Abnormal Vaginal Bleeding: Key Questions and Answers

How to differentiate?

Hello Doctor, I started taking long-acting leuprolide injections after undergoing a laparoscopic ovarian cystectomy at the end of March.
I began the injections in April, and on November 12, I started taking estradiol valerate.
On the night of November 14, just before having a bowel movement, I noticed about a quarter-sized amount of blood coming from my vagina.
I confirmed it was vaginal bleeding and not from the colon (I had a colonoscopy in March).
In the past few days, I haven't experienced bleeding like that again, but I have noticed spotting in my underwear every 2-3 days, similar to what I experienced while on leuprolide.

(1) Is it normal to have spotting every 2-3 days? Typically, this spotting appears as light brown in my underwear, but there was some orange-red blood on November 14, and a little on the tissue when I wiped.

(2) Is there a risk of cervical cancer for someone over 30 who has never had sexual intercourse? If someone does not want to break their hymen, how can they be screened for cervical cancer?
(3) I’ve heard that abnormal bleeding can be related to cervical cancer.
How can I differentiate between the current spotting I’m experiencing during treatment and the possibility of cervical cancer? Thank you.

lulus, 30~39 year old female. Ask Date: 2021/11/17

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the adverse reactions after taking ethinyl estradiol are more commonly observed during the first month of treatment and tend to diminish over time.
The reported adverse reactions include headaches, breast discomfort, mood swings, acne, irregular bleeding, and amenorrhea.
If these adverse reactions persist, it is recommended to return to the clinic to inform your physician for further evaluation and management.
Thank you! Wishing you safety and health.
Dr.
Chang

Reply Date: 2021/11/17

More Info

Abnormal vaginal bleeding can be a source of concern for many women, and understanding its causes and implications is crucial for effective management. Based on your description and the context provided, let's address your questions systematically.

1. Is it normal to have spotting every 2-3 days?
Spotting between periods can occur for various reasons, especially when hormonal treatments like Diphereline (a GnRH agonist) and other medications are involved. The spotting you are experiencing, particularly if it is light and not accompanied by significant pain, can be a common side effect of hormonal therapy. Hormonal fluctuations can lead to changes in the endometrial lining, which may cause intermittent bleeding or spotting.
The fact that you noted a significant amount of blood on November 14, which was more than usual, could indicate a breakthrough bleeding episode, which is not uncommon with hormonal treatments. However, if the bleeding persists or increases in volume, it is essential to consult your healthcare provider for further evaluation. They may consider adjusting your medication or conducting additional tests to rule out any underlying issues.

2. Is there a risk of cervical cancer for someone over 30 with no sexual experience?
Cervical cancer is primarily associated with persistent infection by high-risk strains of the human papillomavirus (HPV), which is typically transmitted through sexual contact. However, it is important to note that cervical cancer can occur in individuals regardless of their sexual history, although the risk is significantly lower in those who have not been sexually active.
For women over 30, it is recommended to begin cervical cancer screening (Pap smear) regardless of sexual history. If you are concerned about maintaining your virginity, you can discuss this with your healthcare provider. They can perform a Pap smear using a gentle technique that minimizes discomfort and respects your preferences.

3. How to differentiate between abnormal bleeding related to treatment and potential cervical cancer?
Differentiating between abnormal bleeding due to hormonal treatment and symptoms indicative of cervical cancer can be challenging. Generally, abnormal bleeding associated with hormonal treatments is often light and sporadic, while bleeding related to cervical cancer may be more consistent, heavier, and often accompanied by other symptoms such as pelvic pain, unusual discharge, or post-coital bleeding.

If you experience any of the following, it is crucial to seek medical attention:
- Bleeding that is heavier than your normal menstrual flow.

- Bleeding after sexual intercourse.

- Bleeding after menopause.

- Any unusual discharge with a foul odor.

Your healthcare provider may recommend a pelvic examination, Pap smear, and possibly a colposcopy if there are any abnormalities noted during the examination. These tests can help identify any precancerous changes or cancerous lesions.

Conclusion
In summary, while spotting can be a normal side effect of hormonal treatments, it is essential to monitor the pattern and volume of bleeding. Regular cervical cancer screenings are vital, even for those without sexual experience, to ensure early detection and peace of mind. If you have concerns about your symptoms or treatment, do not hesitate to reach out to your healthcare provider for personalized advice and management. They can provide the necessary support and interventions to address your concerns effectively.

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