Abnormal Mid-Cycle Bleeding: Causes and Concerns for Women

Abnormal bleeding

Hello Dr.
Chen,
I am unmarried and have a steady partner.
There is no history of cancer in my family.
My menstrual cycle is approximately 27 to 32 days.
However, in the past two to three years, I have experienced abnormal bleeding in the middle of my cycle (sometimes between days 10 to 16, and other times between days 18 to 22), presenting as pink or brown discharge or bright red streaks mixed with stretchy mucus.
Many doctors have suggested that this is ovulation bleeding and advised me not to worry about it.
For over a year, it occurred infrequently (about every 4 to 5 months), but in the past year, according to my records, it has been almost monthly! When I encounter this bothersome symptom, I usually take Provera once daily, and the bleeding typically stops within about two days.
However, this month has been strange; after my menstrual period from May 15 to May 20, I started bleeding again on June 1 (with red streaks and brown discharge).
I initially thought it would stop after three to four days, but it has been over a week, and it is still ongoing.
Premenstrual syndrome symptoms are still quite noticeable (breast tenderness).

I have consulted three obstetricians and gynecologists.
The first prescribed Trasamin and other hemostatic medications three times a day, the second prescribed estrogen combined with progesterone once daily, and the third administered an injection to enhance hemostatic effects, but none of these treatments have been effective! All three doctors have stated that they performed a sonogram, pelvic examination, and Pap smear, ruling out factors such as polyps and tumors, and noted that my endometrium is thickened.
However, why are the medications they prescribed unable to stop this minor bleeding (if it is indeed due to hormonal imbalance)? I am quite worried.
Could this be related to my experience as a nurse two years ago when I worked rotating shifts? I started having sexual intercourse that year, and that is when I first noticed mid-cycle bleeding! Now that I am back in school as a night student, my schedule is quite regular, but why hasn’t my hormone balance improved, and instead, the bleeding has become more frequent? Last month, I even tried traditional Chinese medicine to regulate my body, but it still persists! Could this prolonged bleeding be related to the herbal medicine I took? Or is there something wrong with my ovaries or uterus?

Xiao Ren, 20~29 year old female. Ask Date: 2002/06/13

Dr. Chen Changfu reply Obstetrics and Gynecology

Dear online friend,
Hello! The descriptions provided by healthcare professionals regarding disease symptoms and medical visits are concise yet clear.
From your account, it is evident that you have sought medical attention wisely.
After an examination and ultrasound by a gynecologist, it appears that you are still experiencing intermenstrual bleeding, which has led to concerns due to less than ideal medical results.

Based on your menstrual cycle (27-32 days), the timing of the intermenstrual bleeding (sometimes occurring between days 10-16, and other times between days 18-22), and your symptom descriptions, I concur with the diagnoses of three gynecologists that this is likely ovulatory bleeding.
The underlying cause of ovulatory bleeding in women is believed to be slight fluctuations in estrogen levels during ovulation, which can lead to minimal shedding of the already thickened endometrial lining, resulting in variable amounts of bleeding.

This ovulatory bleeding does not necessarily occur in every cycle, and the symptoms (amount and duration of bleeding) can vary each time, which can be confusing for patients.
During medical consultations, gynecologists will conduct various tests to rule out any organ or tumor-related diseases, and then confirm ovulatory bleeding based on the examination findings.

In clinical treatment, very light bleeding (brown discharge) may resolve on its own within a few days without medication, or may improve with a mild hemostatic agent.
If the bleeding is more significant, higher doses of estrogen may be required to enhance hemostatic function and repair the shedding endometrium to stop the bleeding.
In some cases, progesterone may also be used to regulate the timing of the next menstrual period (commonly referred to as cycle regulation), which can lead to satisfactory treatment outcomes for the patient.
However, this treatment addresses only the current symptoms and does not prevent future episodes of ovulatory bleeding.

Therefore, it is understandable that you are concerned about the recurrent nature of ovulatory bleeding.
Based on experience, women using intrauterine devices (IUDs) may be more prone to such symptoms, with potentially heavier and prolonged bleeding.
You mentioned being unmarried but having a steady partner and suffering from recurrent ovulatory bleeding.
I would suggest considering the regular use of oral contraceptives, as they suppress ovarian ovulation, preventing ovulation and thus avoiding ovulatory bleeding.
This would serve both as contraception and a means to alleviate the occurrence of ovulatory bleeding.

Please consider this suggestion!
Sincerely,
Dr.
Chen Chang-Fu
Department of Obstetrics and Gynecology
Qishan Hospital, Department of Health, Executive Yuan
June 17, 2002, 5 PM

Reply Date: 2002/06/13

More Info

Abnormal mid-cycle bleeding can be a source of concern for many women, especially when it becomes a recurrent issue. Based on your description, it seems that you have been experiencing this type of bleeding for the past couple of years, with a notable increase in frequency over the last year. It is understandable that you feel anxious about this situation, especially after consulting multiple gynecologists without finding a satisfactory solution.

First, let's clarify what mid-cycle bleeding is. This type of bleeding can occur around the time of ovulation, typically occurring about 10 to 16 days after the start of your last menstrual period. It is often referred to as ovulation bleeding and can manifest as light spotting, which may be pink or brown in color. This phenomenon is generally considered normal and is attributed to hormonal fluctuations that occur during the menstrual cycle. Specifically, a drop in estrogen levels just before ovulation can lead to a slight shedding of the uterine lining, resulting in this light bleeding.

However, your case seems to be more complex. The fact that you have been experiencing this bleeding consistently for several months, along with the presence of thickened endometrial lining, raises some questions. While the initial assessments by your doctors ruled out significant pathologies such as polyps or tumors, it is essential to consider other factors that might contribute to your symptoms.

One potential cause of your abnormal bleeding could be hormonal imbalance. Hormonal fluctuations can be influenced by various factors, including stress, lifestyle changes, and even changes in your sleep patterns. You mentioned that you have recently returned to school and have a more regular schedule, which should theoretically help stabilize your hormones. However, if you have experienced significant stress or changes in your emotional well-being, this could still impact your hormonal regulation.

Additionally, you mentioned taking Provera (medroxyprogesterone) to manage the bleeding. While this medication can help regulate the menstrual cycle and reduce abnormal bleeding, it may not address the underlying cause of your symptoms. If your bleeding persists despite treatment, it might be worth discussing with your healthcare provider the possibility of further evaluations, such as hormone level testing or a more detailed ultrasound to assess the endometrial lining.

Regarding your concern about the potential impact of traditional Chinese medicine (TCM) on your condition, it is essential to recognize that while TCM can be beneficial for some individuals, it may not always align with Western medical approaches. If you are considering alternative treatments, it is crucial to communicate this with your healthcare provider to ensure that all aspects of your treatment plan are coordinated.

Lastly, it is important to remember that while mid-cycle bleeding can be concerning, it is not always indicative of a severe underlying condition. Many women experience similar symptoms, and with appropriate management and monitoring, it is often possible to find a solution that works for you. If your symptoms continue or worsen, seeking a second opinion or consulting a specialist in reproductive endocrinology may provide additional insights and treatment options.

In conclusion, while your situation is understandably distressing, there are various avenues to explore for relief. Keeping an open line of communication with your healthcare providers and advocating for your health will be crucial in finding a resolution to your abnormal bleeding.

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