Is It Pregnancy or Just Irregular Menstruation? Early Signs

Am I pregnant?

Due to my girlfriend's regular menstrual cycle, her last period started on October 21, which means her next period should have been on November 18 (her cycle changed to 25 days from the usual 27 days after taking contraceptive pills last month).
However, her period started on the afternoon of November 19, but the flow was lighter than usual and appeared fragmented, with less noticeable pain than normal.
This raised concerns about whether it could be early pregnancy-related spotting or an ectopic pregnancy.
On the night of November 19, she noticed a substance resembling sebaceous material, which was mucous-like and red, a situation she had never experienced before.

In the early morning of November 20, she developed a fever after feeling cold at night, with a temperature of 38.1 degrees Celsius.
By the morning of November 20, her flow gradually increased to a level that exceeded what a pad could absorb, prompting us to change the bedsheets.
Her temperature gradually decreased, measuring 37.8 degrees Celsius at 7:00 AM and 36.55 degrees Celsius at noon.
By midday on November 20, the menstrual flow began to decrease, becoming less than it was on the afternoon of the 19th.
We then used a pregnancy test, which resulted in a "negative" (not pregnant) outcome.
Her temperature continued to stabilize, measuring 36.86 degrees Celsius at 4:37 PM and 36.79 degrees Celsius at 5:57 PM.

On the morning of November 21, her menstrual flow was still less than usual.
Our last sexual encounter was on November 16, and we used the pregnancy test on November 20, but the instructions indicated that it could be used on the first day of a missed period.
By November 22, her menstrual flow had completely stopped.
She then began to experience severe cold symptoms, including headaches and back pain.
On November 23, she had diarrhea, intermittent chest pain, back pain, headaches, and a sore throat.
We visited an ENT clinic, where her temperature was measured at 36.8 degrees Celsius.

I noticed that your diagnosis suggests testing 15 days after the last sexual encounter for the most accurate results, or testing on the day of a missed period.
However, these two recommendations seem contradictory.
We had sexual intercourse on November 4, November 8, and November 16; if the most accurate test is 15 days later, wouldn't that mean we should wait until December 1 to test? Given that her chest pain has persisted until now (November 23) and her period only lasted three days, could this be a case of false menstruation indicating pregnancy? (The menstrual blood color was normal, but there were larger blood clots.) What is my girlfriend's condition? Is there a possibility of pregnancy? We usually track safe periods and use condoms throughout, but this unusual menstrual flow has left us shocked and discouraged.
Thank you! This is very urgent!

AN, 20~29 year old female. Ask Date: 2015/11/23

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
It is possible that the differences in menstrual flow are due to the use of oral contraceptives combined with the effects of a cold.

2.
Since oral contraceptives are being used along with consistent condom use, the likelihood of pregnancy is very low.

3.
Pseudomenstruation typically does not involve heavy bleeding, and the timing may differ from what is expected.

4.
For pregnancy testing, if menstruation is missed, it is recommended to test 15 days after the last sexual intercourse for the most accurate results.
Testing can also be done on the day of the missed period, but sometimes testing too early may yield a negative result.

Respectfully, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/11/23

More Info

Determining whether your girlfriend is pregnant or experiencing irregular menstruation can be quite challenging, especially when there are unusual symptoms involved. Based on the details you've provided, let's break down the situation and address your concerns.

Early Signs of Pregnancy vs. Irregular Menstruation
1. Menstrual Changes: Your girlfriend's last menstrual period (LMP) was on October 21, and she expected her next period around November 18. However, she experienced a lighter flow on November 19, which is atypical for her. Early pregnancy can sometimes cause light spotting, known as implantation bleeding, which occurs when the fertilized egg attaches to the uterine lining. However, this is usually lighter than a normal period and lasts for a shorter duration.

2. Color and Consistency of Blood: The description of the menstrual flow as "fragmented" and the presence of a "mucous-like" substance can be concerning. While some women do experience changes in their menstrual blood during early pregnancy, these symptoms can also indicate hormonal fluctuations or other menstrual irregularities.

3. Negative Pregnancy Test: You mentioned that a pregnancy test taken on November 20 was negative. Home pregnancy tests are most accurate when taken after a missed period, typically around the first day of the expected period. Since your girlfriend's period started on November 19, testing on November 20 may have been too early, especially if implantation bleeding occurred.

4. Symptoms of Illness: The fever and other symptoms your girlfriend experienced, such as headaches and body aches, suggest she may have been coming down with a cold or another illness. Stress and illness can also affect menstrual cycles, leading to lighter periods or changes in flow.

Timing of Testing
You are correct that the most reliable time to take a pregnancy test is about 15 days after the last unprotected intercourse. Given that you had intercourse on November 16, waiting until December 1 would provide a more accurate result. If your girlfriend's next period does not arrive by then, it would be advisable to retest.

Potential for Cryptic Pregnancy
While cryptic pregnancies (where a woman does not realize she is pregnant until much later) are rare, they can occur. However, the combination of negative pregnancy tests and ultrasound findings typically rules out this possibility. If your girlfriend continues to experience unusual symptoms or if her period does not return to normal, it would be wise to consult a healthcare provider for further evaluation.

Recommendations
1. Wait and Retest: Since the timing of the test may have been too early, consider waiting a few days and retesting, especially if her period does not resume as expected.

2. Monitor Symptoms: Keep an eye on any unusual symptoms. If she experiences severe pain, heavy bleeding, or other concerning signs, seek medical attention promptly.

3. Consult a Healthcare Provider: If there is still uncertainty after retesting, or if her menstrual cycle continues to be irregular, it would be beneficial for her to see a healthcare provider. They can conduct a blood test for pregnancy, which is more sensitive than home tests, and evaluate her overall health.

Conclusion
In summary, while there are signs that could suggest early pregnancy, the negative pregnancy test and the unusual menstrual symptoms indicate that it may be more likely a case of irregular menstruation. Monitoring her symptoms and retesting closer to the expected date of her next period will provide clearer answers. If there are any further concerns, consulting a healthcare professional is always the best course of action.

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