, it seems that you have been experiencing prolonged bleeding, irregular periods, and the presence of what may be a polyp or blood clot in the uterus. Let's break down your concerns and explore potential causes, treatments, and considerations.

Causes of Irregular Periods
1. Hormonal Imbalances: Fluctuations in hormones, particularly estrogen and progesterone, can lead to irregular bleeding. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, and perimenopause can disrupt the normal hormonal balance.

2. Uterine Abnormalities: The presence of uterine polyps, fibroids, or other structural issues can cause abnormal bleeding. These growths can develop due to hormonal stimulation and may not always be symptomatic until they cause significant changes in your menstrual cycle.

3. Lifestyle Factors: Stress, significant weight changes, excessive exercise, and certain medications can also impact your menstrual cycle.

Treatments for Irregular Periods
1. Hormonal Therapy: As you mentioned, your doctor prescribed progesterone and estrogen to help regulate your cycle. These hormones can help stabilize the endometrial lining and reduce abnormal bleeding. However, it’s essential to monitor your response to these medications closely.

2. Monitoring and Imaging: Regular ultrasounds can help track changes in the uterine lining and identify any abnormalities like polyps or fibroids. If a polyp is suspected, further evaluation may be necessary.

3. Surgical Options: If hormonal treatments do not resolve the bleeding, or if a polyp is confirmed and causing symptoms, a procedure such as a dilation and curettage (D&C) may be recommended. This procedure involves scraping the uterine lining to remove abnormal tissue and can provide both diagnostic and therapeutic benefits.

Concerns Regarding Your Situation
1. Continued Bleeding: It’s not uncommon for some women to experience breakthrough bleeding while on hormonal therapy. This can happen if the dosage is not sufficient to stabilize the endometrial lining or if there are other underlying issues.

2. Polyp vs. Blood Clot: Distinguishing between a polyp and a blood clot can be challenging. If your ultrasound suggests a polyp, it may need to be removed to prevent further bleeding and to confirm the diagnosis through histological examination.

3. D&C Procedure: A D&C is generally safe, but like any surgical procedure, it carries risks, including the potential for uterine perforation. This risk is higher in women with certain anatomical considerations or if the procedure is performed by less experienced practitioners. It is advisable to have this procedure done in a hospital setting where you can receive appropriate monitoring and care.

4. Long-term Hormonal Use: If you have a benign cyst in your breast, it’s crucial to discuss the implications of long-term hormonal therapy with your healthcare provider. They can help you weigh the benefits and risks based on your overall health and family history.

Recommendations
- Follow-Up: Continue to follow up with your healthcare provider regarding your symptoms and treatment response. If bleeding persists or worsens, further evaluation may be necessary.

- Consider a Specialist: If you feel your current treatment isn’t effective, consider seeking a second opinion from a gynecologist or a reproductive endocrinologist who specializes in hormonal disorders.

- Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and stress management techniques, can also help regulate your menstrual cycle.

- Alternative Treatments: Discuss with your doctor about non-hormonal options, such as lifestyle changes or herbal supplements, which may help manage your symptoms.

In conclusion, while irregular periods can be frustrating and concerning, there are various treatment options available. It’s essential to work closely with your healthcare provider to find the best approach for your specific situation.

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