Abnormal Vaginal Bleeding: Causes and Concerns

Abnormal bleeding for nearly two months?

Hello Dr.
Huang, about two months ago, I started experiencing vaginal bleeding.
Initially, it was pink, then it turned brown after two to three days, and later changed to red, similar to menstrual bleeding.
However, the amount of bleeding has been minimal, sometimes more and sometimes less, but never as heavy as a regular menstrual flow.
After my period ended that month, the bleeding returned to the initial state, occasionally brown and occasionally red, and there has been no pain during this time.
After bleeding for nearly a month, I consulted a doctor.
My family physician suggested it might be related to hormonal changes and scheduled a blood test for a month later.
However, since the bleeding increased slightly compared to a month ago, I went directly to the emergency department to see a gynecologist.
The doctor performed a vaginal ultrasound and said everything looked normal, except that the endometrium was somewhat fragile.
They recommended scheduling a Pap smear since I hadn't had one in nearly two years.
Additionally, in the past few weeks, I have noticed small blood clots accompanying the blood during urination, which has caused confusion and concern every time I see it, even though the gynecologist assured me there was no issue.
I would like to ask Dr.
Huang what possible conditions this situation might indicate.
I hope you can provide some guidance.
Thank you for your patience in listening to my explanation.

Ana, 30~39 year old female. Ask Date: 2017/10/31

Dr. Huang Jianzhong reply Obstetrics and Gynecology

About two months ago, I started experiencing vaginal bleeding.
Initially, it was pink, and after two to three days, it turned brown.
Then it changed to red, similar to menstrual bleeding, but the amount was not heavy—sometimes more, sometimes less, but never as much as during a regular period.
After my menstrual cycle ended that month, the bleeding returned to its initial state, occasionally brown and occasionally red, without any pain during this time.
After bleeding for nearly a month, I consulted a doctor.
My family physician suggested it might be related to hormonal changes and scheduled a blood test for a month later.
However, since the bleeding had increased slightly compared to a month ago, I went directly to the emergency department to see a gynecologist.
The doctor performed a vaginal ultrasound and said everything looked normal, but the endometrium was somewhat fragile.
They recommended scheduling a Pap smear since it had been nearly two years since my last check-up.
Additionally, over the past few weeks, I have noticed small blood clots accompanying the blood during urination, which has caused confusion and concern every time I see it, even though the gynecologist assured me there was no issue.
I would like to ask Dr.
Huang what possible conditions could be causing this situation.
Answer: This situation requires a hysteroscopy with biopsy.

Reply Date: 2017/10/31

More Info

Abnormal vaginal bleeding can be a source of significant concern for many women, and understanding its potential causes is crucial for effective management and peace of mind. Based on your description, it appears that you have been experiencing irregular bleeding patterns, which have included pink, brown, and red blood, along with the presence of small blood clots during urination. While it is reassuring that your gynecologist has conducted an ultrasound and found no immediate issues, there are several factors to consider regarding your symptoms.

Firstly, the variation in bleeding color and consistency you described is often associated with hormonal fluctuations. Hormonal imbalances can lead to irregularities in the menstrual cycle, causing spotting or bleeding between periods. This can be particularly common in women who are experiencing changes in their reproductive health, such as those related to stress, weight changes, or lifestyle factors. Given that you mentioned the bleeding has been ongoing for nearly a month, it is essential to monitor the situation closely.

The fact that your gynecologist noted a "weaker" endometrial lining could indicate that your body is experiencing difficulty in maintaining a stable hormonal environment. This can lead to irregular shedding of the uterine lining, resulting in the abnormal bleeding you are experiencing. It is also worth noting that conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or even perimenopause can contribute to these symptoms, especially if you are in an age group where these conditions are more prevalent.

Regarding the small blood clots you mentioned during urination, this could be indicative of a urinary tract issue, such as a urinary tract infection (UTI) or even a kidney stone. However, since your gynecologist has indicated that there are no significant issues, it may be worthwhile to follow up with a urologist if this symptom persists. Blood in the urine can sometimes be a sign of a more serious condition, so it is essential to address this with a healthcare provider.

Additionally, you mentioned that you have not had a Pap smear in nearly two years. Regular cervical screenings are vital for early detection of any potential issues, including cervical dysplasia or cancer. It is advisable to schedule this test as soon as possible, as it can provide valuable information about your cervical health and help rule out any abnormalities that could be contributing to your symptoms.

In summary, while your symptoms may be related to hormonal fluctuations and a weaker endometrial lining, it is essential to continue monitoring your condition and maintain open communication with your healthcare providers. If the bleeding persists or worsens, or if you experience any new symptoms, do not hesitate to seek further evaluation. Keeping a detailed record of your symptoms, including the timing, color, and amount of bleeding, can also be beneficial for your healthcare team in determining the underlying cause and appropriate treatment.

Similar Q&A

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 Vaginal Bleeding: Causes and Concerns

Abnormal bleeding from the lower body can be caused by several conditions. It’s understandable to be alarmed by finding blood on your underwear, especially if it was unexpected. Since you mentioned that your menstrual cycle is typically regular and you had your period about two w...

Dr. Chen Changfu reply Obstetrics and Gynecology
Hello! Based on the detailed description in your letter, the bleeding you experienced during your occasional menstrual periods (two instances of menstrual bleeding) is likely ovulatory bleeding, and there is no need to be anxious or worried. Just continue to self-monitor for any ...

Understanding Abnormal Vaginal Bleeding: Causes and Concerns

Hello doctor, my situation is quite complex. I initially had a fever, and after taking antipyretics, I started to feel better after a day. However, I then experienced issues with bowel movements, which led to skin irritation between the anus and vagina (at least that's what ...

Dr. Wu Xianghui reply Obstetrics and Gynecology
"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 return to a professional obstetrician-gynecologist fo...

Understanding Abnormal Bleeding: Insights from a Gynecological Perspective

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 nig...

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 cervica...