Abnormal Bleeding Between Periods: Causes and Concerns

Abnormal uterine bleeding outside of the menstrual period?

Hello, I would like to inquire about the issue of abnormal bleeding outside of menstruation.
Here is a summary of my situation: In May, I underwent a series of infertility tests, including hysterosalpingography, transvaginal ultrasound to monitor follicle growth, endometrial thickness assessment, egg white cervical mucus evaluation, and post-coital tests.
I also had blood tests for human papillomavirus and chlamydia, all of which returned normal results.
In May, I received an ovulation induction injection, and the transvaginal ultrasound confirmed ovulation; however, there was no positive outcome.
My menstrual cycle started on June 14 (day 33 of the cycle).

In the new cycle, on day 17 (June 30), I noticed a small amount of brown discharge, which occurred intermittently.
I only noticed it when wiping after urination.
On July 1 (day 18), I visited a gynecologist, and a urine test indicated mild cystitis.
On July 2 (day 19), I experienced bright red abnormal bleeding with small blood clots during urination, prompting another visit to the gynecologist.
A transvaginal ultrasound showed no abnormalities, and the doctor attributed it to stress, prescribing hemostatic medication.

At my follow-up on July 6, there was no further bleeding, but I continued taking the hemostatic medication until July 9 (day 26).
On July 10, my menstrual cycle started (day 27) but only lasted for two days, which was unusual for me (the flow was normal).
On the third day, I had a few instances of brown discharge when wiping, but it cleared up quickly, unlike my usual cycles, which last at least four days.
Concerned about the shortened duration, I thought the hemostatic medication might have caused this, so I sought traditional Chinese medicine for regulation.

On July 17 (day 8), after confirming I was not pregnant, I took Chinese herbal medicine for seven days, hoping my cycle would normalize (I stopped obsessing over pregnancy).
However, on July 29 (day 20), I noticed spotting again before bed (a drop or two).
I decided to observe it, and again, there were intermittent small amounts of brown discharge after urination.
On the night of August 1 (day 23), I experienced spotting again (bright red blood with a small clot).

I feel very helpless about having the same symptoms for two consecutive months.
In February of this year, I had similar symptoms, and the gynecologist attributed it to stress, resolving it with hemostatic medication.
The recent abnormal bleeding has not been accompanied by significant abdominal pain; there is only a slight discomfort, similar to premenstrual symptoms, but milder and not continuous.
I have not taken a pregnancy test for this abnormal bleeding, and my expected menstrual period is from August 5 to August 7.

I would like to ask if you could help clarify my concerns.
I have seen two doctors who both said it was just due to stress, but they could not identify the cause.
Before February 2010, I had never experienced these spotting episodes, except for a specific case in January 2009, when abnormal bleeding was found to be due to a cervical polyp, which was removed at that time.
Over the past year, I have undergone many tests, confirming no recurrence.

All three episodes of abnormal bleeding occurred in the week before my expected period, and there was no sexual intercourse from day 17 until the bleeding started.
The bleeding or brown discharge tends to occur after lying down.
I hope it is indeed just stress and not an undiagnosed underlying condition.
I appreciate your time in helping me clarify this matter.
Thank you very much.

Miss Lin, 30~39 year old female. Ask Date: 2010/08/04

Dr. Chen Changfu reply Obstetrics and Gynecology

Thank you for your hard work! After carefully reading and understanding the detailed medical history, I would like to offer a few personal insights that may be helpful for your reference.
It has been mentioned that multiple gynecological examinations have shown no abnormalities, suggesting that the irregular vaginal bleeding may be attributed to non-gynecological factors, specifically irregular ovulation from the ovaries, medically referred to as Dysfunctional Uterine Bleeding (DUB).
The physician has indicated that stress may be a contributing factor.
If pregnancy is not an immediate concern, you might consider discussing with your gynecologist the option of hormone replacement therapy for 1 to 3 months to temporarily suppress ovarian function, which should alleviate the irregular vaginal bleeding during this period.
Regular use of oral contraceptives can also provide similar benefits.
After the treatment period, ovulation induction medications can be used to promote normal and regular ovulation.

Reply Date: 2010/08/04

More Info

Abnormal bleeding between periods can be a source of significant concern for many women, and understanding its causes is crucial for addressing any underlying issues. Based on the information provided, it appears that you have experienced various forms of abnormal bleeding, including spotting of brown discharge and fresh red blood, often accompanied by stress and other factors.

Understanding Abnormal Bleeding
Abnormal bleeding can manifest in several ways, including spotting between menstrual cycles, heavy periods, or changes in the color and consistency of menstrual blood. The causes can range from hormonal imbalances to structural issues within the reproductive system. Here are some common causes of abnormal bleeding:
1. Hormonal Imbalances: Fluctuations in hormone levels, particularly estrogen and progesterone, can lead to irregular bleeding. This is often seen in conditions such as polycystic ovary syndrome (PCOS) or during perimenopause.

2. Ovulation Bleeding: Some women experience light spotting during ovulation, which is typically harmless and occurs due to the hormonal changes that accompany the release of an egg.

3. Stress: Psychological stress can significantly impact hormonal balance, leading to irregular menstrual cycles and abnormal bleeding. Stress can also exacerbate existing conditions, making symptoms more pronounced.

4. Uterine Conditions: Conditions such as fibroids, polyps, or endometriosis can cause abnormal bleeding. While you mentioned that previous examinations ruled out these conditions, it’s essential to continue monitoring for any changes.

5. Infections: Infections of the reproductive tract, such as pelvic inflammatory disease (PID) or urinary tract infections (UTIs), can also lead to abnormal bleeding. You mentioned a mild bladder infection, which could potentially contribute to your symptoms.

6. Medications: Certain medications, including hormonal contraceptives and blood thinners, can affect menstrual bleeding patterns. You indicated that you have taken various medications, including Provera and herbal remedies, which may also influence your cycle.

Your Specific Situation
From your description, it seems that your abnormal bleeding has been recurrent and associated with periods of stress. The fact that you have undergone extensive testing and received normal results is reassuring, but it does not eliminate the possibility of functional causes related to hormonal fluctuations or stress.

The appearance of brown discharge often indicates older blood that has taken longer to exit the body, while fresh red blood can signify new bleeding. The intermittent nature of your symptoms, particularly the occurrence of spotting before your expected period, suggests that this could be related to hormonal changes rather than a structural issue.

Recommendations
1. Monitor Your Cycle: Keep a detailed record of your menstrual cycle, including the timing, duration, and characteristics of any abnormal bleeding. This information can be valuable for your healthcare provider.

2. Stress Management: Since stress has been identified as a potential trigger, consider incorporating stress-reducing techniques such as mindfulness, yoga, or counseling into your routine.

3. Follow-Up with Healthcare Providers: Continue to communicate with your healthcare providers about your symptoms. If your symptoms persist or worsen, further evaluation may be necessary, including hormonal assessments or imaging studies.

4. Consider Hormonal Treatments: If hormonal imbalances are suspected, your doctor may recommend hormonal treatments to help regulate your cycle and reduce the incidence of abnormal bleeding.

5. Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and adequate sleep, can positively impact hormonal balance and overall well-being.

In conclusion, while abnormal bleeding can be concerning, many cases are related to hormonal fluctuations or stress rather than serious underlying conditions. Continued monitoring and open communication with your healthcare provider are essential for managing your symptoms effectively. If you have any further questions or concerns, do not hesitate to seek medical advice.

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