Secondary Bleeding: Causes and When to Seek Medical Advice

Secondary hemorrhage

Hello Doctor, I received a menopause injection in 2020 due to having an ovarian chocolate cyst and a small uterine adenomyosis.
Due to the medication's effects, I was expected to have my period this year.
I experienced light bleeding from January 27 to January 31, which was very minimal, similar to the fifth or sixth day of a normal period.
I thought that was my period, assuming it was just a light return.
Then, on February 8, I had more bleeding.
As of today, February 9, the amount is still light but seems slightly more than in January.
I would like to ask what might be the cause of this and whether I should schedule an earlier appointment with my doctor (I usually have check-ups every three months).
I am also taking medication for hypothyroidism, and my thyroid levels have been normal; I had blood tests during my mid-January follow-up.
Thank you for taking the time to respond amidst your busy schedule.

Y, 30~39 year old female. Ask Date: 2021/02/09

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Regarding your concerns, based on your description, it is indeed more appropriate to return to your original treating physician to confirm the status of the bleeding.
Thank you for your inquiry, and I wish you health and happiness.

Reply Date: 2021/02/09

More Info

Understanding secondary bleeding, especially in the context of hormonal treatments and underlying conditions like ovarian chocolate cysts and adenomyosis, is crucial for managing your health effectively. Given your history of receiving hormonal injections and your current symptoms, let's delve into the potential causes and when you should seek medical advice.

Firstly, it’s important to recognize that hormonal treatments can significantly affect menstrual cycles. The injections you received may have altered your normal hormonal balance, leading to irregular bleeding patterns. The bleeding you experienced from January 27 to January 31 could indeed have been a light menstrual period, especially if it resembled the tail end of a typical cycle. However, the subsequent bleeding on February 8 raises some concerns.

Secondary bleeding can occur for various reasons, including:
1. Hormonal Fluctuations: After stopping or starting hormonal treatments, your body may take time to adjust, leading to irregular bleeding. This is particularly common after treatments for conditions like adenomyosis or ovarian cysts.

2. Endometrial Changes: Conditions such as adenomyosis can cause the endometrial lining to become thicker or more unstable, leading to unexpected bleeding. If the lining sheds irregularly, it can result in spotting or heavier bleeding at unexpected times.

3. Infection or Inflammation: Any infection in the reproductive tract can lead to abnormal bleeding. This could be due to pelvic inflammatory disease or other infections that might not present with significant symptoms initially.

4. Polyps or Fibroids: These benign growths can also cause irregular bleeding. If you have a history of such conditions, it’s worth considering them as potential causes.

5. Thyroid Issues: Although you mentioned that your thyroid levels are currently normal, thyroid dysfunction can sometimes lead to menstrual irregularities. It’s essential to monitor your thyroid function regularly, especially since you are on medication for hypothyroidism.

Given that your bleeding seems to be increasing slightly and is occurring outside of your expected menstrual cycle, it is advisable to consult your healthcare provider sooner than your scheduled appointment. Here are some specific signs that warrant immediate medical attention:
- Increased Bleeding: If the bleeding becomes heavier than a typical menstrual flow or is accompanied by large clots.

- Severe Pain: If you experience significant abdominal or pelvic pain that is not relieved by over-the-counter pain medications.

- Signs of Infection: Symptoms such as fever, chills, or unusual discharge should prompt a visit to your doctor.

- Fatigue or Dizziness: If you feel unusually tired or dizzy, it could indicate anemia from blood loss.

In conclusion, while some irregular bleeding can be a normal response to hormonal changes, it is essential to remain vigilant. Given your medical history and the recent changes in your bleeding patterns, reaching out to your healthcare provider for an earlier evaluation is a prudent step. They may recommend further investigations, such as an ultrasound or blood tests, to rule out any underlying issues and ensure your reproductive health is managed appropriately. Always prioritize open communication with your healthcare team regarding any changes in your symptoms.

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