Hello,
Thanks for writing to us with your health concern.
Could you provide me with a kind of menstrual diary / menstrual chart?
From what I gather - you had normal periods up until January.
Starting from when you deviated from normal, could you write in with a clear timeline with dates, spotting, bleeding etc?
It would help me to understand the pattern, and guide you in a better manner.
Also, what is your height and weight?
Are you on any hormonal medications?
Do you have any post-coital bleeding / spotting?
Looking forward to hearing from you with more details.
Take care.
Patient replied :
Hello Dr. Vazirini,
Thank you for answering. To provide you with more information, as follows:
I lost a bit of my data for my menstrual chart, so I only have the past 6 months.
Nov 10-13 - (24 days from last)
Missed Dec.
Jan. 8- 11 (59 days from last)
Feb. 3-6 (26 days from last)
Mar. 3-6 (28 days from last)
Mar. 25-28 (22 days)
April 9 light pink spotting followed by dark brown blood (very light flow) (16 days from last)
Before Nov. my periods would average between 21 to 24 days. No spotting or bleeding in between my menses. However, I would on occasion notice large nickel-sized blood clots on the heaviest days.
My height is 5'6" and 135 lbs. I do not smoke or drink other than 1-2 glasses of red wine a week if that. I try to exercies at least 2 - 4 hours a week from running to yoga. I eat mostly organic and take multivitamins and supplements.
No bleeding after coitus and no pain either. I have some milky discharge in between my menses but nothing with an odor or any unusual qualities.
It has been over 3 years since my last Pap. I had scheduled an appointment in December when I was awaiting my skipped period; however, it came the day before I went in so I cancelled it. It appeared everything was returning back to normal, until this strange shortening of my cycle with irregular menstruation.
I'm not sure what I should make of this.
Thank you and I hope I provided you with adequate information,
Thank you for the most detailed updates.
Apart from a one missed period, and this strangely shortened one followed by the spotting, you seem to have a fairly regular cycle.
once in a while, a slight deviation from a normal menstrual pattern is normal.
It could be due to stress, anxiety, travelling, late nights, smoking, drinking, unusual exercise - small factors like these.
I think you should wait for a couple of months more.
IF any deviation occurs again, or any mid-cycle or interim spotting, then just go for an evaluation.
The list of differential diagnoses would include - a cervical / uterine polyp, cervicitis, cervical lesion or growth, fibroid etc.
You would require an internal evaluation by an OB - GYN, a Pap smear, pelvic ultrasound scan.
However, right now, just maintain a menstrual diary / menstrual chart meticulously, and let us see how it goes from here.
If you experience any post-coital bleeding / spotting anyhow though, then you must have the evaluation at the earliest.
All the best
Please feel free to discuss further.