Abnormal Bleeding: When to Seek Medical Advice

Intermenstrual bleeding

Hello, doctor.
My menstrual cycle has generally been regular, but I always experience severe pain and intense premenstrual syndrome.
During ovulation, I sometimes have light spotting that lasts for a day or two.
About five days ago, I suddenly started bleeding, and according to my records from the past few months, this is more than a week before my expected period.
I don't have any abdominal discomfort, and this bleeding is completely different from my usual menstrual flow.
The amount of bleeding has increased day by day and is now close to the volume I typically experience during my period, which is also different from the spotting I had during ovulation.
My lifestyle hasn't changed significantly recently, and I haven't had any sexual intercourse.
Could you please advise what might be going on and whether I need to see a doctor?

Sophie, 20~29 year old female. Ask Date: 2017/12/01

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I have always had a relatively regular menstrual cycle, but each time it comes, I experience severe pain and intense premenstrual syndrome.
Sometimes, I have light spotting during ovulation that lasts for a day or two and is very minimal.
About five days ago, I suddenly started bleeding, and according to my records from the past few months, this is more than a week before my expected period.
I don't have any abdominal discomfort, and this bleeding is completely different from my usual menstrual flow.
The bleeding has increased day by day and is now approaching the volume I typically experience during my period, which is also different from the previous ovulation bleeding.
My lifestyle hasn't changed significantly recently, and I haven't had any sexual intercourse.
What could be the cause of this situation? Do I need to see a doctor? Answer: You should see a doctor to determine what might be going on.

Reply Date: 2017/12/01

More Info

Abnormal bleeding can be a concerning issue for many women, and understanding when to seek medical advice is crucial for maintaining reproductive health. Based on your description, it seems you have experienced a sudden onset of bleeding that is different from your usual menstrual cycle, which raises several important considerations.

Firstly, it’s essential to differentiate between normal variations in menstrual bleeding and abnormal bleeding. Normal menstrual cycles can vary in length and flow, but any significant changes in your pattern—such as unexpected bleeding outside of your regular cycle, especially if it is heavier than usual—should be taken seriously. In your case, you mentioned that the bleeding started about five days ago, is increasing in volume, and is not associated with any abdominal discomfort. This is a notable change from your typical cycle and warrants further investigation.

There are several potential causes for abnormal bleeding, including hormonal imbalances, uterine fibroids, polyps, endometriosis, or even more serious conditions such as infections or malignancies. Given that you have a history of painful periods and premenstrual syndrome (PMS), it is possible that hormonal fluctuations are contributing to your current symptoms. However, the sudden increase in bleeding volume and the timing relative to your menstrual cycle suggest that it could be something more than just a hormonal issue.

In terms of when to seek medical advice, the general recommendation is to consult a healthcare provider if you experience any of the following:
1. Bleeding that lasts longer than a week: If your bleeding continues beyond a week, it is advisable to see a doctor.

2. Heavy bleeding: If you are soaking through one or more pads or tampons every hour for several consecutive hours, this is considered heavy bleeding and requires immediate medical attention.

3. Severe pain: While you mentioned no abdominal discomfort, any sudden onset of severe pain should prompt a visit to a healthcare provider.

4. Signs of infection: If you experience fever, chills, or foul-smelling discharge, these could indicate an infection that needs treatment.

5. Changes in menstrual cycle: Any significant changes in your menstrual cycle, especially if they are accompanied by other symptoms, should be evaluated.

In your case, since the bleeding is increasing and deviating from your normal pattern, it is advisable to schedule an appointment with a gynecologist. They may perform a pelvic exam, ultrasound, or other diagnostic tests to determine the underlying cause of your abnormal bleeding. It’s also important to provide your healthcare provider with a complete history of your menstrual cycles, any medications you are taking, and any other symptoms you may be experiencing.

In conclusion, while some variations in menstrual bleeding can be normal, the sudden change you are experiencing is significant enough to warrant medical evaluation. Early diagnosis and treatment can help address any underlying issues and provide you with peace of mind regarding your reproductive health. Don’t hesitate to reach out to a healthcare professional to discuss your symptoms and get the care you need.

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