Irregularities: Could You Be Pregnant Despite Menstruation?

Thought I was pregnant, but my period came?

Hello Dr.
Lu,
I would like to ask about my menstrual cycle.
My period started on November 1st, and I had a transvaginal ultrasound on November 16th, where the doctor noted a follicle measuring 1.6 cm.
However, during a follow-up ultrasound on November 21st, the follicle was no longer visible, but the endometrium had thickened.
Why was the ovulation test positive on November 21st (t=c)?
During this ovulation period, I had intercourse on November 15th, 18th, and 19th.
Starting November 22nd, my basal body temperature began to rise, and this luteal phase has shown higher temperatures (around 36.8 to 36.9 degrees Celsius) that are stable, along with occasional feelings of warmth at night, leading to sweating.
After about a week, I experienced intermittent abdominal cramping, which was not continuous.
On November 30th, I had noticeable lower abdominal pain, but it only lasted a short time.
In the following 2-3 days, there was some mild discomfort.

Previously, I have not experienced fever or discomfort before my period, usually only having abdominal bloating and pain during the first 1-2 days of menstruation.
Additionally, I have been waking up to use the restroom between 3-5 AM, and on some mornings, I felt hungry (around the stomach area) before getting out of bed.
However, I did not experience nausea or vomiting, although there was slight breast tenderness.
I initially thought these might be signs of pregnancy, but my period started on December 3rd (my cycle is about 32 days).
At first, I wondered if it could be early pregnancy bleeding, but by December 4th, the flow was similar to my usual menstruation, without the heavy bleeding or clots described by others who experienced miscarriage.
A urine pregnancy test on December 4th was negative.

Given that some symptoms felt different from my usual pre-menstrual signs, I would like to know if it is possible that fertilization and implantation occurred but were unsuccessful due to insufficient luteal support (this high-temperature phase lasted about 11 days) or other factors (such as my regular gym workouts, cycling, strength training, running, using the elliptical, jumping exercises, and commuting by motorcycle) that may have prevented the embryo from implanting and developing properly in the uterus.

Thank you for your patience in reading this and for your advice!

Grace, 30~39 year old female. Ask Date: 2015/12/04

Dr. Lü Lizheng reply Obstetrics and Gynecology

1.
The morning urine pregnancy test on December 4th was negative, and the flow on December 4th was similar to a normal menstrual period, indicating that pregnancy is unlikely.

2.
Regular activities such as going to the gym for spinning, strength training, running, using an elliptical machine, performing jumping exercises, and commuting by motorcycle should not affect the likelihood of pregnancy.

3.
Ovulation likely occurred, but it is currently impossible to determine if the egg was not fertilized or if it was just fertilized but has not yet implanted successfully.

4.
If there are concerns about luteal phase deficiency, it would be advisable to consult a specialist in infertility.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/12/04

More Info

Understanding the complexities of pregnancy, particularly in relation to menstruation and potential conception, can be quite challenging. Your situation raises several important points regarding the menstrual cycle, ovulation, and the possibility of pregnancy despite experiencing what seems like a regular menstrual period.

Firstly, it is essential to understand that the menstrual cycle is a complex interplay of hormones that regulate ovulation and menstruation. Ovulation typically occurs about 14 days before the start of your next period, but this can vary based on individual cycles. In your case, you mentioned that you had an ultrasound on November 16, which showed a 1.6 cm follicle, and by November 21, this follicle was no longer visible, indicating that ovulation likely occurred around that time. The positive ovulation test on November 21 further supports this, suggesting that you were indeed in your fertile window.

After ovulation, the body enters the luteal phase, during which the corpus luteum forms from the remnants of the follicle and produces progesterone. This hormone is crucial for maintaining the uterine lining in case of pregnancy. You noted that your basal body temperature (BBT) rose and remained elevated, which is a typical sign of progesterone production and can indicate that ovulation has occurred.

However, the symptoms you described—such as abdominal discomfort, increased urination, and breast tenderness—can also be associated with premenstrual syndrome (PMS) or other hormonal fluctuations. It is not uncommon for women to experience symptoms that can mimic early pregnancy signs, especially if they are closely monitoring their bodies for changes.

Regarding your concern about the possibility of pregnancy despite having a menstrual period, it is important to note that some women experience what is known as "implantation bleeding," which can occur when a fertilized egg attaches to the uterine lining. This bleeding can sometimes be mistaken for a light period. However, you indicated that your flow on December 3 was similar to your regular menstrual cycle, which makes it less likely that this was implantation bleeding.

The negative pregnancy test on December 4 further supports the idea that you may not be pregnant. Pregnancy tests measure the hormone human chorionic gonadotropin (hCG), which is produced shortly after implantation. If you were pregnant, this hormone would typically be detectable in your urine by the time your period is due.

As for the possibility of a luteal phase defect, where the corpus luteum does not produce enough progesterone to support a potential pregnancy, this can indeed lead to difficulties in maintaining a pregnancy. However, given that you experienced a regular menstrual cycle, it is less likely that this was the primary issue in your case.

In conclusion, while it is possible to experience symptoms that mimic pregnancy, the combination of your menstrual cycle, the timing of ovulation, and the results of your pregnancy test suggest that you are likely not pregnant this cycle. If you continue to have concerns about your menstrual cycle, ovulation, or potential fertility issues, it would be beneficial to consult with a healthcare provider who can offer personalized advice and possibly conduct further evaluations. They can help you understand your cycle better and discuss any lifestyle factors that may be influencing your reproductive health.

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