Irregular Bleeding: Causes and Concerns for Women

Abnormal bleeding

Hello Dr.
Lu,
My menstrual cycle is not very regular, but it has always fallen between 31 to 40 days (each menstrual period lasts for 7 days without exception).
I have been trying to conceive for the past few months.
At the end of August, I calculated my ovulation period based on a few cycle lengths (the first day of my last menstrual period was August 10, and it ended on August 16).
The days we tried to conceive were August 25, August 27 (for a 31-day cycle), August 29 (for a 33-day cycle), and August 31 (for a 35-day cycle).

On September 1, I noticed some spotting (only 21 days after the first day of my last period).
From September 2 to today, September 12 ( it has been 11 days ), the bleeding has consistently been bright red with occasional blood clots.
The first three days had only a few drops of blood, but then it increased to a moderate amount compared to my menstrual flow (the sanitary pad was rarely stained, mostly I noticed enough blood to discolor the toilet when I used the restroom).

On September 11, I purchased a pregnancy test, which showed negative.
Following a friend's suggestion, I started tracking my basal body temperature from September 7 (using a traditional oral thermometer, measured every morning upon waking without getting out of bed).
The readings were as follows:
- September 7: 36.8°C
- September 8: 36.5°C
- September 9: 36.7°C
- September 10: 36.7°C
- September 11: 36.9°C
- September 12: 36.8°C
I am unsure about the cause of the continuous bleeding for 11 days.
Currently, there seems to be no indication of it stopping.
I would appreciate your guidance on this matter.
Thank you.

Nina, 20~29 year old female. Ask Date: 2015/09/13

Dr. Lü Lizheng reply Obstetrics and Gynecology

Before the expected date of menstruation, if there is vaginal bleeding that lasts longer than usual but with a lighter flow, several possibilities may exist.
It could be irregular menstruation caused by factors such as insufficient sleep, stress, or changes in routine, all of which can lead to hormonal imbalances.
If the bleeding persists, please seek medical attention.
Another possibility is a very early miscarriage, which may occur shortly after implantation, resulting in a brief presence of the embryo that may not be detectable by a pregnancy test.
It is advisable to rest for a few months before attempting to conceive again.
Other potential causes, such as inflammation, tumors, or injury, should also be evaluated by a healthcare professional.
Sincerely, Dr.
Li-Cheng Lu, Taoyuan Hospital.

Reply Date: 2015/09/13

More Info

Irregular bleeding can be a source of concern for many women, and understanding its potential causes is crucial for addressing any underlying issues. Based on your description, it appears that you have experienced a significant change in your menstrual cycle, with bleeding persisting for 11 days, which is atypical for most women.
Firstly, it’s important to note that menstrual cycles can vary widely among women, and even within the same individual, cycles can change due to various factors such as stress, hormonal fluctuations, lifestyle changes, and health conditions. Your cycle length of 31-40 days, with a consistent duration of 7 days for menstruation, indicates a relatively normal cycle, but the recent irregular bleeding you are experiencing warrants further investigation.

The bleeding you described, which started as spotting and then transitioned to a more substantial flow with blood clots, could be attributed to several factors:
1. Hormonal Imbalance: Hormonal fluctuations are one of the most common causes of irregular bleeding. Conditions such as polycystic ovary syndrome (PCOS), thyroid disorders, or even stress can lead to an imbalance in estrogen and progesterone levels, resulting in unexpected bleeding.

2. Ovulation Bleeding: Some women experience light bleeding or spotting around the time of ovulation, which typically occurs about 14 days before the start of the next period. However, this usually does not last for an extended period like 11 days.

3. Implantation Bleeding: If you were trying to conceive, it’s worth noting that some women experience light bleeding when a fertilized egg implants itself into the uterine lining. However, since your pregnancy test was negative, this may not be applicable in your case.

4. Uterine Polyps or Fibroids: These benign growths in the uterus can cause irregular bleeding. They are often asymptomatic but can lead to prolonged or heavy menstrual bleeding.

5. Infection or Inflammation: Conditions such as pelvic inflammatory disease (PID) or cervicitis can lead to abnormal bleeding. If there are accompanying symptoms such as pain, fever, or unusual discharge, this could be a possibility.

6. Medications: If you are taking any medications, including hormonal contraceptives or fertility treatments, these can also affect your menstrual cycle and lead to irregular bleeding.

Given that you have already taken a pregnancy test that returned negative, it would be advisable to consult with a healthcare provider for a thorough evaluation. This may include a pelvic exam, ultrasound, and possibly blood tests to assess hormone levels and rule out any underlying conditions.

In the meantime, tracking your symptoms, including the amount of bleeding, any associated pain, and your basal body temperature, can provide valuable information to your healthcare provider. It’s also essential to communicate any changes in your lifestyle, stress levels, or recent health issues, as these can all contribute to changes in your menstrual cycle.

In conclusion, while irregular bleeding can be concerning, many potential causes are manageable with appropriate medical care. Seeking guidance from a healthcare professional will help you understand the underlying reasons for your symptoms and determine the best course of action to restore your menstrual health.

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