Abnormal Bleeding: Causes, Treatments, and Concerns

Abnormal bleeding

Hello Doctor: My menstruation started on April 4th and has not stopped since, with varying flow.
I visited a clinic on April 26th, and since I have no sexual experience, only an abdominal ultrasound was performed, which showed no issues.
The doctor prescribed a hemostatic medication (TRANSAMINE) for three days, but my menstruation did not stop.
Therefore, I went to a major hospital for a consultation on May 3rd.
After another ultrasound, the uterus and ovaries were still normal, and I was prescribed "Peili" (Progesterone) soft capsules 100 mg and "Shengda" (Dydrogesterone) enteric-coated tablets 0.625 mg, to be taken twice a day for a total of four pills, along with blood tests for further examination.
When I returned for a follow-up on May 8th, all values were normal, and I did not have menstruation that day.
The doctor then prescribed the same medications for another seven days, advising me to wait for my menstruation to return.
However, in the following days, I experienced some light bleeding (after researching, I learned that taking progesterone can sometimes cause slight bleeding?).
Then yesterday (May 16th), I woke up to find menstrual blood in my underwear, with a significant amount (about 23 cm) and continuous bleeding throughout the day (even dripping after using the restroom).
I would like to ask: 1.
Is this normal? Since I have not yet completed the two-week course of medication! 2.
Should I continue taking the remaining four pills, or should I stop the medication and observe? Should I buy contraceptive pills to regulate my cycle after five days? 3.
If I purchase contraceptive pills on my own, do I need to take estrogen medications as well? 4.
Is there a possibility of "endometrial cancer"? Can an abdominal ultrasound detect "endometrial cancer"? 5.
Can taking myo & D-chiro inositol help improve my condition? Can it be taken together with the contraceptive pills? Thank you for addressing these questions.

Miss Lin, 20~29 year old female. Ask Date: 2023/05/17

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, please stop the medication and try taking the contraceptive pill after 5 days to see if there is any improvement this cycle.
If not, it is recommended to consult a gynecologist.
As for inositol, it does not have any impact.
Wishing you good health.

Reply Date: 2023/05/17

More Info

Abnormal bleeding can be a significant concern for many women, and understanding its causes, treatments, and implications is crucial for managing one's health. Based on your description, it seems you have been experiencing prolonged menstrual bleeding since April 4, which has persisted despite medical intervention. Let's address your questions and provide some insights into the situation.

1. Is this normal?
Prolonged bleeding can occur for various reasons, including hormonal imbalances, uterine abnormalities, or even stress. The medications you've been prescribed, such as Tranexamic Acid (TRANSAMINE) and hormonal treatments like progesterone, are typically used to manage abnormal bleeding. However, it's not uncommon for some women to experience breakthrough bleeding or spotting while on hormonal treatments. This can be due to the body adjusting to the hormonal changes or the specific formulation of the medication. If the bleeding is heavy and resembles a menstrual flow, it may warrant further investigation.

2. Should you continue the medication?
It's essential to follow your doctor's advice regarding medication. If your doctor has prescribed a specific course of treatment, it's generally advisable to complete it unless you experience severe side effects or worsening symptoms. However, if the bleeding continues or intensifies, you should contact your healthcare provider for further evaluation. They may need to reassess your treatment plan or consider alternative therapies.

3. Should you take birth control pills?
Birth control pills can help regulate menstrual cycles and reduce abnormal bleeding. If you decide to start taking them, it's essential to consult with your healthcare provider to ensure they are appropriate for your situation. Depending on your health history and the specific type of birth control, your doctor may recommend a combination of estrogen and progestin or a progestin-only pill.

4. Could this be endometrial cancer?
While abnormal bleeding can be a symptom of endometrial cancer, especially in women over 45 or those with risk factors, it is not the only cause. Ultrasound can help identify abnormalities in the uterus, but it may not definitively diagnose cancer. If there are ongoing concerns, your doctor may recommend further testing, such as an endometrial biopsy, to rule out cancer or other serious conditions.

5. Can myo-inositol improve the situation?
Myo-inositol is often used as a supplement for women with polycystic ovary syndrome (PCOS) and may help regulate menstrual cycles and improve insulin sensitivity. While it can be beneficial for some women, it's essential to discuss its use with your healthcare provider, especially if you are taking other medications. Combining supplements with prescribed medications should always be done under medical supervision to avoid potential interactions.

In summary, while some degree of abnormal bleeding can be common, especially when starting new medications, persistent or heavy bleeding should always be evaluated by a healthcare professional. It’s crucial to maintain open communication with your doctor, report any changes in your symptoms, and follow their recommendations for treatment. If necessary, don't hesitate to seek a second opinion or further testing to ensure your health and peace of mind.

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