Post-Coital and Intermenstrual Bleeding: Causes and Concerns

Postcoital bleeding and non-coital bleeding?

Hello, doctor: I am married with two children and have been troubled by irregular menstruation for a long time.
Recently, it has become more frequent.
A few months ago, I noticed light bleeding after intercourse.
I went to the hospital for an examination, and the doctor said I have pelvic inflammatory disease and a hydrosalpinx in my uterus.
I have been taking medication regularly, but my condition has not improved; instead, I have experienced bleeding even without intercourse, and the amount is greater than the bleeding after intercourse.
I have annual Pap smears, which have all been normal.
I use an intrauterine device (IUD) for contraception.
Could you please inform me if there are any similar conditions associated with the brownish color of the bleeding that occurs without intercourse? Thank you for your assistance! A worried person.

ANN, 30~39 year old female. Ask Date: 2004/01/24

Dr. Chen Changfu reply Obstetrics and Gynecology

Dear User,
Hello! In your letter, you mentioned that you have been troubled by abnormal genital bleeding for the past three months.
It is commendable that you have consulted a physician.
Besides being informed of having pelvic inflammatory disease, no other abnormalities were found, and you have been regularly undergoing Pap smears, all of which have returned normal results, so you should feel reassured.
There are many possible causes of abnormal uterine bleeding, and women using intrauterine devices (IUDs) often experience irregular bleeding during their menstrual periods.
This is because the IUD can trigger a foreign body rejection reaction in the uterus (which may also contribute to its contraceptive effectiveness), leading to congestion of the endometrium.
Therefore, users of IUDs are more likely to experience abnormal spotting.
Since you are using a Mirena IUD and your gynecological examinations have all been normal, it is possible that the abnormal bleeding is simply a result of the IUD.
It is not specified when the device was inserted, but if it was placed only three to four months ago, the likelihood is even greater.
This is because the foreign body rejection reaction is most pronounced in the first three to four months after insertion, often resulting in abnormal bleeding for women using IUDs.
If this is indeed the case, there is no need for concern.
Please consult your physician for symptomatic treatment or patiently wait for your body to adjust to the device.
As the foreign body rejection reaction decreases, the abnormal bleeding and vaginal discharge associated with the IUD will also lessen.
Thank you for your letter, and I hope this response meets your satisfaction.
Wishing you a happy New Year and all the best!

Reply Date: 2004/01/24

More Info

Understanding post-coital and intermenstrual bleeding can be quite complex, as there are numerous potential causes and underlying conditions that may contribute to these symptoms. Based on your description, it seems you have been experiencing irregular menstrual cycles, post-coital bleeding, and intermenstrual bleeding, which can indeed be concerning.

Post-coital bleeding refers to bleeding that occurs after sexual intercourse, while intermenstrual bleeding occurs between menstrual periods. Both can be indicative of various gynecological issues. In your case, the diagnosis of pelvic inflammatory disease (PID) and the presence of a uterine cyst (water tumor) are significant findings. PID is an infection of the reproductive organs that can lead to inflammation and scarring, potentially causing abnormal bleeding. Uterine cysts, depending on their nature, can also contribute to irregular bleeding patterns.

The fact that you are experiencing bleeding even when not engaging in sexual activity raises additional concerns. This could be due to several reasons, including hormonal imbalances, endometrial issues, or even the presence of fibroids or polyps in the uterus. The color of the blood, such as the coffee-colored discharge you mentioned, may indicate older blood that has taken longer to exit the body, which can occur with certain conditions, including endometriosis or retained products of conception.

It is crucial to follow up with your healthcare provider for further evaluation. Since you have been on medication without improvement, it may be time to consider additional diagnostic tests. A transvaginal ultrasound can provide more insight into the structure of your uterus and ovaries, helping to identify any abnormalities such as fibroids, polyps, or cysts. Additionally, a hysteroscopy may be warranted to directly visualize the inside of the uterus and potentially obtain biopsies if necessary.

Given that you have regular Pap smears that are normal, it is less likely that cervical cancer is the cause of your symptoms, but it is still essential to rule out any cervical lesions or other abnormalities. If you are using an intrauterine device (IUD) for contraception, it is also worth discussing with your doctor, as some women experience irregular bleeding with IUDs, especially in the initial months of use.

In summary, while post-coital and intermenstrual bleeding can be distressing, they are often manageable once the underlying cause is identified. It is essential to maintain open communication with your healthcare provider, advocate for further testing if necessary, and explore all treatment options available to address your symptoms effectively. Remember, your health and well-being are paramount, and seeking timely medical advice is crucial in managing these concerns.

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