Abnormal Bleeding: Causes, Concerns, and Next Steps

Abnormal bleeding

Hello Doctor,
I have some concerns that I would like to consult with you! My menstrual cycle is approximately 29-31 days.
However, for over a year now, after my period is clean for the first 7 days, I start experiencing light bleeding around days 18-20, which continues until my next menstruation.
Shortly after this situation began, I visited a gynecology clinic for an examination.
An ultrasound revealed a 2-3 cm cyst, but the doctor advised to just monitor it and diagnosed me with irregular menstruation.
The doctor mentioned that treatment was optional, and I chose not to pursue treatment at that time.

After a few months, the situation did not improve, so I went to another gynecology hospital for further examination.
The ultrasound again showed a 2-3 cm cyst, and this time, I also underwent a pelvic exam and a Pap smear, both of which returned normal results.
The doctor suggested that the bleeding might be due to luteal phase deficiency.
I inquired about hormone testing, but the doctor deemed it unnecessary.
I was also asked if I wanted to undergo treatment for my irregular menstruation, but the doctor indicated that taking hormone medications may not necessarily improve my condition and recommended monitoring instead, so I chose not to pursue treatment again.

As of now, my situation remains the same, with light bleeding occurring around days 18-20 until menstruation begins.
I would like to ask the doctor:
1.
Should I undergo additional tests or consider switching to a larger hospital for treatment?
2.
If the bleeding is indeed due to luteal phase deficiency, will it affect my ability to conceive?
3.
What are the potential harms of menstrual regulation medications? Why do doctors say that treatment is optional?
4.
I hope the doctor can provide me with recommendations for the next steps, as I am very worried about my ability to have children! Thank you for taking the time to read this!

Niming, 30~39 year old female. Ask Date: 2017/10/09

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The menstrual cycle is approximately 29-31 days; however, for over a year, after the first 7 days of menstruation, I have experienced light bleeding starting around day 18-20, continuing until the next period.
Shortly after this situation began, I visited a gynecology clinic for an examination.
An ultrasound revealed a 2-3 cm cyst, but the doctor advised to just monitor it and diagnosed me with irregular menstruation.
The doctor mentioned that treatment was optional, and I chose not to pursue treatment at that time.
A few months later, the situation had not improved, so I went to another gynecology hospital for further examination.
The ultrasound again showed a 2-3 cm cyst, and this time, a vaginal examination and a Pap smear were performed, both of which returned normal results.
The doctor suggested that the bleeding might be caused by luteal phase deficiency.
I asked the doctor if hormone testing was necessary, but the doctor deemed it unnecessary and inquired if I wanted to undergo treatment for my menstrual irregularities.
The doctor stated that taking hormone medications might not necessarily improve my condition and recommended monitoring instead, so I chose not to pursue treatment again.
As of now, my situation remains the same with light bleeding occurring around days 18-20 until menstruation begins.

I would like to ask the doctor:
1.
Should I undergo any additional tests? Or should I switch to a larger hospital for treatment?
Answer: It is recommended to undergo a hysteroscopy at a larger hospital.

2.
If the bleeding is indeed due to luteal phase deficiency, will it affect my ability to conceive?
Answer: Is the bleeding due to luteal phase deficiency?
3.
What are the potential harms of menstrual regulation medications? Why do doctors say treatment is optional?
Answer: It is necessary to rule out malignant possibilities, although the likelihood is low, before discussing menstrual regulation.

4.
I hope the doctor can provide me with further recommendations, as I am very concerned about my ability to have children!
Answer: Currently, it is advisable to undergo a hysteroscopy to rule out malignant possibilities before discussing menstrual regulation and fertility.

Reply Date: 2017/10/09

More Info

Abnormal bleeding can be a source of significant concern for many women, especially when it disrupts the regular menstrual cycle. In your case, experiencing bleeding around days 18-20 of your cycle, following a relatively normal menstrual period, can be indicative of several underlying issues. Let's delve into your questions and provide some clarity on the situation.

1. Further Testing and Specialist Consultation: Given that you have already undergone ultrasounds and a Pap smear, and considering the persistence of your symptoms, it may be beneficial to seek a second opinion from a reproductive endocrinologist or a gynecologist specializing in menstrual disorders. Additional tests could include hormonal assessments (like progesterone and estrogen levels) to evaluate your ovarian function more thoroughly. A hysteroscopy might also be considered to directly visualize the uterine cavity and assess for any abnormalities that may not have been detected via ultrasound.

2. Impact of Luteal Phase Deficiency on Fertility: If your bleeding is indeed due to luteal phase deficiency (a condition where the second half of the menstrual cycle is shorter than normal and progesterone levels are insufficient), it can potentially affect fertility. The luteal phase is crucial for preparing the uterine lining for implantation. If the lining is not adequately prepared, it may lead to difficulties in sustaining a pregnancy. However, many women with luteal phase defects can still conceive, but it may be more challenging.

3. Risks of Hormonal Treatments: Hormonal treatments, such as birth control pills or progesterone supplements, can help regulate the menstrual cycle and address issues like luteal phase deficiency. However, they can also have side effects, including mood changes, weight gain, and increased risk of blood clots, among others. The decision to use hormonal therapy often depends on the severity of symptoms and the individual's health profile. Doctors may suggest "treat or observe" based on the belief that some women may not need intervention if their symptoms are manageable.

4. Next Steps and Recommendations: Given your ongoing concerns about fertility and the persistent abnormal bleeding, I recommend the following steps:
- Consult a Specialist: As mentioned, consider seeing a reproductive endocrinologist for a more comprehensive evaluation of your hormonal status and reproductive health.

- Monitor Your Cycle: Keep a detailed record of your menstrual cycle, including the timing, duration, and characteristics of any abnormal bleeding. This information can be invaluable for your healthcare provider.

- Discuss Fertility Options: If you are actively trying to conceive, discuss with your doctor the potential for fertility treatments or interventions that may help regulate your cycle and improve your chances of conception.

- Consider Lifestyle Factors: Sometimes, lifestyle changes such as stress management, diet, and exercise can positively impact hormonal balance and menstrual regularity.

In conclusion, while abnormal bleeding can be concerning, it is essential to approach the situation with a comprehensive understanding of potential causes and treatments. Engaging in open communication with your healthcare provider and advocating for your health will be crucial in navigating this issue. Remember, many women experience similar challenges, and with the right support and treatment, it is possible to achieve a healthy menstrual cycle and successful pregnancy.

Similar Q&A

Understanding Abnormal Post-Coital Bleeding: Causes and Solutions

Hello doctor, for the past six months, I have been experiencing slight spotting the day after intercourse, which lasts for about ten days, and then it stops until my next period. I have consulted a physician and undergone two Pap smears, pelvic examinations, and a colposcopy, all...

Dr. Wu Zongcheng reply Obstetrics and Gynecology
The causes of abnormal bleeding can be divided into two main categories: 1. Tumors: such as uterine fibroids, uterine polyps, and malignant uterine tumors. 2. Functional bleeding: such as endocrine disorders and poor uterine contractions caused by contraceptive devices. First, ...

Understanding Abnormal Vaginal Bleeding: Causes and Solutions

I would like to ask about recent abnormal bleeding, which is not related to stress, and I am unsure of the cause. I previously had a Pap smear that showed no issues. Recently, I have been trying to lose weight and have developed a habit of jogging. Could this be the reason for my...

Dr. Yang Wangjun reply Obstetrics and Gynecology
Hello: When experiencing abnormal vaginal bleeding, the first step is to rule out bleeding caused by pregnancy. Next, a pelvic examination and ultrasound should be performed to check for any organic causes of bleeding, such as cervical polyps or lacerations. Most cases of abnorma...

Understanding Abnormal Uterine Bleeding: Causes and Management

Doctor, I have not engaged in sexual intercourse. Since the end of my menstrual period in May this year, I have been experiencing a large amount of discharge, which has included blood. After my menstrual period ended in June, I started having abnormal bleeding and orange-colored ...

Dr. Wu Xianghui reply Obstetrics and Gynecology
1. "Abnormal vaginal bleeding" has numerous causes, including lifestyle habits, stress, age, vaginal infections, benign gynecological conditions, and malignant tumors, among others. Therefore, it is recommended that you visit a professional obstetrician-gynecologist for...

Understanding Abnormal Bleeding: When to Seek Further Evaluation?

Hello, I would like to consult a physician. I have not engaged in sexual intercourse, I am overweight, and I have high blood pressure. Two years ago, my menstrual cycle became irregular, and when it did occur, it lasted more than 10 days. Initially, the flow was light. After seei...

Dr. Huang Yuande reply Obstetrics and Gynecology
Thank you for your question. Damage to the hymen can occur during a pelvic examination, so unless necessary, the physician will consider the circumstances. The risk of fibroids becoming malignant is very low, and if the condition is well-controlled with medication, there may not ...