I have PMS after Regestrone. When will my period start?

Question

Hello doctor,

I have had an irregular menstrual cycle for many years, but I have only been diagnosed with fatty liver. My blood tests, USG, and hormone tests are normal.

I had protected intercourse recently, and my last period was a few weeks before that. I took a UPT about 10 days after my missed period, which was negative. I repeated the test later, and it was also negative.

I consulted a doctor, and she advised a seven-day course of Regestrone, twice daily. I completed the course a few days ago. It has been three days since then, and today I started experiencing PMS symptoms. Does this mean withdrawal bleeding is on the way?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

In your case, you already ruled out pregnancy with two properly timed UPTs (urine pregnancy tests), so that is off the table. You completed Regestrone on and now it is day three post-stoppage, you are noticing PMS (premenstrual syndrome)-like symptoms.

That is usually the body’s way of telling that the progesterone withdrawal effect is kicking in, so yes, it points toward withdrawal bleeding coming in the next few days. It generally happens within three to seven days after finishing the course, sometimes up to 10 days.

Irregular ovulation patterns due to hormonal imbalance, worsened by fatty liver or weight issues, seem to be the most likely cause.

To clarify the situation further, tests such as

Thyroid profile (TSH (thyroid-stimulating hormone), T3 (triiodothyronine), T4 (thyroxine)).
Prolactin.
Liver function monitoring may be useful, especially considering the fatty liver.
A repeat pelvic ultrasound may also be considered if cycles continue to be erratic.

Other possibilities include a tendency towards PCOS (polycystic ovarian syndrome) even if the ultrasound looks normal, hypothalamic anovulation related to stress or weight factors, or a lag following Progestin withdrawal. However, the most likely outcome here is a progesterone withdrawal bleed, which is expected.

For the time being, it is best to wait, as bleeding should appear within the next two to five days. If no bleeding occurs even after 10 days of stopping Regestrone (Norethisterone), it would be necessary to revisit the gynecologist for reassessment.

In the longer term, weight management and liver care will play a key role in regulating cycles. Sometimes, cyclical progestin for a few months is prescribed to help maintain regularity.

If no withdrawal bleeding is seen by day 10 after stopping Regestrone, it is important to update the doctor. Keeping a menstrual cycle diary will also help share during the next consultation.

It would be advisable to regularly follow up with a gynecologist for cycle regulation and with a hepatologist or gastroenterologist for fatty liver monitoring.

Preventive measures such as -

Losing even eight to 11 pounds can significantly improve cycle regularity.
Regular exercise, a healthy diet, and proper lifestyle changes will support fatty liver management.
Avoiding late nights and reducing stress will also help minimize cycle irregularities.

I hope this helps.

Thank you and take care.

Regards.