diff --git a/lib/internal/crypto/random.js b/lib/internal/crypto/random.js
index c324b2292b2fb8..af3a0c285c8b64 100644
--- a/lib/internal/crypto/random.js
+++ b/lib/internal/crypto/random.js
@@ -348,6 +348,11 @@ let uuidData;
 let uuidNotBuffered;
 let uuidBatch = 0;
 
+let uuidDataV7;
+let uuidBatchV7 = 0;
+let v7LastTimestamp = -1;
+let v7Counter = 0;
+
 let hexBytesCache;
 function getHexBytes() {
   if (hexBytesCache === undefined) {
@@ -415,35 +420,77 @@ function randomUUID(options) {
   return disableEntropyCache ? getUnbufferedUUID() : getBufferedUUID();
 }
 
-function writeTimestamp(buf, offset) {
+function advanceV7(seed) {
   const now = DateNow();
-  const msb = now / (2 ** 32);
+  if (now > v7LastTimestamp) {
+    v7LastTimestamp = now;
+    v7Counter = seed & 0xFFF;
+  } else {
+    v7Counter++;
+    if (v7Counter > 0xFFF) {
+      v7LastTimestamp++;
+      v7Counter = 0;
+    }
+  }
+}
+
+function writeTimestampAndCounterV7(buf, offset) {
+  const ts = v7LastTimestamp;
+  const msb = ts / (2 ** 32);
   buf[offset] = msb >>> 8;
   buf[offset + 1] = msb;
-  buf[offset + 2] = now >>> 24;
-  buf[offset + 3] = now >>> 16;
-  buf[offset + 4] = now >>> 8;
-  buf[offset + 5] = now;
+  buf[offset + 2] = ts >>> 24;
+  buf[offset + 3] = ts >>> 16;
+  buf[offset + 4] = ts >>> 8;
+  buf[offset + 5] = ts;
+  buf[offset + 6] = (v7Counter >>> 8) & 0x0f;
+  buf[offset + 7] = v7Counter & 0xff;
 }
 
-function getBufferedUUIDv7() {
-  uuidData ??= secureBuffer(16 * kBatchSize);
-  if (uuidData === undefined)
+function getBufferedUUIDv7(monotonic) {
+  uuidDataV7 ??= secureBuffer(16 * kBatchSize);
+  if (uuidDataV7 === undefined)
     throw new ERR_OPERATION_FAILED('Out of memory');
 
-  if (uuidBatch === 0) randomFillSync(uuidData);
-  uuidBatch = (uuidBatch + 1) % kBatchSize;
-  const offset = uuidBatch * 16;
-  writeTimestamp(uuidData, offset);
-  return serializeUUID(uuidData, 0x70, 0x80, offset);
+  if (uuidBatchV7 === 0) randomFillSync(uuidDataV7);
+  uuidBatchV7 = (uuidBatchV7 + 1) % kBatchSize;
+  const offset = uuidBatchV7 * 16;
+  if (monotonic) {
+    const seed = ((uuidDataV7[offset + 6] & 0x0f) << 8) | uuidDataV7[offset + 7];
+    advanceV7(seed);
+    writeTimestampAndCounterV7(uuidDataV7, offset);
+  } else {
+    const now = DateNow();
+    const msb = now / (2 ** 32);
+    uuidDataV7[offset] = msb >>> 8;
+    uuidDataV7[offset + 1] = msb;
+    uuidDataV7[offset + 2] = now >>> 24;
+    uuidDataV7[offset + 3] = now >>> 16;
+    uuidDataV7[offset + 4] = now >>> 8;
+    uuidDataV7[offset + 5] = now;
+  }
+  return serializeUUID(uuidDataV7, 0x70, 0x80, offset);
 }
 
-function getUnbufferedUUIDv7() {
+function getUnbufferedUUIDv7(monotonic) {
   uuidNotBuffered ??= secureBuffer(16);
   if (uuidNotBuffered === undefined)
     throw new ERR_OPERATION_FAILED('Out of memory');
   randomFillSync(uuidNotBuffered, 6);
-  writeTimestamp(uuidNotBuffered, 0);
+  if (monotonic) {
+    const seed = ((uuidNotBuffered[6] & 0x0f) << 8) | uuidNotBuffered[7];
+    advanceV7(seed);
+    writeTimestampAndCounterV7(uuidNotBuffered, 0);
+  } else {
+    const now = DateNow();
+    const msb = now / (2 ** 32);
+    uuidNotBuffered[0] = msb >>> 8;
+    uuidNotBuffered[1] = msb;
+    uuidNotBuffered[2] = now >>> 24;
+    uuidNotBuffered[3] = now >>> 16;
+    uuidNotBuffered[4] = now >>> 8;
+    uuidNotBuffered[5] = now;
+  }
   return serializeUUID(uuidNotBuffered, 0x70, 0x80);
 }
 
@@ -452,11 +499,14 @@ function randomUUIDv7(options) {
     validateObject(options, 'options');
   const {
     disableEntropyCache = false,
+    monotonic = true,
   } = options || kEmptyObject;
 
   validateBoolean(disableEntropyCache, 'options.disableEntropyCache');
+  validateBoolean(monotonic, 'options.monotonic');
 
-  return disableEntropyCache ? getUnbufferedUUIDv7() : getBufferedUUIDv7();
+  return disableEntropyCache ?
+    getUnbufferedUUIDv7(monotonic) : getBufferedUUIDv7(monotonic);
 }
 
 function createRandomPrimeJob(type, size, options) {
diff --git a/test/parallel/test-crypto-randomuuidv7.js b/test/parallel/test-crypto-randomuuidv7.js
index 99d052f356721c..27005a00929998 100644
--- a/test/parallel/test-crypto-randomuuidv7.js
+++ b/test/parallel/test-crypto-randomuuidv7.js
@@ -56,24 +56,37 @@ const {
   const timestamp = parseInt(timestampHex, 16);
 
   assert(timestamp >= before, `Timestamp ${timestamp} < before ${before}`);
-  assert(timestamp <= after, `Timestamp ${timestamp} > after ${after}`);
+  // The monotonic counter may have overflowed in a prior call and advanced
+  // v7LastTimestamp by 1 ms beyond wall-clock time (RFC 9562 §6.2 allows this).
+  assert(timestamp <= after + 1, `Timestamp ${timestamp} > after+1 ${after + 1}`);
 }
 
 {
   let prev = randomUUIDv7();
   for (let i = 0; i < 100; i++) {
     const curr = randomUUIDv7();
-    // UUIDs with later timestamps must sort after earlier ones.
-    // Within the same millisecond, ordering depends on random bits,
-    // so we only assert >= on the timestamp portion.
-    const prevTs = parseInt(prev.replace(/-/g, '').slice(0, 12), 16);
-    const currTs = parseInt(curr.replace(/-/g, '').slice(0, 12), 16);
-    assert(currTs >= prevTs,
-           `Timestamp went backwards: ${currTs} < ${prevTs}`);
+    // With a monotonic counter in rand_a, each UUID must be strictly greater
+    // than the previous regardless of whether the timestamp changed.
+    assert(curr > prev,
+           `UUID ordering violated: ${curr} <= ${prev}`);
     prev = curr;
   }
 }
 
+// Sub-millisecond ordering: a tight synchronous burst exercises the counter
+// increment path and must also produce strictly increasing UUIDs.
+{
+  const burst = [];
+  for (let i = 0; i < 500; i++) {
+    burst.push(randomUUIDv7());
+  }
+  for (let i = 1; i < burst.length; i++) {
+    assert(burst[i] > burst[i - 1],
+           `Sub-millisecond ordering violated at index ${i}: ` +
+           `${burst[i]} <= ${burst[i - 1]}`);
+  }
+}
+
 // Ensure randomUUIDv7 takes no arguments (or ignores them gracefully).
 {
   const uuid = randomUUIDv7();
@@ -92,6 +105,11 @@ const {
   assert.match(randomUUIDv7({ disableEntropyCache: true }), uuidv7Regex);
   assert.match(randomUUIDv7({ disableEntropyCache: true }), uuidv7Regex);
 
+  // monotonic: false — rand_a is random; UUIDs must still be valid but are not
+  // guaranteed to be strictly ordered within the same millisecond.
+  assert.match(randomUUIDv7({ monotonic: false }), uuidv7Regex);
+  assert.match(randomUUIDv7({ monotonic: false, disableEntropyCache: true }), uuidv7Regex);
+
   assert.throws(() => randomUUIDv7(1), {
     code: 'ERR_INVALID_ARG_TYPE',
   });
@@ -99,6 +117,10 @@ const {
   assert.throws(() => randomUUIDv7({ disableEntropyCache: '' }), {
     code: 'ERR_INVALID_ARG_TYPE',
   });
+
+  assert.throws(() => randomUUIDv7({ monotonic: 1 }), {
+    code: 'ERR_INVALID_ARG_TYPE',
+  });
 }
 
 {