Abnormal Bleeding: Causes and Insights for Women

Intermenstrual bleeding

Hello Doctor, at the end of April, I experienced intermenstrual bleeding (I didn't pay special attention to whether it was around ovulation).
I visited a clinic, and the doctor suggested it might be due to irregular sleep patterns.
At that time, I underwent an abdominal ultrasound, and I was indeed going to bed quite late, around 1 to 2 AM.
Later in May, I went to a larger hospital for a transvaginal ultrasound, where they found a blood clot or possibly a fibroid in my right ovary, measuring 3 cm on May 11 (which was not detected during my clinic visit in April).
At the end of May, I had intermenstrual bleeding again, so I went back to the hospital for another transvaginal ultrasound, where the suspected blood clot measured 2.5 cm.
The doctor believed it was a blood clot and advised further observation.
This time, the bleeding was attributed to ovulation, as I visited the doctor within three days of ovulation.
In June, I also had slight bleeding during ovulation for two days, and in July, there was no bleeding or symptoms during ovulation.
Then in August, starting the evening of August 15 (which was ovulation day), I felt some pain in my lower abdomen and had slight bright red bleeding, although it was not much.
This month, I also had a later sleep schedule.
By the morning of August 20, after using the restroom, I noticed some blood when wiping.
My menstrual period ended on August 4, and I had sexual intercourse with my husband on August 9 and August 14 without a condom for a while.
Later, he mentioned wanting to use oral sex, so there was no ejaculation inside.
I found on Google that it could also be implantation bleeding, and I'm unsure if this is a possibility.
I would like to ask the doctor if this could be irregular menstruation or ovulation bleeding.

06, 20~29 year old female. Ask Date: 2021/08/20

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is possible that you are experiencing ovulatory bleeding; please monitor the situation.
Wishing you good health.

Reply Date: 2021/08/20

More Info

Abnormal bleeding can be a source of concern for many women, and understanding its causes is essential for effective management. Based on your description, it appears that you have experienced a range of bleeding episodes, including non-menstrual bleeding, which can be attributed to various factors.

Firstly, it’s important to differentiate between normal physiological processes and potential pathological conditions. One common cause of mid-cycle bleeding is ovulation bleeding, which can occur due to hormonal fluctuations during the ovulation phase. This typically happens around the midpoint of your menstrual cycle, when an egg is released from the ovary. The bleeding is usually light and may be accompanied by other symptoms such as mild cramping. Given that you have noted bleeding around your ovulation days, this could very well be the cause.

However, you also mentioned the presence of a blood clot or a possible fibroid in your right ovary, which was identified during an ultrasound. Fibroids are non-cancerous growths in the uterus that can cause a variety of symptoms, including abnormal bleeding. While they are often asymptomatic, they can lead to heavier menstrual bleeding or bleeding between periods, especially if they are located near the uterine lining. The fact that the size of the clot has changed over time suggests that it may be worth monitoring, as advised by your healthcare provider.

Another potential cause of your symptoms could be related to hormonal imbalances, which can be influenced by lifestyle factors such as sleep patterns and stress levels. You mentioned that your sleep schedule has been irregular, which can affect your hormonal balance and lead to irregular bleeding. Stress can also play a significant role in menstrual irregularities, as it can impact the hypothalamus, which regulates the hormones involved in the menstrual cycle.

Regarding the possibility of implantation bleeding, this typically occurs when a fertilized egg attaches to the uterine lining, and it usually happens around a week to ten days after conception. Since you mentioned having unprotected intercourse around the time of ovulation, it is possible that you could be experiencing implantation bleeding. However, this is usually lighter than a typical menstrual period and may be accompanied by other early pregnancy symptoms.

It’s also worth noting that if you have had multiple episodes of abnormal bleeding, it may be prudent to undergo further evaluation. This could include additional imaging studies or hormonal assessments to rule out other conditions such as polycystic ovary syndrome (PCOS), endometriosis, or other structural abnormalities in the reproductive system.

In conclusion, while some of your symptoms may be attributed to normal physiological processes such as ovulation bleeding, the presence of a blood clot and the irregularity of your cycles warrant further investigation. It is essential to maintain open communication with your healthcare provider, share all relevant information about your symptoms and lifestyle, and follow their recommendations for monitoring and treatment. Keeping a detailed record of your menstrual cycle, including the timing and nature of any bleeding, can also be helpful for your healthcare provider in determining the underlying cause of your symptoms.

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