Abnormal Bleeding vs. Menstrual Cycle in Women’s Health

Bleeding or menstrual period - continuation

Thank you, Dr.
Lu.
So, the bleeding from April 30 to May 2 and from May 13 to May 18 is considered abnormal bleeding, not my menstrual period? I have confirmed that I am not pregnant, but my period still hasn't arrived.
Additionally, is irregular menstruation not a sign of approaching menopause?
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[Obstetrics and Gynecology] Abnormal Bleeding or Menstrual Period 68172 Views 5 Questions:
Questioner: Lin / Female / 45 / 2012/06/10
Dear Doctor, I am almost 45 years old, have endometriosis, and experience severe rectal pain and the urge to defecate during my menstrual period.
I underwent surgery in July 2010.
My last menstrual period started on April 3, and on the second day, I had an extremely heavy flow (23 cm long pad, overflowing in less than an hour).
From April 30 to May 2, I had a small amount of bright red blood on the first day (very brief, only a few minutes, and it was gone by the second bathroom visit), followed by a small amount of brown discharge (similar to the end of a period).
On the third day, I experienced mild rectal pain.
I thought it was the usual sign that my period was coming, but on May 4, the brown discharge stopped, and then from May 13 to May 18, I had a similar brief episode of bright red blood on the second day, followed by a small amount of brown discharge again (like the end of a period).

I would like to ask Dr.
Lin:
1.
What is the phenomenon behind these two episodes?
2.
Is it a sign of ovarian function decline?
3.
Or is it a symptom of menopause?
4.
Given my condition (endometriosis), is it appropriate to supplement hormones like someone approaching menopause?
Response:
Doctor: Dr.
Lu Li-Cheng / 2012/06/15
Dear Lin:
1.
Abnormal vaginal bleeding can have many causes, with the most likely being irregular menstruation.
Other possibilities include pregnancy, inflammation, or growths, among others.

2.
It is unlikely to be ovarian function decline.

3.
It is probably not a symptom of menopause.

4.
Based on your condition, hormone supplementation is not appropriate.

Wishing you peace and health,
Dr.
Lu Li-Cheng, Director of Obstetrics and Gynecology, Taoyuan Hospital, Department of Health.

Lin, 40~49 year old female. Ask Date: 2012/06/15

Dr. Lü Lizheng reply Obstetrics and Gynecology

Hello,
1.
Yes, the bleeding from April 30 to May 2 and from May 13 to May 18 is considered abnormal bleeding, not part of the menstrual period.

2.
If menstruation has not yet occurred, it may also be due to irregular cycles.
It is advisable to consult a gynecologist for evaluation, and if necessary, medication to regulate the menstrual cycle may be provided.

3.
Irregular cycles are not necessarily a sign of perimenopause; young women can also experience irregularities.
However, women approaching menopause do have a higher frequency of irregular cycles.

Wishing you peace and health,
Dr.
Lu Li-Cheng,
Director of the Department of Obstetrics and Gynecology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2012/06/15

More Info

Abnormal bleeding in women can be a complex issue, often leading to confusion and concern. It is essential to understand the various factors that can contribute to abnormal bleeding and how they relate to the menstrual cycle.
Firstly, it is important to differentiate between normal menstrual bleeding and abnormal bleeding. Normal menstrual cycles typically range from 21 to 35 days, with bleeding lasting between 2 to 7 days. Abnormal bleeding can manifest as bleeding between periods, heavy menstrual bleeding, or prolonged bleeding. In your case, the occurrences of bleeding outside your expected menstrual cycle, such as the pink or brown discharge and the fresh red blood, are indicative of abnormal bleeding.

One common cause of mid-cycle bleeding is ovulation bleeding, which occurs when the ovary releases an egg. This can happen around the middle of the menstrual cycle and is often accompanied by a slight drop in estrogen levels, leading to a small amount of bleeding. However, if this bleeding becomes frequent or is accompanied by other symptoms, it may indicate an underlying issue that needs to be addressed.

Hormonal imbalances are another significant factor that can lead to abnormal bleeding. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or even stress can disrupt the delicate balance of hormones that regulate the menstrual cycle. In your case, the fact that you have experienced this bleeding more frequently over the past year suggests that there may be an underlying hormonal issue at play.

Additionally, lifestyle factors such as significant weight loss, changes in diet, or increased physical activity can also impact menstrual cycles. For instance, if you have recently started a new exercise regimen, as mentioned in your query, this could contribute to changes in your menstrual cycle and lead to abnormal bleeding. Exercise can affect hormone levels, and in some cases, excessive exercise can lead to a condition known as hypothalamic amenorrhea, where menstruation stops altogether.

Regarding your concerns about potential underlying conditions, it is crucial to consider that while some causes of abnormal bleeding can be benign, others may indicate more serious conditions such as fibroids, polyps, or endometriosis. Given your history of endometriosis, it is essential to monitor any changes in your bleeding patterns closely. Endometriosis can cause irregular bleeding and pain, and it may require specific treatment to manage symptoms effectively.

In terms of treatment, it is essential to work closely with a healthcare provider who can evaluate your symptoms and possibly recommend further testing, such as blood tests to check hormone levels or imaging studies to assess for structural abnormalities. Hormonal treatments, such as birth control pills, can help regulate the menstrual cycle and reduce the occurrence of abnormal bleeding. However, given your history of endometriosis, any hormonal therapy should be approached with caution and under the guidance of a specialist.

Lastly, it is important to address your concerns about lifestyle changes, such as returning to a more regular schedule after a period of irregularity. While a consistent routine can help stabilize hormone levels, it may take time for your body to adjust. If you have tried various treatments without success, it may be worth seeking a second opinion or consulting a specialist in reproductive endocrinology.

In conclusion, abnormal bleeding can arise from a variety of factors, including hormonal imbalances, lifestyle changes, and underlying medical conditions. It is crucial to seek medical advice to determine the cause of your symptoms and to develop an appropriate treatment plan. Regular monitoring and open communication with your healthcare provider can help you navigate this challenging aspect of women's health.

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