Abnormal Menstrual Bleeding: Causes and Next Steps

Not menstrual bleeding?

Hello, Doctor.
I had a Pap smear done at the end of December last year, which was normal except for some inflammation.
In July, my menstrual cycle was irregular and lasted for 14 days.
I visited a doctor on the 24th and had a vaginal ultrasound, which was normal.
The doctor prescribed me a five-day course of medication to regulate my menstrual cycle, which I took from July 25 to July 29.
My period started on August 8 and ended normally.
However, on August 29, I got my period again while having a cold, so I went to see a doctor and took some medication.
During this time, I had trouble sleeping for three days.
I had an upper gastrointestinal endoscopy on September 7, and my period ended on September 8.
However, on September 11, my period returned, and the flow was moderate.
I went back to see the doctor, and another vaginal ultrasound showed normal results, but there was a mild adenoma.
I usually do not experience much pain during my periods.
The doctor mentioned that based on the thickness of the endometrium, it seems like my period might be irregular again.
They prescribed me medication to regulate my cycle, stating that I could choose to take it or not, and to wait until my period is over to see if there will be any further bleeding.
If there is bleeding, I can take the medication then, but I chose not to take it.

From September 11 until today, September 16, I have continued to experience bleeding.
I have had leg cramps twice, and while the amount of blood on the sanitary pad is not much, I have noticed that whenever I urinate, there is sometimes more blood and sometimes less.
However, if I exert myself, there is definitely a lot of blood and clots.
I am 164 cm tall and weigh around 44-45 kg, but I weighed myself recently and found that I am now down to 43.6 kg.
Two years ago, I had a check for galactorrhea, which was related to hormonal imbalance, and I had irregular periods once before that resolved without medication.

Could you please help me understand what might be causing my irregular menstrual cycle now? Should I ask the obstetrician to perform any specific tests?

Wenwen, 40~49 year old female. Ask Date: 2020/09/16

Dr. Huang Yuande reply Obstetrics and Gynecology

First, you need to consult a gynecologist for a diagnostic evaluation to determine the cause, including: 1.
whether there is a tumor, 2.
hormone testing, and 3.
assessment of endometrial thickness.
The treatment steps include: 1.
medications for contraction and hemostasis, 2.
hormone therapy, and 3.
endometrial biopsy or curettage.
If a tumor is found, appropriate management should be undertaken.
There are many causes of menstrual irregularities, making it difficult to assess solely from written information.
It is important to note that if hormone medications are prescribed, they must be taken according to the physician's plan.

Reply Date: 2020/09/16

More Info

Abnormal menstrual bleeding can be a complex issue, often influenced by a variety of factors including hormonal imbalances, structural abnormalities, and underlying health conditions. Based on your description, it seems you have been experiencing prolonged and irregular menstrual cycles, which can be concerning. Here’s a comprehensive overview of potential causes, next steps, and recommendations for managing your situation.

Potential Causes of Abnormal Menstrual Bleeding
1. Hormonal Imbalances: Fluctuations in hormones, particularly estrogen and progesterone, can lead to irregular menstrual cycles. Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can disrupt hormonal balance.

2. Uterine Abnormalities: Structural issues such as fibroids, polyps, or adenomyosis can cause heavy bleeding or prolonged menstrual periods. You mentioned having a mild adenomyosis, which could contribute to your symptoms.

3. Medications: Certain medications, including hormonal contraceptives or anticoagulants, can affect menstrual bleeding patterns. If you have recently started or changed any medications, this could be a factor.

4. Stress and Lifestyle Factors: Stress, significant weight changes, and sleep disturbances can impact menstrual cycles. You mentioned having trouble sleeping, which could be a contributing factor.

5. Underlying Health Conditions: Conditions such as endometriosis, pelvic inflammatory disease, or bleeding disorders can also lead to abnormal bleeding.

Next Steps
1. Follow-Up with Your Healthcare Provider: Since you have already undergone a vaginal ultrasound and have been prescribed medication, it’s essential to maintain communication with your healthcare provider. If your symptoms persist or worsen, you should schedule a follow-up appointment.

2. Consider Additional Testing: Depending on your doctor’s assessment, they may recommend further tests such as:
- Endometrial Biopsy: To check for abnormalities in the uterine lining.

- Hormonal Testing: To evaluate levels of estrogen, progesterone, and thyroid hormones.

- Hysteroscopy: A procedure to look inside the uterus for any abnormalities.

3. Monitor Your Symptoms: Keep a detailed record of your menstrual cycle, including the duration, flow, and any associated symptoms (like pain or clots). This information can be valuable for your healthcare provider.

4. Lifestyle Modifications: Consider implementing stress-reduction techniques such as yoga, meditation, or regular exercise. Maintaining a balanced diet and ensuring adequate sleep can also support hormonal balance.

5. Medication Management: If your doctor has prescribed medication to regulate your menstrual cycle, it’s important to follow their guidance. If you choose not to take the medication, discuss this decision with your healthcare provider to understand the implications.

Conclusion
Abnormal menstrual bleeding can stem from a variety of factors, and it’s crucial to approach this issue with a comprehensive strategy. By working closely with your healthcare provider, considering additional testing, and monitoring your symptoms, you can gain a clearer understanding of the underlying causes and appropriate management strategies. Remember, it’s essential to prioritize your health and seek medical advice whenever you notice significant changes in your menstrual cycle.

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