Ovulation Bleeding: Concerns and Follow-Up Care in Gynecology

I previously asked a question, and now I have new information after the examination (including background information)?

Hello Doctor, I previously had yellowish vaginal discharge and consulted a doctor who prescribed medication for improvement.
However, due to a 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 after not being intimate for about half a month due to a busy schedule.
The next morning, on May 8, I woke up to find a fresh red blood spot on my panty liner, about the size of a 50 NT dollar coin.
I did not experience any 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 bleeding, a Pap smear could not be performed.
After confirming 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 discharge on my panty liner, so I decided to visit a nearby obstetrics and gynecology clinic.
The doctor performed an abdominal ultrasound and suggested that it was likely my menstrual period, as I was still in my ovulation phase.
He mentioned that any tests conducted at this time would not be accurate, including the transvaginal ultrasound done by the emergency physician on May 8, and advised me to wait until after my next period for further examination.
He prescribed progesterone and estrogen, stating that I should not experience any more bleeding after taking them.

I am seriously worried about the possibility of cervical cancer or other serious diseases.
Is there a quicker way to determine the cause of the bleeding? I am so anxious that I cannot eat or sleep and am feeling quite hopeless.

Note:
1.
I have had a fixed sexual partner for 15 years, with two abortions 15 years ago.
Since then, we have used condoms for contraception and have not had children.

2.
My last menstrual period started on April 24, and I have always had regular cycles.
I usually experience cramping when my period begins, and towards the end, the blood on the sanitary pad turns into a small amount of brownish discharge with a little fresh blood.

3.
My vaginal discharge disappears every time I have my period, and during this recent episode of bleeding, there was also no discharge.

Response from Taipei Hospital / Obstetrics and Gynecology / Dr.
Tsao Kuo-Tao, May 11, 2016: Based on the timing of your bleeding, it is possible that it is ovulatory bleeding.
Your current examinations show no significant abnormalities.
It is recommended to wait until after your next period to perform a Pap smear to rule out cervical cancer, and then monitor the situation.
Wishing you good health.
The above is the question I previously asked the doctor and the valuable response from the doctor.
Below are additional follow-up questions regarding the bleeding issue from May 8.

After my period ended on May 23, I immediately went to see a doctor in obstetrics and gynecology on May 24.
The doctor said that the menstrual blood was expelled completely and that I could undergo examinations.
They first performed a Pap smear and then a transvaginal ultrasound.
The doctor indicated that the transvaginal ultrasound appeared normal with no abnormalities.
I expressed my concerns about cervical cancer, and the doctor kindly offered to take a closer look at my cervical condition (I am not sure how they would do this, but it was likely through transvaginal ultrasound).
After the examination, the doctor reassured me that my cervix looked fine and that I should not worry.
Regarding the bleeding on May 8, the doctor concluded that it was ovulatory bleeding.
After taking the progesterone and estrogen prescribed by the doctor on May 9, the bleeding stopped three days later, and the amount was minimal.
Additionally, the cyst and polyp observed during the emergency transvaginal ultrasound on May 8 were no longer visible during the transvaginal ultrasound on May 24.
The doctor stated that these were all phenomena associated with ovulatory bleeding.

However, I wondered why a Pap smear was still necessary if the cause of the bleeding had already been identified.
Upon reflection, I realized that I had never had a Pap smear before, so the doctor responsibly performed one for me.
The doctor also checked my vaginal discharge issue and diagnosed it as a yeast infection, providing me with medication.
On May 28, I returned to the doctor for a follow-up on my discharge, and he said the condition was okay and prescribed me more medication.
I again expressed my fears about cervical cancer to the doctor.
He asked if I was experiencing any discomfort, and I replied that I was not, just anxious.
The doctor showed me the transvaginal ultrasound results from May 24 and kindly performed another transvaginal ultrasound to check my cervix again, assuring me that everything was fine.
I realized that my fears primarily stemmed from reading online, which only increased my anxiety, especially since there is no cancer in my family.
I tend to feel anxious until the Pap smear report comes back.
1.
Should I be less worried about my situation and consider the Pap smear as a routine examination?
2.
I am very eager to undergo a colposcopy before the Pap smear results come back to alleviate my anxiety.
Where can I go for a self-paid examination? I am very scared, which is why I feel so anxious.
Thank you very much, doctor.

Xiao Xuan, 30~39 year old female. Ask Date: 2016/05/29

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, your examination results are generally normal.
You just need to wait for the Pap smear report, so there is no need to worry; the chances of any issues are low.
If you wish to have additional tests at your own expense, you can consider getting a HPV test.
Wishing you good health!

Reply Date: 2016/05/29

More Info

Understanding ovulation bleeding can be a source of concern for many women, especially when it presents with unusual symptoms or coincides with other health issues. Based on your detailed account, it seems you have experienced a range of symptoms that have understandably caused you anxiety. Let's break down your situation and provide some clarity.

Ovulation Bleeding Explained
Ovulation bleeding, also known as mid-cycle spotting, occurs when a woman experiences light bleeding or spotting around the time of ovulation, which typically happens about 14 days before the next menstrual period. This phenomenon is often attributed to hormonal fluctuations, particularly the drop in estrogen levels that can occur just before ovulation. For many women, this is a normal occurrence and does not indicate any underlying health issues.

In your case, the timing of the bleeding you experienced on May 8, shortly after sexual intercourse, aligns with the typical ovulation period for someone with a regular menstrual cycle. The presence of fresh red blood followed by a cessation of bleeding can further support this theory. However, it is essential to differentiate between normal ovulation bleeding and other potential causes of abnormal bleeding, such as polyps, fibroids, or hormonal imbalances.

Concerns About Other Conditions
Your concern about conditions like cervical cancer is valid, especially given the anxiety surrounding abnormal bleeding. However, the fact that your recent examinations, including ultrasounds and a Pap smear, returned normal results is reassuring. It is important to remember that while the internet can provide a wealth of information, it can also lead to unnecessary anxiety. Your healthcare providers have conducted thorough evaluations, and the absence of significant findings is a positive indicator.

Follow-Up Care and Recommendations
1. Routine Screening: The recommendation to undergo a Pap smear is standard practice for women, especially those who are sexually active. This test is crucial for early detection of cervical cancer and other abnormalities. It is a preventive measure and should not be viewed as a cause for alarm.

2. Managing Anxiety: It is understandable to feel anxious about your health, especially when experiencing unusual symptoms. Engaging in open communication with your healthcare provider about your fears can help alleviate some of this anxiety. They can provide reassurance based on your test results and medical history.

3. Self-Care and Monitoring: Keep track of your menstrual cycle and any unusual symptoms you experience. This information can be valuable for your healthcare provider in future consultations. If you notice any significant changes, such as heavier bleeding, prolonged spotting, or severe pain, do not hesitate to seek medical advice.

4. Consider Additional Testing: If your anxiety persists, discussing the option of a colposcopy (a more detailed examination of the cervix) with your healthcare provider may be beneficial. This procedure can provide additional reassurance and clarity regarding your cervical health.

5. Lifestyle Adjustments: Maintaining a healthy lifestyle, including regular exercise, a balanced diet, and stress management techniques, can positively impact your overall well-being and hormonal balance.

In conclusion, while your experience with ovulation bleeding and subsequent symptoms has understandably caused concern, the evaluations you have undergone suggest that there are no immediate health threats. Continue to follow up with your healthcare provider, adhere to routine screenings, and prioritize your mental health. Remember, being proactive about your health is a positive step, and seeking clarification from your healthcare provider is always encouraged.

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