Abnormal Vaginal Bleeding: Causes and Concerns for Women

Bleeding issues

Hello Doctor, I started taking long-acting leuprolide injections after having a laparoscopic ovarian cystectomy at the end of March.
I began the injections in April, and on November 12, I started taking estradiol.
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 rectum, as 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 to 3 days, similar to when I was on leuprolide.

(1) Is it normal to have spotting like this every 2 to 3 days? Typically, the spotting is a light brown color 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 little 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 am experiencing during treatment and potential cervical cancer? Thank you.

Li Ya, 30~39 year old female. Ask Date: 2021/11/18

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
This is a normal phenomenon, and the bleeding will not be excessive.
2.
In theory, it is possible, so after informing the physician, a Pap smear can still be performed without damaging the hymen.
3.
This needs to be determined after examination by a clinical physician.

Reply Date: 2021/11/18

More Info

Abnormal vaginal bleeding can be a source of significant concern for many women, and understanding its causes is crucial for effective management. Based on your description, it seems you have been experiencing irregular bleeding after starting treatment with medications like Diphereline and Endometrin. Let's address your questions and concerns systematically.

1. Understanding the Nature of Your Bleeding: The spotting you describe, occurring every 2-3 days and presenting as light brown or orange-red, can be attributed to hormonal fluctuations caused by the medications you are taking. Diphereline (a GnRH agonist) is often used to manage conditions like endometriosis or fibroids by suppressing ovarian function, which can lead to changes in menstrual bleeding patterns. Spotting can be common during the initial stages of treatment as your body adjusts to the hormonal changes. However, if the bleeding becomes heavier or is accompanied by pain, it is essential 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 risk factor for cervical cancer, the absence of sexual experience does not completely eliminate the risk. The primary cause of cervical cancer is persistent infection with high-risk types of human papillomavirus (HPV). Regular screening via Pap smears is recommended for women starting at age 21, regardless of sexual history. If you are concerned about maintaining your hymen, you can discuss with your healthcare provider about non-invasive screening options or the possibility of a gentle examination that respects your preferences.

3. Differentiating Between Causes of Abnormal Bleeding: It is true that abnormal bleeding can be associated with various conditions, including cervical cancer. However, the characteristics of the bleeding can provide clues. For instance, bleeding that is light and sporadic, especially in the context of hormonal treatment, is less likely to be indicative of cervical cancer. In contrast, bleeding that is heavy, persistent, or associated with other symptoms such as pain or unusual discharge should prompt further investigation. Regular follow-ups and screenings are essential to monitor your health and address any concerns.

4. Consultation and Follow-Up: Given your current treatment and symptoms, it is advisable to maintain open communication with your healthcare provider. They can help you understand the implications of your symptoms and the best course of action. If you experience any significant changes in your bleeding pattern or if you have additional symptoms, do not hesitate to seek medical advice.

In summary, while your current symptoms may be related to the hormonal changes from your treatment, it is essential to monitor them closely. Regular screenings for cervical cancer and open discussions with your healthcare provider about your concerns will help ensure your reproductive health is managed effectively. Remember, your health is paramount, and addressing these issues proactively is the best approach.

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