Abnormal Bleeding: When to Seek Further Evaluation?

Is it menstruation or bleeding? Why not conduct further examinations?

Hello, I would like to consult a physician.
I have not engaged in sexual intercourse, I am overweight, and I have high blood pressure.
Two years ago, my menstrual cycle became irregular, and when it did occur, it lasted more than 10 days.
Initially, the flow was light.
After seeing a doctor and undergoing an abdominal ultrasound, I was told there were no issues and that I did not need medication.
The following year, I had the same problem, and after another ultrasound, the doctor again said there were no issues.
Subsequently, I did not have a period for six months.
On January 2 of this year, my period returned with heavy flow, lasting over a week, and the color was bright red throughout.
After seeing a doctor and undergoing an ultrasound, I was diagnosed with a 5 cm uterine fibroid and prescribed hemostatic medication, which helped control the bleeding.
Blood tests indicated ovarian function decline, and the doctor advised monitoring the situation.
On January 28, my period returned with even heavier flow than before.
After taking the hemostatic medication for two days, the bleeding eased.
Since I am in a high-risk group, I wanted to undergo further detailed examinations, but the doctor mentioned that the effectiveness of the hemostatic medication suggests a low likelihood of malignant tumors, so I was advised to continue monitoring.
I then consulted another doctor, who provided the same reasoning and believed that, due to my lack of sexual experience, an internal examination was unnecessary.
I have seen three doctors in total, and I am puzzled as to why a virgin cannot undergo further examination.
I am very concerned that if there is indeed a problem, it may worsen if left unchecked.
I would appreciate any advice you could provide.
Thank you.

Mi Mi, 40~49 year old female. Ask Date: 2020/01/31

Dr. Huang Yuande reply Obstetrics and Gynecology

Thank you for your question.
Damage to the hymen can occur during a pelvic examination, so unless necessary, the physician will consider the circumstances.
The risk of fibroids becoming malignant is very low, and if the condition is well-controlled with medication, there may not be a need for many invasive procedures.
It is advisable for you to discuss the associated risks with your physician before proceeding with further diagnosis and treatment.

Reply Date: 2020/01/31

More Info

Abnormal bleeding can be a concerning issue for many women, and understanding when to seek further evaluation is crucial for maintaining reproductive health. Based on your description, it seems you have been experiencing irregular menstrual cycles, prolonged bleeding, and significant changes in menstrual flow. These symptoms warrant careful consideration and may require further investigation.

Firstly, it is important to recognize that menstrual irregularities can stem from a variety of causes, including hormonal imbalances, structural abnormalities (such as fibroids or polyps), and other medical conditions. In your case, the presence of a 5 cm uterine fibroid, as noted in your ultrasound, could be contributing to your abnormal bleeding. Fibroids can cause heavy menstrual bleeding, prolonged periods, and even spotting between periods. They are benign tumors of the uterus, but their size and location can significantly affect menstrual patterns.

Your history of hypertension and the fact that you are overweight can also play a role in your menstrual irregularities. Both conditions can influence hormonal balance and may lead to conditions such as polycystic ovary syndrome (PCOS), which is characterized by irregular periods, excess androgen levels, and often, polycystic ovaries. It is essential to consider these factors as they may complicate your symptoms.

Regarding your concern about not being able to undergo a pelvic examination due to being a virgin, it is important to note that healthcare providers should respect your comfort and boundaries. However, a thorough evaluation of your symptoms is necessary, and there are alternative methods to assess your reproductive health without a pelvic exam. For instance, transvaginal ultrasound can provide detailed images of the uterus and ovaries and can be performed without a full pelvic examination. Additionally, blood tests to assess hormone levels, such as estrogen, progesterone, and thyroid hormones, can help identify any underlying hormonal imbalances.

Given your situation, it is advisable to seek a second opinion from a gynecologist who specializes in menstrual disorders. You may want to discuss the following options with your healthcare provider:
1. Further Imaging Studies: If the ultrasound findings are inconclusive, consider additional imaging studies such as a hysterosonogram (saline infusion sonography) or MRI, which can provide more detailed information about the uterine cavity and any abnormalities.

2. Endometrial Biopsy: If you continue to experience abnormal bleeding, an endometrial biopsy may be warranted. This procedure involves taking a small sample of the uterine lining to check for any abnormal cells or changes that could indicate hyperplasia or malignancy.

3. Hormonal Evaluation: Given your history of irregular cycles and the recent findings of ovarian function decline, a comprehensive hormonal evaluation may help identify any underlying endocrine disorders.

4. Lifestyle Modifications: Addressing lifestyle factors such as weight management, diet, and exercise can have a positive impact on menstrual health and overall well-being. Weight loss, in particular, can help regulate menstrual cycles and improve hormonal balance.

5. Medication Management: If your bleeding is heavy and persistent, your doctor may consider prescribing hormonal treatments, such as birth control pills or other hormonal therapies, to help regulate your cycle and reduce bleeding.

In conclusion, while your current healthcare providers may have assessed your situation as low risk for malignancy, your persistent symptoms and concerns are valid and should not be dismissed. Seeking a specialist who can provide a comprehensive evaluation and discuss all available options is essential. Remember, your health and peace of mind are paramount, and you deserve thorough care and attention to your concerns.

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