I'm 31, no children, overweight and have extremely irregular cycles

Patient

Q: I'm 31, no children, overweight and have extremely irregular cycles. My fiancé and I are trying to conceive and haven't tried any methods as of yet. My last cycle was last July when induced by Provera. He is currently on chemo 5 days a month for a year and has a hard time ejaculating after three craniotomies. In the last 1-1.5 months, my breasts have been extremely tender, especially my right breast, and I have been spotting blood off and on. I find that it's not enough to have to use a hygiene product, I only notice when I wipe after urination. My urine is normal looking and the blood varies from light pink, bright red and brown. I also notice small red spots in the toilet that look like tissue from time to time. Where should I start looking for answers?

Doctor

A:   Hi,
Thanks for the query.

I understand your concern.
Irregularities in menstrual cycles can occur due to many causes like weight changes, lifestyle modifications, polycystic ovary disease etc leading to gonadal hormonal imbalance, thyroid hormonal imbalance, prolactin level changes, general conditions like anemia, altered blood sugar levels etc.
Delayed periods can lead to overgrowth of the endometrium and that can cause intermittent spotting.
Breast tenderness and spotting can be seen premenstrually sometimes.
Thick color of the blood indicates collected blood in uterus and the tissue you mentioned could be endometrial tissue.
Better to start from taking treatment with irregular cycles.
So, please do consult your doctor, get examined and go for investigations like ultrasound, gonadal hormonal profile, thyroid hormonal profile, prolactin levels, hemoglobin and blood sugar levels estimation etc.
With this workup, the possible cause of your problem can be identified and treated.
Decreasing the weight helps in the regularization of cycles.
Please check for the seminal analysis of your finance to rule out male factor abnormality.

Take care.

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