Hello Amber,

Thank you for your question.

If I understand correctly, you are concerned that your periods have been irregular for the past year.

I would still want to ask you a few other questions: what were your periods like before? Do you have any other health problems? Have there been any changes in your hair (quality and distribution), your weight, or your energy level? Do you take any medications? Were you ever on any birth control? Are your periods, now, more or less heavy than before? Does the amount of blood you lose vary unpredictably from month to month? Are you experiencing more cramping?

You mention you are showing some of the signs of menopause. Do you mean that you are having hot flashes? Mood swings? Anything else?

These are all questions that your doctor should consider as they would guide him or her towards the proper diagnostic tests and diagnosis.

One of the most urgent things that would need to be ruled out in the case of irregular bleeding from the vagina is an ectopic pregnancy as it can cause rupture of a fallopian tube, tremendous blood loss, and even death. Another diagnosis to be ruled out is a spontaneous completed abortion or a threatened abortion. Since you say you have not been sexually active for a year, both these possibilities can be ruled out, although you will find that if you go the emergency room, doctors will still do a urine pregnancy test just to be sure, because, as I said before, ectopic pregnancies can be deadly to the parent.

Another diagnosis, as you say, that needs to be ruled out is a sexually transmitted infection (STI–most commonly gonorrhea or chlamydia). Most often STIs do not have any symptoms, but may also manifest themselves as bleeding from the vagina or a change in normal vaginal discharge. If gonorrhea or chlamydia spread more significantly through the uterus and pelvis, they may also produce “pelvic inflammatory disease” (PID). People with PID often have fever and severe abdominal pain. People who have had surgical procedures done in the uterus may extremely rarely developed PID caused by other kinds of bacteria (non-sexually transmitted bacteria that normally live on the skin or in the intestines). I would still suggest being tested for STIs even if you have not been sexually active for a long time because gonorrhea and chlamydia are easily treatable and it would be a shame to “miss” them.

There are other causes of irregular menstrual bleeding. The cause may be hormonal: hypothyroidism, hyperprolactinemia, or what is called polycystic ovarian syndrome (PCOS). Hypothyroidism is quite common, diagnosed with a blood test, and treated by supplementing with thyroid hormone. Hyperprolactinemia (a high level of the hormone prolactin in the blood) can be caused by certain medications and very rarely by a kind of brain tumour. PCOS is relatively common and is diagnosed by a doctor asking specific questions, doing a physical exam, and eventually by an ultrasound of the ovaries. There are various treatments for PCOS. Irregular and heavy menstrual bleeding may be produced when people do not ovulate every month (“anovulatory cycles”) – and these anovulatory cycles may be due to many causes, including what is called “premature ovarian failure.” Sometimes people also bleed a little at the time of their ovulation (called “ovulation bleeding”) and this is in no way harmful. It is also important to rule out more dangerous (but also more rare!) causes of irregular menstrual bleeding, including various kinds of cancerous and pre-cancerous lesions of the cervix and endometrium (the lining of the uterus). At the least, your doctor should perform a Pap smear to rule out any changes in the cells of your cervix.

In short, there are many causes of irregular menstrual bleeding. I think it would best to return to your doctor, explain that your symptoms have not subsided and discuss with him what would be the most likely possibilities in your case. Since he has already done some tests that were normal, he can now consider other diagnoses (by asking more questions and maybe considering other tests) and he may also consider trying a treatment to see if that would help regularize your periods.

I hope this answer has been helpful. Please let us know if you have any other questions.

Rimma, for Alterhéros