Abnormal Bleeding: When to Seek Further Evaluation

Abnormal bleeding

My last menstrual period started on October 30 and ended about four to five days later, after which I began experiencing some bleeding (the amount has not been significant; sometimes it's brown, sometimes red, and occasionally there are blood streaks in my discharge).
This has been ongoing for ten days.
Concerned about potential issues, I visited a gynecologist on the evening of November 14.
Since I have not engaged in sexual intercourse, the doctor only performed an abdominal ultrasound, which showed no abnormalities (and I could see an egg at that time).
The doctor suggested that it was likely ovulation bleeding.
However, three days have passed since then, and I am still experiencing occasional light bleeding...
(I have never had ovulation bleeding last this long before).
I researched online and found that an abdominal ultrasound can only visualize the uterus and ovaries, and it seems it cannot assess the cervix, which makes me worried about potential cervical abnormalities (but since I have not had sexual intercourse, it seems unlikely that I would be infected with HPV).
Should I schedule a follow-up appointment soon and request the doctor to perform a Pap smear to check for cervical cancer? Thank you.

lisa, 20~29 year old female. Ask Date: 2019/11/17

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The last menstrual period started on October 30 and ended about four to five days later, after which I began to experience some light bleeding (sometimes brown, sometimes red, and occasionally with blood-tinged discharge).
This has been going on for ten days.
Concerned about potential issues, I visited the obstetrics and gynecology outpatient clinic on the evening of November 14.
Since I have not engaged in sexual intercourse, the doctor only performed an abdominal ultrasound, which showed no abnormalities (and I could see a follicle at that time).
The doctor suggested that it was likely ovulation bleeding.
However, three days later, I am still experiencing occasional light bleeding...
(In the past, my ovulation bleeding did not last this long).
I researched online and found that abdominal ultrasounds can only visualize the uterus and ovaries, and it seems they cannot assess the cervix, which makes me worried about possible cervical abnormalities (but since I have not had sexual intercourse, it seems unlikely that I would be infected with HPV).
Should I return for a follow-up appointment soon and request the doctor to perform a Pap smear to check for cervical cancer?
Answer: Since you have not engaged in sexual intercourse, a Pap smear cannot be performed, and it is also unlikely that you have cervical cancer.

Reply Date: 2019/11/17

More Info

Abnormal bleeding can be a concerning symptom for many individuals, and it is important to understand when to seek further evaluation. In your case, you have experienced bleeding that started shortly after your menstrual period and has persisted for an extended period, which is understandably worrisome.
From your description, it seems that you have already taken a proactive step by visiting a gynecologist, who performed an abdominal ultrasound and found no abnormalities. The presence of an egg during the ultrasound suggests that your ovaries are functioning normally, and the doctor’s assessment of ovulation bleeding is a common explanation for light bleeding that occurs mid-cycle. Ovulation bleeding can occur in some women due to hormonal fluctuations and is typically not a cause for concern.

However, the fact that you are still experiencing intermittent bleeding after several days raises some questions. While ovulation bleeding can last for a few days, it usually does not extend beyond a week. The color variations you mentioned (brown and red) and the presence of blood-tinged discharge can also be typical of hormonal changes, but they can also indicate other conditions that may need further investigation.

Regarding your concern about cervical abnormalities, it is true that an abdominal ultrasound primarily assesses the uterus and ovaries, and it does not provide a direct view of the cervix. While it is less common for someone who has not been sexually active to develop cervical issues, it is not impossible. Conditions such as cervical polyps or other benign lesions can occur regardless of sexual history. Additionally, while HPV is often associated with sexual activity, there are other factors that can contribute to cervical changes.

Given your ongoing symptoms and concerns, it would be prudent to follow up with your gynecologist. You can certainly request a Pap smear (cervical cytology) to screen for any cervical abnormalities, including precancerous changes or cancer. The American College of Obstetricians and Gynecologists (ACOG) recommends that individuals begin cervical cancer screening at age 21, regardless of sexual history. If you are experiencing unusual bleeding, it is reasonable to discuss this with your doctor as part of your evaluation.

In summary, while your initial evaluation did not reveal any significant issues, the persistence of your symptoms warrants further investigation. A Pap smear can provide valuable information about your cervical health, and it is always better to err on the side of caution when it comes to your reproductive health. If you continue to experience bleeding or if it becomes heavier, or if you develop other symptoms such as pain or unusual discharge, do not hesitate to seek medical attention sooner. Your health and peace of mind are important, and open communication with your healthcare provider is key to addressing your concerns effectively.

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