Abnormal Bleeding: Causes, Concerns, and Solutions

Abnormal bleeding

Hello Doctor, my menstrual cycle is very regular, with a maximum difference of no more than a week.
My last period was from July 10 to July 16.
I had intercourse with my boyfriend on July 13, and we used contraception.
After that, my period ended on July 18.
On July 19, during intimate activities, I used a vibrator.
In the past, I have experienced bleeding when using it more vigorously, but it usually stopped on its own after two to three days.
This time, I am unsure if it was due to overuse, but the bleeding has continued for more than ten days.
During those days, I also developed a larger pimple in the genital area.

Later, in early August, I visited a gynecologist.
The doctor used an ultrasound to check for any abnormalities in my uterus.
He said the endometrial thickness was normal and there were no growths.
He mentioned that my irregular sleep schedule in July, where I mostly slept during the day and was awake at night, might have caused hormonal imbalances due to stress.
Therefore, he prescribed hormone medication to help regulate my body: one tablet of Medroxyprogesterone and one tablet of Estrogen each morning and evening.
The doctor prescribed a three-day supply of medication to see if it would help, and during those three days, the bleeding significantly decreased but did not stop.

Upon my follow-up visit, the doctor prescribed another seven days of medication, advising me to continue for another week, which would coincide with my expected period on the 10th.
Currently, my routine has been adjusted, and I have started exercising regularly (walking briskly and cycling) because I am slightly overweight.

1.
After taking the medication for five days, the bleeding had reduced significantly, but yesterday, after walking a bit faster, the bleeding started again.
Should I rest or switch to a slower walking pace?
2.
I am concerned that my period may come early while I am still taking the medication.
Will taking hormone-adjusting medication affect my menstrual cycle? I worry that if my period arrives while I am taking the medication, I might mistake it for abnormal bleeding, which could lead to a decreased flow.

3.
Additionally, I am experiencing some symptoms: my lower back is quite sore, and I occasionally feel some sensations on both sides below my navel (around the ovarian area), but it doesn't feel like pain.
The sensation is more pronounced on the right side.
Could this indicate an ectopic pregnancy? I purchased a pregnancy test on July 29, but it only showed one line.

Thank you for your help, Doctor!

Xiao Zhu, 20~29 year old female. Ask Date: 2017/08/06

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Last menstrual period was from July 10 to July 16.
I had intimate relations with my boyfriend on July 13, using contraception.
After my period ended, I experienced bleeding on July 18 and 19.
During those days, I used a vibrator during intimate activities.
In the past, I had experienced bleeding after vigorous use, but it would stop on its own within two to three days.
This time, I am unsure if it was due to overuse, as the bleeding lasted for more than ten days.
Additionally, I developed a larger pimple in the genital area.

In early August, I visited a gynecologist who performed an ultrasound to check for any abnormalities in my uterus.
He stated that the endometrial thickness was normal and there were no growths.
Due to my irregular sleep schedule in July, where I mostly slept during the day and was awake at night, the doctor suggested that the hormonal imbalance might be due to stress from my lifestyle.
He prescribed hormonal medication to help regulate my body, specifically one tablet of Medroxyprogesterone and one tablet of Estrogen each morning and evening.
The doctor provided a three-day supply of medication to assess its effectiveness, and during those three days, the bleeding significantly decreased but did not stop completely.

Upon my follow-up visit, the doctor prescribed another seven days of medication, advising me to continue for another week, which would coincide with the expected arrival of my period on the 10th.
Currently, my routine has returned to normal, and I have started exercising regularly (walking briskly and cycling) as I am slightly overweight.

1.
After taking the medication for five days, the bleeding had reduced significantly, but yesterday, after walking a bit faster than usual, the bleeding resumed.
Should I rest or switch to a slower walking pace?
Answer: Switch to a slower walking pace.
2.
I am concerned that my period might arrive early while I am still taking the medication.
Will taking hormonal adjustment medication affect my menstrual cycle? I worry that if my period arrives, I might mistake it for abnormal bleeding, leading to a decrease in menstrual flow.

Answer: There is no need to worry.
3.
I am currently experiencing some symptoms, such as lower back pain and slight discomfort on both sides below the navel (around the ovarian area).
Sometimes I feel a little sensation, but it doesn't feel like pain, and it is more pronounced on the right side.
Is there a possibility that this could be an ectopic pregnancy? I purchased a pregnancy test on July 29, but it only showed one line.

Answer: There is no possibility of an ectopic pregnancy.

Reply Date: 2017/08/06

More Info

Abnormal bleeding can be a source of significant concern for many women, and understanding its causes, implications, and potential solutions is crucial for managing one’s health. Based on the information provided, it appears that you have been experiencing irregular bleeding following a regular menstrual cycle, which has raised several questions regarding its causes and management.

Firstly, it is important to recognize that abnormal bleeding can stem from a variety of factors, including hormonal imbalances, physical trauma, infections, or underlying medical conditions. In your case, the bleeding that occurred after using a massage device may suggest that physical irritation or trauma could be a contributing factor. It is not uncommon for vigorous sexual activity or the use of sexual aids to cause minor injuries to the vaginal walls, leading to temporary bleeding. However, if the bleeding persists for an extended period, as you described, it warrants further investigation.

Your recent visit to a gynecologist, where an ultrasound was performed and no abnormalities were found, is reassuring. The normal thickness of the endometrial lining suggests that there are no immediate concerns regarding polyps or fibroids, which are common causes of abnormal bleeding. The physician’s assessment that your irregular bleeding may be related to stress and hormonal fluctuations due to lifestyle changes is also plausible. Stress can significantly impact the menstrual cycle, leading to irregularities, including prolonged bleeding.

Regarding your specific questions:
1. Activity Level and Bleeding: If you notice that increased physical activity, such as walking briskly, leads to renewed bleeding, it may be wise to reduce the intensity of your exercise. Opting for gentler activities, such as slow walking or light stretching, could help minimize further irritation. Listening to your body is key; if you feel discomfort or notice increased bleeding, it is advisable to rest and allow your body to recover.

2. Hormonal Medication and Menstrual Cycle: Hormonal medications can indeed influence your menstrual cycle. While they are often prescribed to regulate bleeding and restore hormonal balance, they can also cause changes in the timing and flow of your menstrual period. It is possible that while taking these medications, you may experience breakthrough bleeding or an altered menstrual cycle. If your period arrives while you are still on the medication, it may be challenging to distinguish between normal menstruation and abnormal bleeding. It is essential to communicate with your healthcare provider about any changes you observe while on hormonal therapy.

3. Pelvic Discomfort and Concerns about Ectopic Pregnancy: The discomfort you are experiencing in the lower abdomen, particularly on the right side, could be related to various factors, including ovulation pain, hormonal changes, or even muscle strain from increased activity. While ectopic pregnancy is a serious condition, the negative pregnancy test you conducted diminishes the likelihood of this diagnosis. However, if the discomfort persists or worsens, or if you experience any additional symptoms such as severe pain, dizziness, or fainting, it is crucial to seek medical attention promptly.

In summary, while abnormal bleeding can be concerning, many cases are related to benign causes such as hormonal fluctuations or physical irritation. Maintaining open communication with your healthcare provider, adhering to prescribed treatments, and monitoring your symptoms will be essential in managing your health. If you continue to experience irregular bleeding or other concerning symptoms, do not hesitate to follow up with your gynecologist for further evaluation and guidance. Your health and well-being are paramount, and proactive management is key to addressing any issues that may arise.

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