Abnormal Bleeding After Menstruation: What You Need to Know

Bleeding a few days after the end of menstruation?

Hello Doctor, I went to the clinic on April 20th and received a positive HPV report.
The doctor recommended a biopsy, which was performed that same day.
My next menstrual period was originally due on May 4th, but five days after the biopsy, on April 24th, my period started.
That evening, I returned for a follow-up to check the healing of the biopsy site and to consult with the doctor.
The doctor mentioned that my period likely came early (only a pelvic examination was performed that day).
By April 29th, there was no bleeding at all, but four days later, on May 2nd, I started bleeding again.
The amount of blood was similar to my menstrual flow, bright red, and there were one or two instances of blood clots.
Today, May 3rd, is the second day of this bleeding.
Is this bleeding considered normal? If I return for a follow-up, can I ask the doctor to perform an abdominal ultrasound or a transvaginal ultrasound? The doctor has only conducted pelvic examinations without using any other instruments.
Thank you for your response.

Niming, 30~39 year old female. Ask Date: 2023/05/03

Dr. Huang Yuande reply Obstetrics and Gynecology

1.
HPV positivity typically does not warrant an immediate biopsy, but colposcopy or regular Pap smear follow-up can be performed.
2.
It is difficult to determine from the description whether the bleeding is from the uterus or from a biopsy site; a clinical examination is necessary for clarification.
3.
I hope you can communicate your concerns with your physician; I believe they will provide you with an explanation.

Reply Date: 2023/05/03

More Info

Abnormal bleeding after menstruation can be concerning, especially in the context of recent medical procedures such as a biopsy. In your case, it appears that you experienced an early onset of your menstrual period shortly after the biopsy, followed by a subsequent episode of bleeding that occurred a few days later. This situation raises several important considerations regarding the nature of your bleeding and the potential underlying causes.

Firstly, it is not uncommon for menstrual cycles to be disrupted following a medical procedure, particularly one involving the cervix or uterus, such as a biopsy. The body may react to the trauma of the procedure, leading to changes in hormone levels and menstrual timing. The initial bleeding you experienced on April 24 could indeed be a result of your menstrual cycle being affected by the biopsy. However, the subsequent bleeding on May 2, which you described as being similar in volume to your regular menstrual period and accompanied by blood clots, warrants further investigation.

The presence of bright red blood and clots can indicate several possibilities. It could be a continuation of your menstrual cycle, especially if your cycles are typically heavy. However, it could also suggest other issues, such as:
1. Post-procedural bleeding: Sometimes, after a biopsy, there may be residual bleeding from the site of the procedure, which can manifest as abnormal bleeding days or weeks later.

2. Hormonal fluctuations: The biopsy may have caused temporary hormonal changes that could lead to irregular bleeding patterns.

3. Uterine or cervical issues: Conditions such as fibroids, polyps, or even infections can cause abnormal bleeding and should be ruled out.

Given your concerns and the nature of your symptoms, it is advisable to follow up with your healthcare provider. You have the right to request further diagnostic imaging, such as an abdominal ultrasound or a transvaginal ultrasound, to assess the uterus and ovaries for any abnormalities that could be contributing to your bleeding. These imaging studies can provide valuable information about the structure of your reproductive organs and help identify any potential issues that may require treatment.

When you visit your doctor, be sure to communicate all your symptoms clearly, including the timing, volume, and characteristics of the bleeding, as well as any other symptoms you may be experiencing, such as pain or discomfort. This information will assist your healthcare provider in making an accurate diagnosis and determining the best course of action.

In summary, while some irregular bleeding can be a normal response to a recent biopsy, the timing and characteristics of your bleeding suggest that further evaluation is warranted. Do not hesitate to advocate for yourself and request the necessary tests to ensure your health and peace of mind. Your healthcare provider is there to help you navigate these concerns and provide the appropriate care.

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