Irregular Menstrual Cycles: When to Seek Further Evaluation

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Good day: My last menstrual period was on May 4th.
I had very little bleeding in June (there were a few days with some brown discharge).
On July 12th, I was prescribed medication to induce menstruation by my gynecologist, but I could only take it for two days due to an allergic reaction.
On July 16th, I consulted a Traditional Chinese Medicine practitioner who diagnosed me with hormonal imbalance and uterine weakness, and I took herbal powder for a week, but there was no improvement.
It has been over two months without a menstrual period, and I am quite worried.
(I have taken a urine test, and I am not pregnant.) On July 23rd, I received an injection to induce menstruation, and on the morning of July 24th, I had a very light flow, but it stopped in the afternoon.
As of July 25th, I am completely dry.
Does this count as a period? I am 35 years old and am unsure if I need to undergo any further examinations.

kangaroo, 30~39 year old female. Ask Date: 2001/07/26

Dr. Lin Zhaopei reply Obstetrics and Gynecology

On July 23, a menstrual induction injection was administered, and menstruation is expected to occur between the evening of July 25 and July 27.
The menstruation that started on July 24 may be influenced by previous oral medication or insufficient dosage of the injection.
If there has been a history of uterine surgery (such as abortion) or inflammation, it is possible that cervical stenosis could lead to amenorrhea.
Other factors that can cause menstrual irregularities include weight gain, weight loss, stress, excessive exercise, breastfeeding, and endocrine disorders (such as elevated prolactin levels or hypothyroidism), as well as medications (especially psychiatric drugs).
Regarding menopause at the age of 35, the probability is less than 1 in 120, which is referred to as premature ovarian failure.
Common causes may include surgery, radiation therapy, chemotherapy, or postpartum hemorrhage.

Reply Date: 2001/07/26

More Info

Irregular menstrual cycles can be a source of concern for many women, and understanding when to seek further evaluation is crucial for maintaining reproductive health. Based on your description, it appears that you have experienced significant changes in your menstrual cycle over the past few months, including a prolonged absence of menstruation (amenorrhea) and the use of medications to induce menstruation.
Firstly, it is important to note that menstrual cycles can be influenced by a variety of factors, including hormonal imbalances, stress, weight changes, and underlying medical conditions. In your case, the diagnosis of endocrine imbalance and uterine weakness by a Traditional Chinese Medicine practitioner suggests that there may be a hormonal component contributing to your irregular cycles.
Given that you have not had a menstrual period for over two months and have experienced a very light flow after receiving medication, it is advisable to seek further evaluation from a healthcare provider, particularly a gynecologist or an endocrinologist. Here are some steps and considerations for your situation:
1. Comprehensive Evaluation: A thorough evaluation is essential. This may include a physical examination, a detailed medical history, and possibly blood tests to check hormone levels (such as estrogen, progesterone, thyroid hormones, and prolactin). These tests can help identify any underlying hormonal imbalances that may be affecting your menstrual cycle.

2. Pelvic Ultrasound: An ultrasound may be recommended to assess the structure of your uterus and ovaries. This can help identify any abnormalities such as polycystic ovary syndrome (PCOS), fibroids, or other conditions that could be contributing to your irregular cycles.

3. Lifestyle Factors: Consider discussing lifestyle factors that may be affecting your menstrual health. Stress management, maintaining a healthy weight, and regular exercise can all play a role in regulating menstrual cycles.

4. Medication Review: Since you have had adverse reactions to medications prescribed for inducing menstruation, it is important to communicate this to your healthcare provider. They can explore alternative treatment options that may be more suitable for you.

5. Follow-Up: After initial evaluations, it is crucial to have follow-up appointments to monitor your condition. If you continue to experience irregular cycles or if new symptoms arise, further investigations may be warranted.

6. When to Seek Immediate Care: If you experience severe abdominal pain, heavy bleeding, or any other concerning symptoms, it is important to seek immediate medical attention.

In summary, while occasional irregularities in menstrual cycles can be normal, the duration and nature of your symptoms suggest that further evaluation is warranted. Early intervention can help identify any underlying issues and guide appropriate treatment, ultimately helping to restore your menstrual health and alleviate your concerns. Please consult with a healthcare professional to discuss your symptoms and the best course of action moving forward.

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