Nosebleeds During Menstruation: Causes and Concerns

Prolonged menstruation with nosebleeds?

Hello, Doctor.
Since high school, I have been experiencing frequent nosebleeds around my menstrual period or about a week before it.
The nosebleeds do not occur spontaneously; they usually happen after I rub my nose, pick my nose, or blow my nose due to allergies.
It feels like the nasal mucosa becomes particularly fragile during that time.
However, I rarely experience nosebleeds when I engage in those activities outside of my menstrual period.
In high school, I had an ultrasound, and the doctor said there was nothing wrong, only that my endometrium was slightly thick, and that I should just monitor it.
At that time, I forgot to mention the nosebleeds, so I have not visited a gynecologist since then.
From my online research, I found possible explanations such as endometriosis affecting the nasal cavity or hormonal changes during my menstrual cycle causing congestion in the nasal microvasculature.
Could you please explain the main reasons for experiencing nosebleeds during my menstrual period? Thank you! Additionally, I would like to ask about premenstrual syndrome (PMS).
Typically, it occurs about a week before menstruation, but I usually start experiencing breast tenderness and pain in my armpits about two weeks prior.
Is this normal? Thank you, Doctor!

Wendy, 20~29 year old female. Ask Date: 2022/05/26

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, there are two potential causes for nosebleeds: one is that certain specific areas of the nasal mucosa are more sensitive to estrogen stimulation.
During the menstrual period, when estrogen levels rise, the blood vessels in these areas may proliferate, swell, and become congested, leading to rupture and bleeding.
The other cause could be the presence of ectopic endometrial tissue in the nasal mucosa, which may result in nosebleeds in accordance with the menstrual cycle.
It is advisable to consult an otolaryngologist to confirm the cause.
Additionally, premenstrual syndrome may present symptoms a week prior to menstruation, so it may be beneficial to have an evaluation by a gynecologist if necessary.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2022/05/26

More Info

Nosebleeds, or epistaxis, during menstruation can be concerning and may arise from various factors. It’s important to understand the potential causes and when to seek medical attention.
Firstly, hormonal fluctuations during the menstrual cycle can significantly affect the body, including the nasal mucosa. Estrogen and progesterone levels rise and fall throughout the cycle, and these hormonal changes can lead to increased blood flow and vascular permeability in various tissues, including the nasal passages. This can make the nasal mucosa more susceptible to bleeding, especially if there is any irritation or trauma, such as from blowing the nose, allergies, or even dry air.
Additionally, during menstruation, some women may experience a condition known as "nasal congestion" due to hormonal changes, which can lead to increased pressure in the nasal vessels. This increased pressure can make the blood vessels in the nose more prone to rupture, especially if there is any additional irritation from actions like nose-picking or vigorous blowing.
Regarding your experience of having nosebleeds primarily around your menstrual cycle, it is plausible that the hormonal changes are contributing to the fragility of your nasal mucosa. The fact that you mentioned a history of a slightly thickened endometrium observed via ultrasound is not directly related to nosebleeds but indicates that your gynecological health is being monitored. It’s essential to continue regular check-ups with your healthcare provider to ensure that any changes in your menstrual cycle or symptoms are appropriately evaluated.

You also mentioned experiencing breast tenderness and pain in the armpits two weeks before your period. This symptom can be associated with premenstrual syndrome (PMS) or even premenstrual dysphoric disorder (PMDD), which can cause a range of physical and emotional symptoms due to hormonal changes. While breast tenderness is common, the timing and severity can vary significantly among individuals. If these symptoms are severe or impacting your quality of life, it would be advisable to discuss them with a healthcare provider who can offer guidance on management strategies.

In summary, the nosebleeds you are experiencing during your menstrual cycle could be attributed to hormonal changes affecting the nasal mucosa, making it more susceptible to bleeding. It is essential to monitor these symptoms and consult with a healthcare provider, particularly an ear, nose, and throat (ENT) specialist or a gynecologist, to rule out any underlying conditions and to discuss your menstrual symptoms in detail. They may recommend further evaluation or treatment options to help manage your symptoms effectively.
If you notice any significant changes in your bleeding patterns, experience frequent or severe nosebleeds, or have other concerning symptoms, do not hesitate to seek medical attention. Keeping a symptom diary that tracks your menstrual cycle, nosebleeds, and any other symptoms can also be helpful for your healthcare provider in understanding your situation better.

Similar Q&A

Understanding Frequent Nosebleeds: Causes and Solutions for Your Sister

Hello: My sister has had habitual nosebleeds since she was young. She has seen a doctor who said it is due to thin nasal membranes. However, when she has a nosebleed, it lasts for half an hour to an hour, and each time there are different sizes of blood clots. Sometimes, after on...

Dr. Cai Zhenggu reply Otolaryngology
Hello, sister: The common cause of nosebleeds in children is allergic rhinitis, which leads to nasal itching and frequent nose picking, resulting in the rupture of small blood vessels. The treatment method must first address the symptoms of allergic rhinitis.

Understanding Frequent Nosebleeds: Causes and When to Seek Help

Hello Doctor, I would like to ask you about something. I have been experiencing nosebleeds for four consecutive days. A doctor once mentioned that the mucosa in my nasal wings is thinner. However, there have been instances recently where I have not touched my nose at all, and it ...

Dr. Xiao Yongxun reply Internal Medicine
Hello: Nosebleeds refer to acute bleeding from the nostrils, nasal cavity, or nasopharynx; they are primarily caused by damage to the nasal mucosa and blood vessel walls. There are many causes; locally, it can be due to trauma, a deviated septum, infections, allergies, surgery, t...

Understanding Nosebleeds: Causes, Symptoms, and Treatment Insights

Hello Doctor: To ensure you have a clear understanding of my symptoms, I will provide a detailed account and hope you can share all relevant information. I am here to consult about my nosebleeds. Firstly, I have no history of nasal diseases and have not experienced a nosebleed fo...

Dr. Ji Zhaoyun reply Otolaryngology
Hello, based on your description: There are many causes of nosebleeds, the most common being thin nasal mucosa, which can result from forceful nose blowing. However, conditions such as nasopharyngeal or nasal cavity tumors (like nasopharyngeal carcinoma), sinusitis, fungal infect...

Understanding Frequent Nosebleeds: Causes and Concerns for Your Health

Hello, doctor! I have been experiencing habitual nosebleeds for a while now. The nosebleeds occur at no specific time, and the blood is mostly bright red. I do not have any noticeable discomfort in my body. I'm wondering if these nosebleeds could affect my brain in any way.

Dr. Chen Duliang reply Otolaryngology
Hello, young girl: A small amount of nosebleed will not affect the brain. Please visit our ENT outpatient department for a detailed examination and treatment. Wishing you health and happiness. Sincerely, Dr. Chen Du-Liang.