Abnormal Vaginal Bleeding: Key Concerns for Women

Hello, how can I assist you today?

Hello Doctor, here’s my situation: I started taking the contraceptive pill at the end of March this year and began receiving long-acting leuprolide injections in April.
On November 12, I started taking ethinyl estradiol, and on the night of November 14, I noticed about a quarter-sized amount of blood coming from my vagina just before having a bowel movement.
I confirmed that 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 on my underwear every 2-3 days, similar to when I was on leuprolide.

(1) Is it normal to have spotting every 2-3 days? Typically, this spotting appears as light brown on my underwear, but there is none on the tissue when I wipe.
On November 14, the blood on my underwear was a reddish-orange color, and there was also a bit of blood on the tissue.

(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 potential cervical cancer? Thank you.

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

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
Etonogestrel may cause abnormal bleeding as a side effect.

2.
Squamous cell carcinoma of the cervix is 100% caused by HPV (a sexually transmitted infection); adenocarcinoma of the cervix, which has a lower incidence than squamous cell carcinoma, is not caused by HPV.

3.
Yes, it cannot be distinguished.

Reply Date: 2021/11/17

More Info

Abnormal vaginal bleeding is a common concern among women and can be indicative of various underlying health issues. Your situation, particularly with the recent use of medications like Diphereline and the occurrence of spotting, raises several important questions regarding the nature of your bleeding, potential risks, and the need for appropriate screenings.

1. Understanding Spotting and Abnormal Bleeding: The spotting you are experiencing, especially after starting hormonal treatments, can be a common side effect. Hormonal medications, including those used for endometriosis or to manage menstrual cycles, can lead to irregular bleeding patterns. The fact that you mentioned seeing light brown or orange-red blood could suggest that this is old blood being expelled from the uterus, which is often not a cause for alarm. However, if the bleeding persists or increases in volume, it is crucial to consult your healthcare provider.

2. Risk of Cervical Cancer: Regarding your concern about cervical cancer, it is important to note that while sexual activity is a significant risk factor for cervical cancer, it is not the only one. The human papillomavirus (HPV) is the primary cause of cervical cancer, and it can be transmitted through skin-to-skin contact, not just penetrative sex. Therefore, even without sexual experience, it is advisable to discuss HPV vaccination and screening options with your healthcare provider.
3. Screening for Cervical Cancer: For women who are concerned about cervical cancer but wish to maintain their virginity, there are still options for screening. The Pap smear, which is a test that can detect precancerous changes in the cervix, can often be performed without penetration. Some healthcare providers may use a smaller speculum or alternative methods to collect samples. It is essential to communicate your concerns with your doctor, who can provide guidance on how to proceed with screening while respecting your wishes.

4. Differentiating Between Causes of Bleeding: Distinguishing between abnormal bleeding due to hormonal treatment and potential signs of cervical cancer can be challenging. Typically, abnormal bleeding related to hormonal changes is irregular and may not be accompanied by other symptoms like pain or unusual discharge. In contrast, bleeding associated with cervical cancer may present with other symptoms such as pelvic pain, unusual discharge, or bleeding after intercourse. If you notice any of these additional symptoms, it is crucial to seek medical attention promptly.

5. Next Steps: Given your current situation, I recommend keeping a detailed record of your bleeding patterns, including the timing, color, and volume of blood. This information will be helpful for your healthcare provider in assessing your condition. Additionally, consider scheduling a follow-up appointment to discuss your concerns about cervical cancer screening and the implications of your current treatment regimen.

In conclusion, while abnormal vaginal bleeding can be concerning, it is essential to approach the situation with a clear understanding of your symptoms and the potential underlying causes. Open communication with your healthcare provider will be key in navigating your health concerns and ensuring appropriate screenings and treatments are in place.

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