Are my irregular periods, acne, and painful sex connected?

Question

Hi doctor,

My periods are irregular, and it takes me two weeks to finish. But this month, I had three periods in one month. It stopped for only four days, then it continued. Right now, I have been bleeding for almost a month. What should I do with this?

Also, I got acne on the back. I am not sexually active, but whenever I have sex, my lower abdomen hurts afterward. I also became constipated. Is it connected or not?

Previously, I went to a clinic, and they said I was fine even though I was bleeding for almost a month. She gave me Duphaston, but later on stopped saying I was fine. But it never gets better.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com

I understand your concern.

Bleeding almost continuously with only a few days' gap in between is not normal, and with your background of always having irregular cycles plus new acne and cramps, this does look like a hormonal imbalance picture.

Sometimes what happens is that the lining of the uterus does not shed properly, so it keeps spotting or bleeding off and on. Duphaston (Dydrogesterone) can temporarily regulate, but if the root cause is not checked, it keeps recurring.

The probable cause is likely anovulatory cycles due to hormonal imbalance (polycystic ovary syndrome, PCOS-like picture, even if not diagnosed yet), or endometrial dysfunction.

The different investigations to be done include:

Complete blood count (CBC).
Iron studies are needed to check for anemia if bleeding has been ongoing for this long.
Pelvic ultrasound to see the endometrium, ovaries for PCOS features, fibroids, and polyps.
Hormonal profile: Thyroid-stimulating hormone(TSH), prolactin, Leutinizing hormone (LH), follicle-stimulating hormone (FSH), and androgens (because of acne and irregular cycles).

The differential diagnosis in your case will be:

PCOS or ovarian dysfunction.
Thyroid disorder.
Endometrial polyp or fibroid.
Coagulation issue (rare, if long history of prolonged bleeding since menarche).

The most probable diagnosis is abnormal uterine bleeding due to hormonal imbalance.

I will suggest the following treatment plan:

First, you need to stop this prolonged bleeding and correct anemia if present. The best is to consult a gynecologist in person, as sometimes we start with:

Hormonal tablets (like progesterone courses or combined pills) to stabilize the lining.
Iron supplements are usually needed if hemoglobin is low. If the cause is PCOS, long-term cycle regulation is needed.

You must also:

Maintain a healthy weight.
Avoid skipping meals.
Exercise regularly, but do not overdo it.
Keep track of your cycles in an app.

You must get an ultrasound and basic blood work done, and update with reports. If bleeding is heavy, causing weakness or dizziness, please do not delay. See a gynecologist in person soon. Follow-up is important because prolonged, untreated bleeding can cause anemia and endometrial thickening.

I hope this answers your query.

Thank you.