Abnormal Bleeding: Causes and Concerns in Gynecology

Abnormal bleeding

Medical History: 38 years and 11 months old.
Has had two pregnancies, both delivered via cesarean section, with both pregnancies requiring 2-3 months of hospitalization for bed rest.
In 2012, due to frequent abnormal bleeding, endometrial polyps were discovered and removed via hysteroscopy.
Annual Pap smears have all been normal.
Last year, there were symptoms of inflammation, but the physician stated it was normal and advised to return if symptoms persisted.
In August of last year, a clinic physician noted a cervical polyp, describing it as small and benign, with no need for intervention.
Menstrual cycle is 26-28 days, lasting approximately 7-8 days each time.
In the past six months, there have been three instances where, after menstruation, on days 13-14 or 16-18 of the cycle, there was blood-tinged mucus, which the clinic doctor attributed to ovulation bleeding.
However, after the last menstrual cycle, the bleeding seemed to worsen, with daily discharge of blood-tinged mucus from day 16 of the cycle until the most recent menstruation, consisting of clear mucus mixed with fresh blood.
On January 26, a transvaginal ultrasound at the hospital indicated the presence of a uterine polyp, and the clinic physician recommended a hysteroscopic examination.
On January 29, a hysteroscopic examination was performed by Dr.
Yang Cheng-Hsien at National Taiwan University, who reported no polyps or other abnormalities, with a smooth endometrium.
However, it was noted that the cesarean scar had poor healing with a groove, which was believed to cause prolonged menstruation due to menstrual accumulation rather than polyps.
Today, on January 31, there is again a mixture of dark brown and blood-tinged mucus, causing considerable distress.
I would like to ask the physician: 1.
If it is menstrual accumulation, then the discharge from menstruation to days 17 and 26 of the cycle should not still be bright red (this is my personal understanding, and I forgot to ask the physician at the time), but my discharge is clear with blood-tinged mucus; what could that be? 2.
Is there a possibility of cervical pathology? 3.
If the hysteroscopic examination shows no abnormalities, are there other causes that require further investigation? Thank you, doctor!

IRENE.LIN, 30~39 year old female. Ask Date: 2018/01/31

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the factors that can affect the menstrual cycle or cause intermenstrual bleeding are numerous, including age, environment, lifestyle, stress, emotional instability, weight changes, medications, emergency contraceptive pills, diet, polycystic ovary syndrome, lesions in the uterus, endometrium, or cervix, infections, ovulation, pregnancy, and breastfeeding, among others.
If there are lesions found during a hysteroscopy, it is important to discuss treatment options with your physician.
If your symptoms persist or worsen, it is advisable to consult a gynecologist for an ultrasound, pelvic examination, blood tests, hysteroscopy, and other diagnostic evaluations to determine the appropriate treatment options.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2018/01/31

More Info

Abnormal bleeding can be a significant concern for many women, particularly when it occurs outside of the normal menstrual cycle. Understanding the potential causes and implications of such bleeding is crucial for effective management and peace of mind. Based on your medical history and the symptoms you've described, let's delve into the possible explanations and considerations regarding your situation.

Understanding Your Symptoms
1. Menstrual Cycle and Abnormal Bleeding: Your menstrual cycle, which typically lasts 26-28 days, is relatively regular, but the occurrence of bleeding between cycles—especially with the presence of blood-tinged mucus—can be indicative of several conditions. The fact that you have experienced this for several months raises the need for careful evaluation.

2. Ovulation Bleeding: One common cause of mid-cycle bleeding is ovulation bleeding, which can occur around the 13th to 16th day of your cycle. This type of bleeding is usually light and can be accompanied by clear or slightly blood-tinged mucus. However, if the bleeding is persistent and increasing in severity, as you mentioned, it may warrant further investigation.

3. Endometrial Polyps and Other Conditions: Although your recent hysteroscopy did not reveal any polyps or abnormalities, it is essential to consider that sometimes small lesions can be missed, or new polyps can develop. Additionally, the presence of endometrial thickening or irregularities in the uterine lining can lead to abnormal bleeding.
4. Cervical Changes: Given your history of cervical polyps, it is also prudent to consider the possibility of cervical changes, including inflammation or dysplasia, which could contribute to abnormal bleeding. A Pap smear is essential to rule out any cervical pathology, especially if you have had any changes in your sexual health or if you have not had a Pap test recently.

Addressing Your Concerns
1. Persistent Blood-Tinged Mucus: The presence of blood-tinged mucus beyond the expected timeframe of your menstrual cycle could suggest several things. If the bleeding is bright red, it may indicate fresh blood, which is often associated with active bleeding rather than old blood. If it is brown or dark, it may be older blood that is taking longer to exit the body. However, the consistency and color of the discharge can vary widely and may not always correlate with a specific pathology.

2. Potential for Other Conditions: If your hysteroscopy was clear, but you continue to experience abnormal bleeding, it may be worthwhile to explore other potential causes, such as hormonal imbalances, which can lead to irregular shedding of the endometrial lining. Conditions such as polycystic ovary syndrome (PCOS) or thyroid dysfunction can also contribute to abnormal bleeding patterns.

3. Further Investigations: If the bleeding persists or worsens, further investigations may be necessary. This could include additional imaging studies, such as a pelvic ultrasound, or even a repeat hysteroscopy if there are concerns about the uterine lining or if new symptoms arise. Additionally, blood tests to evaluate hormone levels, including estrogen and progesterone, may provide insight into potential endocrine issues.

Conclusion
In summary, while your symptoms may initially suggest ovulation bleeding or minor cervical changes, the persistence and severity of your bleeding warrant a thorough evaluation to rule out any significant underlying conditions. It is essential to maintain open communication with your healthcare provider, ensuring that all your concerns are addressed and that you receive appropriate follow-up care. Regular monitoring and proactive management can help alleviate your worries and ensure your reproductive health remains a priority. If you have any further questions or if your symptoms change, do not hesitate to seek further medical advice.

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 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...

Understanding Abnormal Vaginal Bleeding: Symptoms and Treatment Options

Hello doctor, I experienced light bleeding in my genital area for a week starting from February 29. On March 7, I consulted a gynecologist who informed me that my vaginal bleeding was abnormal and attributed it to adenomyosis. The doctor prescribed treatment for amenorrhea and ov...

Dr. Cao Guotao reply Obstetrics and Gynecology
Hello, you are experiencing irregular menstruation. It is recommended to see a gynecologist. Wishing you good health.