Abnormal Vaginal Bleeding: Causes and Solutions

Abnormal bleeding

Hello Dr.
Huang,
On August 2nd, I suddenly experienced unexplained vaginal bleeding in the afternoon.
I remember having sexual intercourse the day before the bleeding started.
Since August 2nd, I have had bleeding every day, but the timing is strange; sometimes in the morning, the blood is dark red, and in the afternoon, it turns dark brown and appears dry (somewhat like mucus).
I visited two gynecologists who performed ultrasounds and urine tests.
Both doctors said the ultrasound of my uterus looked normal with no signs of pregnancy, and they both suggested that it might be due to hormonal imbalance, prescribing oral medication for me.
However, I also went to a large hospital for a consultation, where the doctor visually examined my cervix and said it looked normal.
I then consulted a traditional Chinese medicine practitioner and started taking herbal medicine, avoiding Western gynecological medications.

On August 15th, after taking the Western medication (I took it in the morning, and it stopped the bleeding), I thought the medication was very strong, so I only took it for one day and stopped.
From August 16th to August 19th, I had no bleeding for about four days, during which I had sexual intercourse twice.
One day after intercourse, there was no issue, but the next day after intercourse, I suddenly started bleeding again.
Starting August 20th, the bleeding resumed, but since my last menstrual period was on July 12th, I felt that the bleeding from August 20th to August 24th was my menstrual period.
The flow was heavier and the color was normal bright red, but it continued for a week until today, August 30th, with slight bleeding still present.
The bleeding pattern is similar to early August, with varying amounts and colors (especially noticeable when wiping after a bowel movement or urination).

I would like to ask the doctor if hormonal imbalance can cause such severe symptoms.
I have never experienced abnormal bleeding before, and this is the first time I have encountered these symptoms, which have been troubling me for a month.
Would it be okay to perform a Pap smear given the bleeding situation? I am very concerned about the possibility of an underlying condition.
Could you please provide some analysis and advice? Thank you.

Xiao C, 20~29 year old female. Ask Date: 2017/08/30

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On August 2nd, I suddenly noticed unexplained vaginal bleeding in the afternoon.
I remember having sexual intercourse the day before the bleeding started.
Since August 2nd, I have experienced bleeding every day, but the timing is strange; sometimes the blood is dark red in the morning, and in the afternoon, it turns dark brown and appears dry (somewhat like mucus).
I visited two gynecologists who performed ultrasounds and urine tests.
Both doctors said that the ultrasound of my uterus appeared normal with no signs of pregnancy, and they both suggested that it might be due to hormonal imbalance, prescribing oral medication for me.
However, I also went to a large hospital for a consultation, where the doctor visually examined my cervix and said it looked normal.
I then consulted a traditional Chinese medicine practitioner and started taking herbal medicine, avoiding Western gynecological medications.

From August 15th, after taking the Western medication (I took it in the morning and the bleeding stopped, but I thought the medication was too strong, so I only took it for one day), I experienced about four days without bleeding from August 16th to August 19th.
During those four days, I had sexual intercourse twice; one day there were no issues, but the next day after intercourse, I suddenly started bleeding again.
Starting August 20th, the bleeding resumed, but since my last menstrual period was on July 12th, I felt that the bleeding from August 20th to August 24th was my menstrual period, with a heavier flow and normal bright red color.
However, it continued for a week until today, August 30th, with slight bleeding resembling the early August symptoms, fluctuating between heavier and lighter amounts with varying colors (especially noticeable when wiping after a bowel or urinary movement).

I would like to ask the doctor if hormonal imbalance can cause such severe symptoms.
I have never experienced abnormal bleeding before, and this is the first time encountering these symptoms, which have troubled me for a month.
Would it be okay to perform a Pap smear given the bleeding situation? I am very concerned about the possibility of an organ lesion.

Answer: Unexplained vaginal bleeding, especially after recent sexual intercourse, warrants a Pap smear (out-of-pocket expense).

Reply Date: 2017/08/30

More Info

Abnormal vaginal bleeding can be a concerning symptom for many women, and it is essential to understand the potential causes and appropriate responses. Based on your description, it seems you have experienced a range of bleeding patterns following a sexual encounter, which has led to multiple consultations with healthcare providers.
Firstly, it’s important to note that abnormal bleeding can arise from various factors, including hormonal imbalances, structural issues within the reproductive system, or even external factors such as stress or changes in lifestyle. In your case, the fact that you have had normal ultrasound results and no signs of pregnancy is reassuring. The doctors' assessments suggesting hormonal imbalance as a cause of your bleeding are consistent with common medical understanding.

Hormonal fluctuations can lead to irregular bleeding patterns, especially if you have experienced changes in your lifestyle, such as stress from school or changes in your routine. These fluctuations can affect the menstrual cycle, leading to spotting or bleeding outside of your regular period. This is often referred to as dysfunctional uterine bleeding and can be linked to conditions like polycystic ovary syndrome (PCOS), which you mentioned you have.
The bleeding you described, which varies in color and consistency, is not uncommon in cases of hormonal imbalance. The presence of bright red blood typically indicates fresh bleeding, while darker blood may suggest older blood that has taken longer to exit the body. The fact that you experienced bleeding after sexual intercourse could also indicate that the vaginal or cervical tissues were irritated or slightly injured, which can happen if there is insufficient lubrication or if the tissues are sensitive.

Regarding your concerns about cervical health, it is indeed advisable to undergo a Pap smear (cervical cytology) if you are experiencing abnormal bleeding, especially if it persists. A Pap smear can help detect any precancerous changes in the cervical cells, and it is a routine part of gynecological care for sexually active women. It is understandable to feel anxious about potential underlying conditions, but early detection through regular screenings can be beneficial.

In terms of treatment, it is crucial to follow the advice of your healthcare providers. If hormonal medications were prescribed, they may help regulate your cycle and reduce abnormal bleeding. However, if you choose to explore alternative treatments, such as traditional Chinese medicine, it is essential to communicate this with your healthcare providers to ensure a coordinated approach to your care.

If your symptoms persist or worsen, or if you experience additional symptoms such as severe pain, fever, or an unusual odor, it is vital to seek immediate medical attention. Keeping a detailed record of your bleeding patterns, associated symptoms, and any other changes in your health can also be helpful for your healthcare provider in determining the best course of action.

In conclusion, while hormonal imbalances can lead to significant changes in your menstrual cycle and cause abnormal bleeding, it is essential to remain vigilant and proactive about your health. Regular check-ups, open communication with your healthcare providers, and adherence to prescribed treatments can help manage your symptoms effectively. If you have any further concerns or if your symptoms change, do not hesitate to reach out to a healthcare professional for guidance.

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