Persistent Vaginal Bleeding: Causes and Concerns

Vaginal bleeding

Around mid-April, I experienced vaginal bleeding and visited a gynecologist who diagnosed me with a cervical polyp, which was subsequently removed.
A Pap smear was performed, and the results were normal.
However, after the removal of the polyp, I continued to have persistent bleeding, although the amount was minimal.
The doctor indicated that this bleeding was not caused by the polyp and advised me to monitor the situation for three months.

From late April to August, my menstrual flow was normal, but I experienced ongoing ovulatory bleeding.
On August 21, my period arrived a week earlier than usual.
Two weeks after that, on September 7, I had another episode of bleeding.
The night before this bleeding, I had significant lower back pain and abdominal discomfort, similar to the soreness after doing many sit-ups.

On September 13, I went to the hospital for a vaginal ultrasound, which showed that my uterus and ovaries were normal, and there were no polyps.
The doctor used a speculum to examine my cervix and noted a small abrasion with some blood.
However, they could not determine the cause of the bleeding.
As of September 18, I am still experiencing persistent bleeding, which is brownish discharge with occasional streaks of blood and some liquid bright red blood that is not very dark.
I would like to know what could be causing this bleeding.

Qin Qin, 30~39 year old female. Ask Date: 2021/09/18

Dr. Wu Xianghui reply Obstetrics and Gynecology

"Abnormal vaginal bleeding" has many causes, including lifestyle habits, stress, age, vaginal infections, benign gynecological conditions, and malignant tumors, among others.
Therefore, it is recommended that you visit a professional obstetrician-gynecologist for examination and evaluation.

Reply Date: 2021/09/18

More Info

Persistent vaginal bleeding can be a concerning symptom for many women, and understanding its potential causes is essential for effective management and peace of mind. Based on your description, it appears that you have undergone several evaluations, including the removal of a cervical polyp and a Pap smear, both of which returned normal results. However, you continue to experience intermittent bleeding, which can be frustrating and worrisome.

Potential Causes of Persistent Vaginal Bleeding
1. Hormonal Imbalances: One of the most common reasons for irregular bleeding is hormonal fluctuations, particularly involving estrogen and progesterone. These hormones regulate the menstrual cycle, and any imbalance can lead to unexpected bleeding, including mid-cycle spotting or prolonged bleeding after menstruation.

2. Ovulation Bleeding: As noted in previous discussions, some women experience ovulation bleeding, which typically occurs around the midpoint of the menstrual cycle. This can manifest as light spotting or bleeding and is often accompanied by changes in cervical mucus. While this is generally benign, it can be concerning if it becomes frequent or prolonged.

3. Cervical or Uterine Issues: Although you had a cervical polyp removed, other conditions such as cervical ectropion (where the cells from the inside of the cervical canal are present on the outside of the cervix) can also cause bleeding. Additionally, endometrial issues, such as hyperplasia or polyps, can lead to abnormal bleeding patterns.

4. Infections: Infections of the reproductive tract, including sexually transmitted infections (STIs), can cause inflammation and bleeding. Even if you have been screened, some infections may not present with obvious symptoms, so it may be worth discussing this possibility with your healthcare provider.

5. Trauma or Injury: As you mentioned experiencing pain and discomfort, it is possible that there could be minor trauma to the vaginal or cervical tissue, especially if there was any recent sexual activity or vigorous physical activity. This can lead to localized bleeding, which may not necessarily indicate a serious underlying condition.

6. Other Medical Conditions: Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or clotting disorders can also contribute to abnormal bleeding patterns. Given your history of PCOS, it may be worthwhile to evaluate how this condition is being managed and whether it could be contributing to your symptoms.

Recommendations for Management
1. Follow-Up with Your Healthcare Provider: Since your symptoms have persisted, it is essential to maintain open communication with your healthcare provider. If you feel that your concerns are not being adequately addressed, consider seeking a second opinion or asking for further diagnostic tests, such as a hysteroscopy or additional imaging studies.

2. Track Your Symptoms: Keeping a detailed record of your bleeding patterns, including the timing, duration, and characteristics of the blood (color, consistency), as well as any associated symptoms (pain, discharge), can provide valuable information for your healthcare provider.

3. Consider Hormonal Treatments: If hormonal imbalances are suspected, your doctor may recommend hormonal contraceptives or other medications to help regulate your menstrual cycle and reduce abnormal bleeding.

4. Lifestyle Modifications: Stress management, regular exercise, and a balanced diet can help support hormonal balance and overall reproductive health.
5. Educate Yourself: Understanding your body and its cycles can empower you to make informed decisions about your health. Resources such as books, reputable websites, and support groups can provide additional insights.

In conclusion, while persistent vaginal bleeding can be distressing, many potential causes are manageable with appropriate medical care. It is crucial to advocate for your health and ensure that you receive the necessary evaluations and treatments to address your symptoms effectively.

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