Abnormal Bleeding: Causes and Concerns for Women

Intermenstrual bleeding

Hello, doctor! My menstrual cycle has always been very regular.
My last period started on January 27 and lasted for 6 to 7 days.
On February 4, I had intimate contact with my boyfriend (the first time involving one finger insertion and genital rubbing).
The next day (February 5), I noticed fresh blood when wiping after using the restroom, and from February 6 to February 9, there was a small amount of brown discharge when wiping.
On February 10 and 11, I observed light red blood when wiping.
On February 13, I had intimate contact with my boyfriend again, similar to the previous time.
From February 10 to 13, in the evenings, I noticed a significant amount of brown discharge when using the restroom, which appeared to resemble endometrial tissue (once a day, only when wiping, similar to the feeling of the first day of menstruation).
There were also traces of red or brown blood on the panty liner.
On February 14, there was intermittent brown discharge, which is still ongoing.

Note: 1.
An ultrasound last May showed a uterine polyp, which subsequently resolved on its own (the most recent check was on February 12).
2.
I have consistently experienced brown spotting during ovulation and suspected ovulation pain, but this time the bleeding seems particularly severe.

I would like to ask the doctor if this could be ovulation bleeding (although online sources say that ovulation bleeding usually lasts 1 to 3 days), or if the possibility of pregnancy cannot be ruled out after the intimate contact on February 4, indicating potential implantation bleeding? What could be the reasons for the bleeding, and what nutrients should I supplement? Given my situation, do I need to arrange for a hysteroscopy? (I have not had any formal sexual intercourse).
Thank you, doctor!

Niming, 20~29 year old female. Ask Date: 2022/02/14

Dr. Huang Zifei reply Obstetrics and Gynecology

Dear Anonymous,
1.
Based on your description, the bleeding you are experiencing is more likely due to ovulation bleeding or bleeding caused by intercourse or friction.
Although vaginal intercourse was not completed, there is still a possibility of pregnancy.
If your period is delayed by a week, it is advisable to take a pregnancy test.
2.
For light bleeding, a normal diet is sufficient.
If you wish to supplement, consider increasing your intake of iron-rich foods, such as dark green vegetables and red meat.
3.
Regarding the scheduling of a hysteroscopy, it is recommended to consult with a gynecologist after a thorough examination to discuss whether it is appropriate to proceed with the procedure.
Sincerely,
Dr.
Huang Tzu-Fei, Department of Obstetrics and Gynecology, Nantou Hospital

Reply Date: 2022/02/14

More Info

Abnormal bleeding can be a source of significant concern for many women, and understanding its causes is crucial for addressing any underlying issues. Based on your description, it appears that you are experiencing a range of symptoms that could be attributed to several factors, including hormonal fluctuations, potential ovulation bleeding, or even the possibility of implantation bleeding if there is a chance of pregnancy.

Firstly, let's clarify what abnormal bleeding entails. Abnormal bleeding refers to any bleeding that occurs outside of your regular menstrual cycle. This can include bleeding between periods, heavy menstrual bleeding, or bleeding after intercourse. In your case, the timeline of events suggests that you may be experiencing a combination of factors.

You mentioned that your menstrual cycle has been regular, with your last period starting on January 27 and lasting for 6-7 days. The intimate contact with your boyfriend on February 4, followed by the onset of bleeding on February 5, raises questions about the nature of this bleeding. The presence of fresh blood and then subsequent brown discharge could indicate several possibilities.

1. Ovulation Bleeding: It is not uncommon for some women to experience light bleeding or spotting during ovulation, which typically occurs around the midpoint of the menstrual cycle. This bleeding is usually light and can be accompanied by other symptoms such as mild cramping. However, you noted that this episode seems more pronounced than previous instances of ovulation bleeding, which typically lasts 1-3 days.

2. Implantation Bleeding: If there is a possibility of pregnancy, the bleeding you are experiencing could be implantation bleeding, which occurs when a fertilized egg attaches to the lining of the uterus. This type of bleeding is usually light and can be brown or pink in color. However, given that you mentioned the nature of your intimate contact, it is essential to consider whether there was any risk of sperm entering the vagina.

3. Hormonal Imbalance: Fluctuations in hormones can lead to irregular bleeding patterns. Stress, changes in lifestyle, or even dietary changes can impact your hormonal levels, leading to unexpected bleeding. You mentioned experiencing significant changes in your routine, which could contribute to this.

4. Uterine Polyps or Other Conditions: Although you previously had a uterine polyp that resolved, it is essential to keep in mind that other conditions, such as fibroids or endometriosis, can also cause abnormal bleeding. Since you have a history of uterine polyps, it may be worth discussing further evaluation with your healthcare provider.

Given your symptoms and history, it would be prudent to consult with a healthcare professional for a thorough evaluation. A transvaginal ultrasound or a hysteroscopy may be recommended to visualize the uterine lining and rule out any structural abnormalities. Additionally, a pregnancy test could help clarify whether implantation bleeding is a possibility.

In terms of nutritional support, maintaining a balanced diet rich in iron, vitamins, and minerals can be beneficial, especially if you are experiencing any bleeding. Foods high in iron, such as leafy greens, lean meats, and legumes, can help replenish any lost blood. Staying hydrated and managing stress through relaxation techniques or exercise can also support overall hormonal balance.

In conclusion, while your symptoms may suggest ovulation bleeding, the possibility of other causes, including hormonal imbalances or even implantation bleeding, should not be overlooked. A thorough evaluation by a healthcare provider will help determine the appropriate course of action and provide you with peace of mind regarding your reproductive health.

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