What could cause delayed periods and spotting?

Question

Hello doctor,

I am a 19 year old female. I am concerned about my menstrual cycle. About two weeks ago, I noticed spotting in my underwear. It went on for two and a half days. On the first day it was reddish, and on the second day, it seemed a bit brownish. I was supposed to get my periods four days ago. Last week, I felt slight cramping, and I was quite sure that my period would start, but it did not. On the same week that the spotting happened, my boyfriend and I were intimate. He was rubbing my genitals very very roughly, but we did not have sex. He did not even stick his finger in me. I am still a virgin.

A little background on my period and my health: I started my first period when I was 13. Since then, I have always had very painful cramps every time. Also, I would experience some nausea and diarrhea. The bleeding is somewhat heavy. I cannot remember if I have ever had a light period. My periods are sometimes irregular. But, they go back to normal by themselves. They would be late by a maximum of a couple of days or a week.

I have gotten my blood work done last spring, and everything was normal, except maybe a slightly elevated testosterone level, which my doctor concluded to be normal for my age. I was tested for polycystic ovarian syndrome, and I was negative for that. I was also tested for thyroid problems, and my doctor did not say anything was abnormal. I do not think I am anemic, but it does run in my mother's family. My mother was also diagnosed with stage two breast cancer last year. Other than that, I am healthy. I do not feel any other symptoms. I weigh around 112 lbs, and I am 5 feet 3 inches. I do not know if this piece of information will help, but I am a first-year medical student, and my stress levels have been extremely high lately.

Answer 1

Hello,

Welcome to icliniq.com.

How are you doing? That was an excellent and elaborate history. You will do well in medicine. And, I am happy that I can use medical terms. Let me tell you though that the only significant part of this history was the high-stress levels which you laughed away.

1. About the pain, it is spasmodic dysmenorrhea. You are 19 years, and your hypothalamic-pituitary-ovarian axis is now maturing. By the age of 21, it will be fully mature. Until then menstruation disorders can be expected. When the hormones are slightly elevated, the endometrial lining breaks down and, comes out through a narrow cervical canal. Only after you have had a normal vaginal delivery, the cervical canal would dilate, and you will be completely relieved of pain. Till then, I suggest taking antispasmodics and tablet Tranexamic acid to reduce the bleeding.

2. As you know, the hypothalamus controls the release of hormones from the pituitary, which in turn controls the hormones from the ovaries needed for ovulation. When you are under stress, the brain stops the flow of hormones from the pituitary. Hence, ovulation does not occur. If you do not ovulate, you do not get your periods. It is nature's way of letting you handle stress.

3. Do not worry. The delay has nothing to do with your sex history, family history of cancer or anemia. It is a misunderstanding that anemia leads to amenorrhea, while in reality, menorrhagia leads to anemia. Just wait for a maximum of 10 to 14 days after the expected date of menses, and then meet a gynecologist who will give you a hormone course to have a withdrawal bleeding. Once the stress is over, your periods will normalize.

4. You are slightly underweight. I will not advise you to put on weight but, do have a lot of proteins, fruits, and vegetables. Being underweight can also delay your periods.

Hope I have clarified your query. Do write back. All the best.

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