Irregular Menstrual Bleeding: Causes and Concerns

Abnormal menstrual bleeding?

Hello doctor, my last menstrual period started on September 17th.
It was delayed (my August period was on August 11th), but my cycle has always been irregular.
Normally, my period lasts until September 24th, but as of now (October 4th), I am still experiencing bleeding.
The bleeding from September 17th to 24th was normal, starting as bright red and then turning dark brown, which is also typical for me, with varying flow from heavy to light.
However, the bleeding has not stopped since then, and it is still dark brown (almost black).
Note: I had sexual intercourse on September 24th without any discomfort, but I am concerned about the continuous bleeding.
What could cause this situation? Thank you.

W.Y., 10~19 year old female. Ask Date: 2015/10/04

Dr. Lü Lizheng reply Obstetrics and Gynecology

The response suggests that this is likely irregular menstruation.
If it is not severe, using hemostatic agents for symptomatic treatment may suffice.
However, if the bleeding is excessive or persists for a long time, hormonal medications for menstrual regulation will be necessary.
Other potential causes for delayed bleeding include inflammation, polyps, pregnancy, and tumors.
Sincerely, Dr.
Lu Li-Cheng, Taoyuan Hospital.

Reply Date: 2015/10/04

More Info

Irregular menstrual bleeding can be a concerning issue for many women, and understanding the potential causes is crucial for addressing the problem effectively. Based on your description, it appears that you experienced a normal menstrual cycle from September 17 to September 24, but have since had persistent bleeding that has changed in color and consistency. This situation can arise from various factors, and it’s important to consider both physiological and pathological causes.

Firstly, menstrual irregularities can be influenced by hormonal fluctuations. The menstrual cycle is regulated by a complex interplay of hormones, including estrogen and progesterone. Stress, changes in weight, excessive exercise, or significant lifestyle changes can disrupt this hormonal balance, leading to irregular bleeding. In your case, the delay in your menstrual cycle in August and the subsequent irregularity in September may suggest a hormonal imbalance.

Another common cause of prolonged bleeding is the presence of uterine fibroids or polyps. These benign growths can lead to heavier and prolonged menstrual bleeding. They can also cause changes in the menstrual cycle, including irregularities. If you have a history of heavy periods or pelvic pain, this could be a possibility worth discussing with your healthcare provider.

Additionally, conditions such as endometriosis or adenomyosis can lead to abnormal bleeding patterns. Endometriosis occurs when tissue similar to the lining of the uterus grows outside of it, often causing pain and irregular bleeding. Adenomyosis involves the lining of the uterus growing into the muscular wall of the uterus, which can also result in heavy and prolonged bleeding.

Infections, such as pelvic inflammatory disease (PID) or sexually transmitted infections (STIs), can also lead to abnormal bleeding. While you mentioned having no discomfort or other symptoms following sexual intercourse, it is still important to rule out any underlying infections, especially if the bleeding persists.

Another factor to consider is the use of contraceptives. If you are using hormonal birth control, it can sometimes lead to irregular bleeding, especially during the initial months of use. If you have recently started or changed your contraceptive method, this could be a contributing factor.

Given that your bleeding has persisted beyond the normal duration of a menstrual cycle and has changed in color, it is advisable to consult with a healthcare provider. They may recommend a pelvic examination, ultrasound, or blood tests to evaluate hormone levels and check for any underlying conditions. It is essential to rule out any serious issues, such as pregnancy complications or malignancies, especially if the bleeding is heavy or accompanied by other symptoms like pain or fever.

In summary, irregular menstrual bleeding can result from various factors, including hormonal imbalances, structural abnormalities, infections, or contraceptive use. Since your bleeding has continued beyond the expected timeframe, it is crucial to seek medical advice for a thorough evaluation and appropriate management. Early intervention can help address any underlying issues and restore your menstrual cycle to a regular pattern.

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