Abnormal Bleeding and Hormonal Imbalances in Women

Intermenstrual bleeding

Hello, Doctor: For the past six months, I have been experiencing intermenstrual bleeding.
I have visited a gynecologist several times, and health checks on my uterus and ovaries showed no significant issues.
The doctor mentioned it could be ovulation bleeding.
Due to my shift work, my schedule is irregular.
Even though the ovulation bleeding usually lasts about 3-5 days, this time the bleeding has been unusually prolonged, so I am seeking consultation.

Question 1: I had my period from April 1 to April 4, 2021.
In May 2021, I did not have a period at all, and then I had my period again from June 5 to June 9.
However, from June 19 to July 3, I needed to use panty liners, and the bleeding was somewhat thick with some blood streaks (I initially thought it was ovulation bleeding, but there were occasional small black clots).

Question 2: Over the past six months, I have developed an unusual number of acne breakouts, and I suspect it might be a hormonal or endocrine imbalance issue (I initially thought it was mask-related acne, but it has spread to my forehead).

Question 3: I have no sexual experience.
I am scheduled to receive the third dose of the cervical cancer vaccine in September 2021.
Recently, my boyfriend has occasionally engaged in sexual activities with me through manual or oral stimulation (but there has been no penetration).
Most gynecological clinics have told me that since I have no sexual experience, I do not need a Pap smear, but I still feel anxious.
I would like to know if there is still a risk of cervical cancer despite not having had penetrative intercourse.

Ms. S, 30~39 year old female. Ask Date: 2021/07/03

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Regarding your concerns, here are the responses to questions one and two: Even if the gynecological examination shows no structural issues with the uterus and ovaries, functional disorders can still lead to the abnormal conditions you described.
Question three: The relationship between sexual experience and the cervix is not necessarily direct.
Although women with no sexual experience have a relatively lower risk of developing cervical cancer, this does not mean they are exempt from it.
It is advisable to discuss with your primary physician whether further examinations are necessary.
Thank you for your questions, and I wish you health and happiness.

Reply Date: 2021/07/03

More Info

Abnormal bleeding in women can be a source of significant concern and confusion, particularly when it occurs outside of the regular menstrual cycle. Your situation, characterized by prolonged bleeding, hormonal imbalances, and concerns about sexual health, is not uncommon, and it’s crucial to understand the underlying factors that may contribute to these symptoms.

Understanding Abnormal Bleeding
Abnormal bleeding can manifest in various forms, including intermenstrual bleeding (bleeding between periods), postcoital bleeding (bleeding after sexual intercourse), or prolonged menstrual bleeding. In your case, the bleeding you are experiencing, which has been described as occurring around the time of ovulation and lasting longer than usual, may indeed be classified as ovulatory bleeding. This type of bleeding is generally caused by fluctuations in hormone levels, particularly estrogen and progesterone, which can lead to slight shedding of the endometrial lining during ovulation.

Hormonal Imbalances
Hormonal imbalances are a common cause of abnormal bleeding. Factors such as stress, significant changes in weight, excessive exercise, and irregular sleep patterns (which can be exacerbated by shift work) can all disrupt the delicate balance of hormones in the body. The fact that you have noted an increase in acne, particularly on your forehead, may further suggest an underlying hormonal issue, such as polycystic ovary syndrome (PCOS) or other endocrine disorders. These conditions can lead to irregular menstrual cycles and increased androgen levels, which are often associated with acne.

The Role of Lifestyle
Your work schedule and lifestyle choices can significantly impact your hormonal health. Irregular sleep patterns and stress from shift work can lead to disruptions in the hypothalamic-pituitary-ovarian axis, which regulates the menstrual cycle. This disruption can result in irregular ovulation and, consequently, abnormal bleeding patterns. It is essential to prioritize a balanced lifestyle, including regular sleep, a healthy diet, and stress management techniques, to help regulate your menstrual cycle.

Sexual Health Concerns
Regarding your concerns about cervical health, it’s important to note that while penetrative sexual intercourse is a common risk factor for sexually transmitted infections (STIs) and cervical issues, non-penetrative sexual activities, such as finger or oral stimulation, carry a lower risk. However, it is still possible to contract STIs through these activities, especially if there is any exchange of bodily fluids. The HPV vaccine you mentioned is an excellent preventive measure against cervical cancer, and it is advisable to complete the vaccination series as recommended.

Recommendations
1. Consult a Specialist: Since you have already seen multiple gynecologists, consider seeking a specialist in reproductive endocrinology or a healthcare provider who focuses on hormonal health. They may recommend further testing, such as hormone level assessments or imaging studies, to better understand your condition.

2. Track Your Cycle: Keep a detailed record of your menstrual cycle, including the timing, duration, and characteristics of any bleeding, as well as any other symptoms like acne or mood changes. This information can be invaluable for your healthcare provider.

3. Lifestyle Modifications: Aim to establish a regular sleep schedule, engage in stress-reducing activities (like yoga or meditation), and maintain a balanced diet. These changes can help improve your hormonal balance.

4. Regular Check-ups: Even if you haven’t had penetrative intercourse, it’s still wise to have regular gynecological check-ups. Discuss your concerns openly with your healthcare provider, including your anxiety about cervical health.

5. Consider Hormonal Treatments: If hormonal imbalances are confirmed, your doctor may suggest hormonal contraceptives or other treatments to help regulate your cycle and alleviate symptoms like acne.

In conclusion, while abnormal bleeding and hormonal imbalances can be distressing, understanding the potential causes and seeking appropriate medical advice can help you manage your symptoms effectively. Prioritize your health and well-being, and don’t hesitate to advocate for yourself in medical settings.

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