Post-Menstrual Bleeding: Causes and When to Seek Medical Attention

Bleeding after the normal menstrual period?

Hello, Director Cao.
I apologize for bothering you, but I would like to ask for your advice.
My girlfriend is currently in mainland China and it's inconvenient for her to ask directly, so I'm asking on her behalf.
She has been taking the emergency contraceptive pill (Ella) for three months now, and her menstrual periods for the first two months were regular, occurring around the 10th of each month.
This month, her period started around July 10th as well, but it only lasted for two to three days and was lighter than usual.
The last time she had sexual intercourse was on July 16th, about nine days after her period ended.
On July 22nd, she started experiencing bleeding that was bright red and heavy, similar to a regular menstrual flow.
She used a pregnancy test, which came back negative.
Two days before the bleeding started, she missed taking her contraceptive pill and took two days' worth to catch up.
She has been bleeding for two days now and is experiencing breast tenderness and nausea.
Since she is in mainland China and medical care is not very accessible, she is not expected to return to Taiwan until the 20th of next month.
I would like to ask Director Cao if she needs to seek medical attention immediately, and what could this situation possibly indicate?

Guanjie, 30~39 year old female. Ask Date: 2023/07/24

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you can just observe and do not need to seek immediate medical attention.
Just take the next pack of contraceptive pills on July 27.
Wishing you good health.

Reply Date: 2023/07/24

More Info

Post-menstrual bleeding, also known as intermenstrual bleeding, can be concerning, especially when it occurs unexpectedly after a regular menstrual cycle. In your girlfriend's case, she has been taking the oral contraceptive pill (OCP) for three months, and while her previous cycles were regular, she is now experiencing unusual bleeding after her menstrual period.
There are several potential causes for post-menstrual bleeding, particularly in someone who is on hormonal contraceptives. These can include:
1. Hormonal Fluctuations: Oral contraceptives work by regulating hormones, but missed doses can lead to fluctuations that may cause breakthrough bleeding. Since your girlfriend missed a pill and took two doses to catch up, this could have contributed to the bleeding.

2. Breakthrough Bleeding: This is common in the first few months of starting a new contraceptive method. It can occur due to the body adjusting to the hormones, especially if there have been missed pills.

3. Pregnancy: Although she tested negative for pregnancy, it is important to consider the possibility of a false negative, especially if the test was taken too early. If she continues to experience bleeding, it may be advisable to repeat the pregnancy test after a few days.

4. Infections: Conditions such as pelvic inflammatory disease (PID) or sexually transmitted infections (STIs) can cause abnormal bleeding. If there are accompanying symptoms such as unusual discharge, fever, or pelvic pain, this could indicate an infection.

5. Polyps or Fibroids: These benign growths in the uterus can cause irregular bleeding. They are more common in women of reproductive age and can sometimes be detected through a pelvic exam or ultrasound.

6. Other Medical Conditions: Conditions such as thyroid disorders, clotting disorders, or endometriosis can also lead to abnormal bleeding patterns.

Given the situation, it is advisable for your girlfriend to seek medical attention, especially if the bleeding continues or worsens. While she may not have immediate access to healthcare in her current location, she should monitor her symptoms closely. If she experiences severe pain, heavy bleeding (soaking through a pad in an hour), or any signs of infection (fever, chills, foul-smelling discharge), she should seek emergency medical care.

In the meantime, here are some recommendations for her:
- Track Symptoms: Keep a record of the bleeding, including the amount, duration, and any other symptoms (like pain or changes in discharge).

- Avoid Sexual Intercourse: Until she has a clearer understanding of the cause of the bleeding, it may be wise to avoid sexual activity.

- Continue Taking Pills: She should continue taking her contraceptive pills as prescribed, even if she is experiencing bleeding, unless advised otherwise by a healthcare provider.

In conclusion, while breakthrough bleeding can be a common side effect of hormonal contraceptives, it is essential to rule out other potential causes. If the bleeding persists or is accompanied by concerning symptoms, seeking medical attention is crucial for her health and peace of mind.

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