Had only spotting and menses are delaying. Pregnancy tests are negative. What could be the reason?

Question

Hello doctor,

I am a 24 year old female. My weight is 170lbs and my height is 5'8". I am currently on Advair and Albuterol inhaler. After urinating and wiping (last Wednesday morning, April 1st) I had a spot of blood on the toilet paper. I thought it was my period, so I just put on a tampon and went on about my day.

When I got home from work, I took out my tampon and it was still "clean". Nothing was on it.

I did have mild cramping that whole day and the next two days after that but it was weird to me because, when I get my period I get cramps so bad that I have to take prescription medication. This was not the case at all.

Since then, I have felt dizzy, nauseous and more tired than usual but I do not know if it is work related or something else.

It is already more than a week and still no period. I have taken two pregnancy tests on different days and both were negative. I am supposed to start my cycle again on the 11th. I am just waiting for that day.

But I still do not understand the one time spotting on that Wednesday morning.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

It is assumed from the history that you normally have a regular period and this has been the first time that your periods had been delayed.

The spotting which you experienced on April 1st was probably scanty menses in the form of spotting and it was associated with premenstrual symptoms and also it was your natural due date.

Sometimes menses are delayed or women experience reduced flow due to stress induced hormonal imbalances which can affect the cycle during the month.

The stress factor can be physical, social, emotional or psychological and all have a bearing on the hormonal balance.

So it is fairly common though that progesterone withdrawal was not initiated adequately and that the next menses may be heavier if at all.

As the pregnancy has been ruled out completely, the reason is stress induced.

I suggest you to get an ultrasound pelvis done to check for endometrial thickness of the uterus and if it is more than or equal to 10mm, then you may opt for a withdrawal bleed with progestins (available on prescription) to resume your menses within 7 days of taking the last dose.

Following which you may practice or incorporate stress busting techniques in your lifestyle to reduce the stress like meditation or yoga which are known to be helpful.

That should keep your hormones in balance and such episodic delays with regards to menses which can be further distressful, can be avoided.

Wish you good health.

Revert back with your ultrasound pelvis reports to an obstetrician and gynaecologist online.