I have irregular menses. How can they be treated?

Question

Hello doctor,

I have discussed this issue before, but my periods are still irregular and concerning me. For the past year, my menstrual cycles have been coming roughly every six weeks instead of monthly. The bleeding is also very unusual because there is hardly anything on the pad. Most of the blood only comes out when I sit on the toilet and urinate. Sometimes I also pass large clots in the toilet, which makes me feel that the blood flow may be thick or abnormal.

I am worried about why my periods are still irregular, why the flow is so minimal on the pad, and what the clots could mean. I have been under stress for a long time, and I wonder if stress or hormonal imbalance could be contributing to this problem.

I also have a new concern. A few days ago, while masturbating by rubbing my clitoris and vaginal area, I noticed some blood on my finger. This happened on two consecutive days. I did not have any pain, discomfort, or injury that I noticed, but seeing blood worried me because this has never happened before, despite masturbating many times in the past. I could not tell exactly where the blood came from.

My last period started about five weeks ago, and my next period is due soon, although my cycles are usually delayed to around six weeks. I initially thought the blood might mean my period was starting, but I have not noticed the usual bleeding afterward.

I am sexually active, but we use condoms consistently. I still have anxiety about pregnancy and would like to know whether bleeding during masturbation could be related to pregnancy or if this is something that can happen in pregnant women.

Could you please explain:

Why are my periods occurring every six weeks, and why is the flow so light or only noticeable when urinating?
What could be causing the large clots?
Why did I experience bleeding during masturbation for the first time?
Whether stress, hormones, or another gynecological issue could be responsible?
Is pregnancy likely despite condom use and these symptoms?

Please provide a detailed explanation.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query.

The current irregularity in your menses for the last year and the occasional passage of clots indicate a possibility of PCOS (polycystic ovarian syndrome). This can be evaluated with a hormonal profile including FSH (follicle-stimulating hormone), LH (luteinizing hormone), and AMH (Anti-Mullerian hormone) levels, and a pelvic ultrasound to rule out polycystic ovaries.

High testosterone and low myoinositol levels can bring about delayed menses or oligomenorrhea. This can be treated by a low dose of oral contraceptive pills like Ginette 35 (Ethinylestradiol and Cyproterone) for at least six cycles. These shall regulate your hormone levels and shall regularise your periods. Consult your specialist doctor, discuss with him/her and take the medicines with their consent.

Also important would be to get a thyroid profile and a serum prolactin level checked, which can also cause oligomenorrhea.

Thirdly, the blood spots while masturbating are likely to be due to a frictional lesion or a minor cut, which would have bled and then healed in the next six hours without any associated pain.

Your concern about pregnancy can be dealt with by undertaking a urine pregnancy test with an early morning urine sample. If negative, then you are not pregnant. The spotting is not an implantation bleed. Bleeding during masturbation is not indicative of pregnancy, but most of the time, it is a frictional sore or a lesion that bleeds.

My suggestion would be to get the above hormonal profile and investigations done so that the diagnosis can be reached and a specific treatment can be planned for you.

I hope it helps.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

This is an irregular shedding which can occur, especially due to progesterone deficiency, which is causing the darkish brown discharge. This can last for two to four days; however, the treatment requires that you start on oral contraceptive pills to regulate your cycle.

Natural supplements or foods like tofu (bean curd), alpha sprouts (shoots of the alfalfa plant), and flaxseeds are known to be high in phytoestrogens (plant-derived xenoestrogens) and isoflavones (plant-derived compounds). You can incorporate them into your diet. But at present, with one year of irregularity in menses, the treatment of choice would be low-dose oral contraceptive pills and not injectables.

Pregnancy seems unlikely as there was no ejaculation involved, but if there was, then even an implantation bleed can often be present in a similar manner, accompanied by a mild lower abdominal ache and nausea. So, to rule out any chances of pregnancy, I suggest you get a serum beta hCG test, which is a blood test. If the hCG levels are less than 5 mIU/mL, then there is no pregnancy.

I hope this helps.

Thank you.