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.
Because of the medication, 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 light since it was the first one after resuming.
Then, on February 8, I had more bleeding, and as of today, February 9, the amount is still light but seems slightly more than the January episode.
I would like to know what might be causing 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, with blood tests conducted during my mid-January appointment.
Thank you for taking the time to respond amidst your busy schedule.

Y, 30~39 year old female. Ask Date: 2021/02/10

Dr. Chen Zhiyu reply Obstetrics and Gynecology

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

Reply Date: 2021/02/10

More Info

Understanding secondary bleeding, especially in the context of hormonal treatments and underlying conditions such as ovarian chocolate cysts and adenomyosis, is crucial for ensuring appropriate medical care. In your case, the bleeding you experienced in late January and early February could be attributed to several factors related to your medical history and the medications you are taking.

Firstly, the administration of hormonal treatments, such as the menopause injection you received, can lead to irregular bleeding patterns as your body adjusts to the hormonal changes. It is not uncommon for women to experience variations in menstrual flow, especially after starting or stopping hormonal therapies. The initial bleeding you experienced in January, which was light and similar to the end of a typical menstrual cycle, may have been a result of your body re-establishing its menstrual cycle after the hormonal intervention.

The subsequent bleeding in early February, which you noted was slightly heavier, could indicate a few possibilities. One potential cause is the presence of breakthrough bleeding, which can occur when the hormonal levels fluctuate or when the body is adjusting to the effects of the medication. Additionally, conditions like adenomyosis can contribute to abnormal bleeding patterns, as the endometrial tissue grows into the muscular wall of the uterus, leading to heavier and more painful periods.

Given that you have a history of ovarian cysts and adenomyosis, it is essential to monitor any changes in your bleeding patterns closely. While light bleeding can be normal, any significant changes, such as increased volume or duration of bleeding, should be evaluated by a healthcare professional. It is also important to consider other factors that could contribute to bleeding, such as thyroid function, which you mentioned is currently stable. However, fluctuations in thyroid hormone levels can also affect menstrual cycles.

In your case, since you have a scheduled follow-up appointment every three months, it is advisable to contact your healthcare provider sooner if the bleeding continues, increases in volume, or is accompanied by other symptoms such as severe pain, dizziness, or fatigue. These could be signs of more serious conditions that may require immediate attention, such as hormonal imbalances, fibroids, or other gynecological issues.

In summary, while some irregular bleeding can be expected after hormonal treatments, it is essential to remain vigilant and proactive about your health. If you feel uncertain or anxious about the changes in your bleeding patterns, do not hesitate to reach out to your healthcare provider for guidance. They may recommend further evaluation, such as an ultrasound or blood tests, to rule out any underlying issues and ensure that you receive the appropriate care. Your health and well-being are paramount, and staying informed and engaged with your healthcare is the best approach to managing your condition.

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