I have PCOS, which means that my period only comes 2-4 times a year. I haven't had a "real" period in probably about 8 months, a "real" period for me is about 7 days of heavy bleeding, with the occasional blood clot. I also sometimes have severe cramping, even though I'm not having my period. My issue is that the last two times where I felt the symptoms of having my period, I passed a blood clot and figured I was starting my cycle, but it never came, just the clot. The last time was a couple of months ago and then again today, passed a blood clot, figured I was starting, but there's no blood. Is this something to be concerned about? I'm not in any pain or anything, just wondered.
Dear Anon: As you have shared, periods can be infrequent with PCOS. When a bleed does start it tends to be very heavy as though several months of built up lining are shed. My best GUESS is that the passed blood clots over the past months (but no full on bleed) probably represent a partial shed of the top layer of the lining.
My concern for you is that abnormal cells can develop within a too thick lining. I actually had a 26 year old patient who developed uterine cancer; she had a lifetime history of very infrequent periods (and evidence of PCOS). It might be a good idea to talk with your GYN or local family planning clinic about options for having more regular sheds of any uterine lining. Some of these can include:
1. Hormonal forms of birth control
2. Progesterone pills to take every few months if one has not had a recent bleed. One will usually have a flow within 72 hours after using the progesterone.
Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining ), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced as n PCOS) are at a greater risk for too thick lining.
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