Abnormal Bleeding and Lower Abdominal Pain in Women

Intermenstrual bleeding with lower abdominal discomfort?

Hello, doctor.
Recently, I have experienced non-menstrual bleeding (lasting more than five days) and a dull pain in my lower abdomen.
When I use toilet paper, there is a small amount of pinkish and sometimes light brown discharge.
The bleeding has not worsened; in fact, it has decreased day by day, but I am still quite concerned.
Could this possibly be a small amount of bleeding before my period? If I visit a gynecologist, will an internal examination be necessary? I am quite averse to internal exams.
Thank you, doctor.

Niming, 20~29 year old female. Ask Date: 2020/08/13

Dr. Lin Manying reply Obstetrics and Gynecology

Hello, if there has been sexual intercourse, it is necessary to first rule out the possibility of pregnancy.
Following that, a preliminary pelvic examination or ultrasound is required to determine the cause.
Hualien Hospital, Ministry of Health and Welfare, cares about your health.

Reply Date: 2020/08/13

More Info

Abnormal bleeding and lower abdominal pain in women can be concerning symptoms that warrant careful evaluation. Based on your description, you are experiencing non-menstrual bleeding that has persisted for over five days, accompanied by a dull pain in the lower abdomen. The presence of pinkish or light brown discharge on toilet paper is also noted, but you mention that the bleeding is gradually decreasing.
First, it is important to understand that abnormal bleeding can have various causes, ranging from hormonal imbalances to structural issues within the reproductive system. Some common causes of abnormal bleeding include:
1. Hormonal Imbalances: Fluctuations in hormone levels can lead to irregular bleeding. Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can affect menstrual cycles.

2. Uterine Fibroids or Polyps: These benign growths in the uterus can cause heavy or irregular bleeding. They may also contribute to pelvic pain.

3. Endometriosis: This condition occurs when tissue similar to the lining of the uterus grows outside of it, leading to pain and abnormal bleeding.

4. Pregnancy-Related Issues: Early pregnancy can sometimes present with spotting, which may be normal (implantation bleeding) or indicate a potential miscarriage or ectopic pregnancy.

5. Infections: Pelvic inflammatory disease (PID) or sexually transmitted infections (STIs) can lead to abnormal bleeding and pelvic pain.

6. Other Medical Conditions: Conditions such as clotting disorders or certain cancers can also manifest with abnormal bleeding.

Given that your bleeding is not worsening and is decreasing, it may be a sign that your body is resolving whatever issue is causing the bleeding. However, it is essential to consult a healthcare provider to rule out any serious conditions.
Regarding your concern about an internal examination (pelvic exam), it is a common practice in gynecological evaluations, especially when abnormal bleeding is present. While it may feel uncomfortable, an internal exam can provide valuable information about the health of your reproductive organs. Your healthcare provider may also recommend additional tests, such as an ultrasound, to assess for any structural abnormalities.

If you are particularly anxious about the internal exam, it is advisable to communicate this with your healthcare provider. They can explain the necessity of the exam and may offer alternatives or reassurance to make the process more comfortable for you.

In summary, while the symptoms you describe could potentially be related to premenstrual spotting or other benign causes, it is crucial to seek medical advice to ensure proper evaluation and management. Early diagnosis and treatment can help address any underlying issues and alleviate your concerns.

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