Abnormal Bleeding: Insights from a Gynecological Perspective

Intermenstrual bleeding. A transvaginal ultrasound has been performed?

Hello Doctor, I previously had yellowish vaginal discharge and consulted a doctor who prescribed medication for improvement.
However, due to lack of continuous treatment, the discharge has recurred recently.
What concerns me is an incident that occurred a few days ago.
On the night of May 7, I had sexual intercourse with my boyfriend, and prior to that, I hadn't engaged in sexual activity for about half a month due to a busy schedule.
On the morning of May 8, I woke up to find a fresh red blood stain on my panty liner, approximately the size of a 50 NT dollar coin.
After that, there was no further bleeding throughout the day.
That evening, feeling very anxious, I went to the emergency department of a large hospital.
After performing a transvaginal ultrasound, the doctor noted a polyp in my uterus and a 2 cm cyst, but due to slight internal bleeding, a Pap smear could not be performed.
After confirming that I was not pregnant through a urine test, the doctor prescribed medication to stop the bleeding and sent me home.

On the morning of May 9, I noticed a small amount of brownish blood on my panty liner, so I decided to visit a nearby obstetrics and gynecology clinic.
The doctor only performed an abdominal ultrasound and suggested that it was likely my menstrual period since I was still in my ovulation phase.
He mentioned that any tests conducted at this time, including the transvaginal ultrasound from the emergency department on May 8, would not be meaningful.
He advised me to wait until my next menstrual period ends before undergoing further examination and prescribed progesterone and estrogen, stating that after taking them, I should not experience any more bleeding.
I am seriously worried about the possibility of cervical cancer or other serious diseases.
Is there a faster way to determine the cause of the bleeding? I am so anxious that I can't eat or sleep and am feeling quite hopeless.

Note: 1.
I have had a fixed sexual partner for 15 years, and I had two abortions 15 years ago.
Since then, we have used condoms for contraception and have not had any children.
2.
My last menstrual period started on April 24, and my cycles have been regular.
I have always experienced cramping when my period begins, and towards the end of my period, the blood on the sanitary pad usually turns into a small amount of brownish discharge with a slight amount of fresh blood.
3.
I do not notice any vaginal discharge when my period starts, and during this recent bleeding episode, there was also no discharge.

Xiao Xuan, 30~39 year old female. Ask Date: 2016/05/10

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, based on your bleeding duration, it is possible that you are experiencing ovulatory bleeding.
Currently, your examination shows no significant abnormalities.
It is recommended to wait until after your next menstrual period is over to perform a Pap smear to rule out cervical cancer, and then continue to monitor your condition.
Wishing you good health.

Reply Date: 2016/05/10

More Info

Abnormal bleeding can be a source of significant concern for many women, and understanding its potential causes and implications is crucial for effective management and peace of mind. Based on the information provided, it appears that you have been experiencing irregular bleeding, which has prompted you to seek medical advice multiple times.
Firstly, it’s important to recognize that abnormal bleeding can arise from various factors, including hormonal imbalances, structural abnormalities in the reproductive system, or even infections. In your case, the presence of a polyp and a cyst, as noted by the emergency physician, could be contributing to your symptoms. Polyps are benign growths on the cervix or inside the uterus that can cause irregular bleeding, while ovarian cysts can sometimes lead to bleeding if they rupture or cause hormonal fluctuations.

The fact that you experienced a sudden episode of bright red bleeding after a period of sexual activity could suggest several possibilities. One common cause is ovulation bleeding, which can occur when the follicle ruptures and releases an egg, sometimes accompanied by a small amount of blood. However, given your history and the findings from your ultrasound, it’s essential to consider other factors as well.

Your concern about potential serious conditions, such as cervical cancer, is understandable, especially given your history of abortions and the fact that you have not had a child. While the risk of cervical cancer increases with certain factors, including multiple sexual partners and a history of sexually transmitted infections, regular screenings (Pap smears) are crucial for early detection. Since the emergency physician was unable to perform a Pap smear due to the bleeding, it’s advisable to follow up with your gynecologist once the bleeding has stabilized.

In terms of management, the medications prescribed (progesterone and estrogen) are often used to help regulate the menstrual cycle and can assist in stabilizing the endometrial lining, potentially reducing abnormal bleeding. However, it’s essential to monitor your symptoms closely. If the bleeding persists or worsens, or if you experience additional symptoms such as severe pain, fever, or significant changes in your overall health, you should seek immediate medical attention.

Additionally, lifestyle factors can also play a role in menstrual irregularities. Stress, significant weight changes, and changes in physical activity can all impact hormonal balance and menstrual regularity. Since you mentioned being busy and possibly stressed, it might be beneficial to explore stress management techniques, such as mindfulness, yoga, or counseling, which can help improve your overall well-being.

In conclusion, while abnormal bleeding can be alarming, it’s essential to approach it with a comprehensive understanding of potential causes and to work closely with your healthcare provider. Regular follow-up appointments, open communication about your symptoms, and adherence to prescribed treatments will be key in managing your condition effectively. If you continue to feel anxious or overwhelmed, consider discussing your feelings with a mental health professional, as emotional well-being is just as important as physical health.

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