Abnormal Bleeding After Menstruation: Causes and Next Steps - Obstetrics and Gynecology

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Bleeding started two days after the menstrual period ended?


A few months ago, I had issues with a vaginal infection.
I consulted a doctor and had an ultrasound, which showed no abnormalities.
The doctor prescribed medication and suppositories.
Recently, after having sexual intercourse, I experienced slight pink bleeding.
My menstrual period started on the 12th of this month, but the blood was mostly dark brown and more abundant.
On the 22nd, I passed more brown discharge, and on the 23rd, I began to have bright red bleeding accompanied by abdominal pain.
Could this be due to an unresolved vaginal infection? Do I need to undergo any further tests?

77, 20~29 year old female. Ask Date: 2018/01/25

Dr. Huang Jianzhong reply Obstetrics and Gynecology


A few months ago, I had issues with a vaginal infection.
After an ultrasound, the doctor found no abnormalities and prescribed medication and suppositories.
Recently, after having sexual intercourse, I noticed slight pink bleeding.
My period started on the 12th of this month, but the flow was mostly brown and darker red.
On the 22nd, I passed more brown discharge, and on the 23rd, I began to experience bright red bleeding accompanied by abdominal pain.
Could this be due to an unresolved vaginal infection? Do I need to undergo any further tests?
Answer: Since you are experiencing slight pink bleeding after recent sexual intercourse, it is recommended to consider paying out of pocket for a Pap smear test.

Reply Date: 2018/01/25

More Info


Abnormal bleeding after menstruation can be concerning and may arise from various underlying causes. Given your recent history of vaginal infections and the symptoms you are experiencing, it is essential to approach this situation with care and seek appropriate medical evaluation.

Firstly, the presence of light pink blood after sexual intercourse could indicate several possibilities, including cervical irritation, which can occur due to infections or trauma, or it may be related to hormonal fluctuations. The fact that you have experienced a change in your menstrual flow, with darker, coffee-colored blood and then transitioning to fresh red blood accompanied by abdominal pain, warrants further investigation.

The color and consistency of menstrual blood can vary significantly throughout the menstrual cycle. Darker blood often indicates older blood that has taken longer to exit the uterus, while fresh red blood typically signifies new bleeding. The abdominal pain you mentioned could be related to several factors, including uterine contractions, inflammation, or even the presence of an underlying condition such as endometriosis or fibroids.

Given your history of vaginal infections, it is crucial to consider whether the infection has resolved completely or if it has led to complications. Infections can sometimes cause changes in menstrual patterns and may lead to pelvic inflammatory disease (PID) if left untreated. PID can result in scarring and other long-term reproductive health issues.

To address your concerns, here are some recommended steps:
1. Consult a Healthcare Provider: It is essential to schedule an appointment with a gynecologist or healthcare provider who can perform a thorough evaluation. They may conduct a pelvic exam to assess for any signs of infection, inflammation, or other abnormalities.

2. Diagnostic Tests: Your doctor may recommend several tests, including:
- Transvaginal Ultrasound: This imaging test can help visualize the reproductive organs and identify any structural issues such as cysts, fibroids, or signs of infection.

- Pap Smear: If you haven't had one recently, a Pap smear can help screen for cervical abnormalities.

- STI Testing: Given your history of vaginal infections, testing for sexually transmitted infections (STIs) may be appropriate.

- Blood Tests: Hormonal levels can be assessed to rule out any endocrine issues that may be contributing to abnormal bleeding.

3. Monitor Symptoms: Keep track of your menstrual cycle, noting the flow, color, and any associated symptoms such as pain or discomfort. This information can be valuable for your healthcare provider in diagnosing the issue.

4. Follow-Up Care: Depending on the findings, your doctor may recommend treatment options, which could include antibiotics for infections, hormonal therapies to regulate your menstrual cycle, or other interventions based on the diagnosis.

5. Lifestyle Considerations: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can support overall reproductive health. Additionally, managing stress and ensuring adequate rest can positively impact your menstrual cycle.

In summary, while your symptoms may be related to a previous infection, they could also indicate other underlying conditions that require attention. Seeking medical advice is crucial to ensure proper diagnosis and treatment, ultimately helping to restore your reproductive health and alleviate any discomfort you may be experiencing.

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