Bleeding treated with shot
of estrogen
I am 250 lbs., at 5'6" and 39 years old. I started bleeding
the first week of March. I had just started an aerobics tape and was
using it every day in February. The first week bleeding in March was
light to average, the second week it was spotting, then the 3rd and 4th
was very heavy. My GP gave me a shot of estrogen to stop the bleeding so
that we could get a pap since it had been awhile. It did stop for about
5 days but then started again before a pap was taken. He went on
vacation and another doctor gave me progesterone to take. I took it for
3 weeks but nothing happened. The whole month of April, I bled average
to heavy with 3 days of extreme heaviness in which I flooded the bed at
night. I have HMO insurance so I have to wait for the doctors to refer
me but I am demanding it be soon!! My feet have been swelling up a lot
and I have been drinking more water. That has helped. Other than the
bleeding, there has been no period.
The abnormal bleeding in March can be an ovulatory problem (lack of
or premature corpus luteum dysfunction) or a mechanical cause such as
a polyp or fibroid. Either can be brought on by exercise or can be
spontaneous, we won't know.
The initial estrogen shot you received may temporarily stop
bleeding, but it always needs to be followed up with progestin (e.g.
Provera) otherwise you may resume bleeding again (as you did after 5
days). The Provera you were then given was appropriate. It may slow
the bleeding but the bleeding doesn't usually resolve until it is
discontinued and a withdrawal happens (sometimes called a medical
curettage). You said the 3 weeks of Provera "didn't work",
what did you mean by that?
Well, the doctor said the first week I would still bleed but not
the second and third week. I bled the whole time I was on it. I
completed the 3 week dosage on Monday. Since then I have had just light
spotting. Do you think it's over?
No. You will probably start another period in 2 days to two weeks.
This next period may or may not be normal but after it is over, your
menses may be straightened out. One or two cycles of BC pills would be
insurance to really straighten it out (if you can take pills). Then,
if you have any bleeding after that, an office endometrial biopsy
needs to be done.
If the cause of the bleeding was just mechanical, was it due to me
being obese and trying to exercise?
If there is a "plush" endometrium (estrogen stimulated
because of synthesis of estrogen in fat cells), exercise could cause
the bleeding. Now, after the endometrium has sloughed due to the
progesterone withdrawal (in next several days), exercise should no
longer cause bleeding.
Should I lose weight first with walking and not aerobics until I
have lost 50 lbs?
I don't think that will make a difference.
I will comment that my second doctor said after a failed attempt at
a pap again: "Well, you have three options..progesterone, D&C
or hysterectomy!!" I am so glad I took the progesterone! I thought
this "options" thing was a bit premature!
Is the 2nd doctor a gynecologist? Nothing against GPs but sometimes
they don't do the same volume of office endometrial biopsies as
gynecologists so they may have more technical difficulty. I would be
sure to see a gynecologist if the bleeding isn't straightened out
after this cycle.
I was so hopeful. Today was the first day, in 2 1/2 months, of no
bleeding! One or two cycles of BC pills? What is BC? Yes, the second
doctor was a GP. We have HMO insurance and he wouldn't refer me to a GYN
until a pap was taken. We have HMO because it's better for kids and
preventive medicine, but not for choice of doctor. So when Jan 1, 1999
hits, we are switching back to the old insurance. I did demand on
Tuesday a referral and finally got one. I have an appointment with a GYN
on June 10th. I don't know what I will be doing by then..I could be in
the middle of a bad period. But either way, eventually I do need a
complete GYN physical. It has been 10 years for one.
BC stands for birth control. I'm sorry, I shouldn't use
abbreviations. Sometimes you'll see OCPs standing for oral
contraceptive pills which is the same as BCPs, birth control pills.
Both these are different than HRT (hormone replacement therapy) or ERT
(estrogen replacement therapy), although sometimes birth control pills
are being used for "HRT" in the perimenopausal age ranges.
Confusing isn't it. Glad you asked.
I am learning lots of abbreviations with this bleeding. I may be a
rare case, but I have never used birth control pills. My husband takes
care of that, he said he wants to make sure. Think there is a trust
issue here? Anyway, thanks for all the advice.
Viagra and bleeding
We just got the new Viagra and it worked! But, now three days later
I started spotting. Pinkish discharge when I go to the bathroom, no flow
or anything at this time. I haven't had a period in about 6 months, I
think I am pretty much into peri- menopause. I am 45 and diabetic also.
Is it possible that this is just a friction thing. I have noticed I am
very dry lately, too. Any advice appreciated.
Did you use Viagra or your husband? Are you referring to bleeding
after sexual relations? More information is needed.
My husband takes the Viagra, not me. I think I just got a regular
period because, after I sent this thing, it has just become a regular
cycle. Normal flow, nothing weird. I guess the excitement and
anticipation made me ovulate a couple of weeks of ago. Actually, I feel
better since I have had it--I was kinda hormonal.---From what I've read,
this type of pattern can go on for a few more years. I'm going to have
the FSH level done when I go for my refills on my diabetic meds. Thanks,
anyway for your following-up. Re:--bleeding started 3 days later, not
directly after sex if this helps.
Since the bleeding started 3 days later, that is more consistent
with a menses that was induced. Trauma to an atrophic vagina from
increased intercourse would have started either right after relations
or within 12-24 hours.
Menses after stopping the
pill
I am 29 years old and have been on the pill for about 12 years. I
decided to take a break and my first period occurred on day 36. It has
been 50 days since the first day of my last period. Before I went on the
pill I used to have 35 day cycles. I am not pregnant - can anybody
explain. It seems this may be normal after going off the pill! Is it?
Birth control pills do not seem to change your body's ovulation
timing no matter how long you are on them. They mask what your normal
cycle would have done had you not been taking the pills. When you
discontinue the pills, your body goes back to whatever its cycle would
have been at this point in your life had you not taken the pills. This
may take up to three cycles to get back to that pattern however.
Premenstrual spotting
For the last 3 months I've been spotting brown or black discharge
for about 3 to 5 days then I have my regular period which lasts about 5
to 6 days. I have severe cramping and I've been having a period every 15
days. I am not taking BC pills. What can cause this?
Ovarian cysts can cause the bleeding you describe. Endometriosis is
another possibility. Sometimes is is just inadequate corpus luteum
function which may go away on its own.
Want to delay my period
Going to a nude beach over the holiday weekend! My period will
start about 1 or 2 days into my vacation. I am not on the pill. Is there
any safe way to postpone my menstrual start date with less than a month
to go?
Not that I know of. You would have to start BC pills now in order to
do what you want. If you were on a BC pill this entire cycle it might
be possible by extending the active pills (i.e., using the three week
active pills then taking another week of active pills and then
discontinuing). If you are much more than a week or so into this
cycle, it probably would not work.
Change in menstrual flow
I am 25 and only during the past 2 yrs have my periods been normal.
But in the last 2 months my periods have been strange. They have started
out light for the 1st 2 days and then normal. Then this month it was
light for about 3 or 4 days and then it really started. I had my period
for about 5 days. It really started on a Thursday and was over on a
Monday. Then the following Saturday I got it again. Only I noticed I
passed 2 blood clots with heavy bleeding then it went to a very light
flow. It is still that way now. I think it is over because the pad is
clean but there is blood when I go to the bathroom, but not in my urine.
It is very light. This is the first time this has happened. My last pap
smear was in January and it was normal as was my last exam. I am not a
virgin but not sexually active for over 8 yrs and feeling no pain or
discomfort.
As I understand, the character of the flow has changed the last two
months with spotting and then normal flow and in addition, this month
you are actually having extra bleeding that might be characterized as
intermenstrual bleeding. These questions are actually some of the most
difficult to answer because at this time, we are not sure if it is
going to be a chronic, recurrent change or whether this is an isolated
one or two cycles that just gets off kilter for reasons we'll never
know.
The general rule-of-thumb is to just observe and do nothing unless
the menstrual abnormality occurs three cycles in a row. That is
because a situation such as you describe happens not infrequently to
many women at some time, but does not usually continue as a long term
problem. While we don't often know the causes, it is likely that
something interfered with normal ovulation during the previous one or
two cycles. Sometimes it can be stress or trauma or unusual physical
exertion. It may be prescription or over-the-counter medicines taken.
Any infections or illnesses could also affect this. If causes such as
this don't continue, the menstrual problem will usually straighten out
by the third cycle. If it doesn't, you should have an evaluation. Do
you think any of these things might apply to your situation?
Yes, some of these may apply to me. During my first abnormal
period, I had a cold and was taking Hall's cough drops-4 or 5 a day and
Alka-Seltzer Cold Medicine. Then I had taken a sinus sudafed-like
medicine from Walmart. The next day I began with the 2nd part to my
period. Plus, I have been under stress with exams --3 last week-- and 2
weddings I am in this summer. Thank you for you help.
Eight months of irregular
bleeding
I am 26 years old and in 8 months ago I went to my doctor because I
had finished a regular period but in just over a week I began another
one. I do not have a history of abnormal periods before this. At the
time, I was not on any kind of birth control. The bleeding continued for
over a week so I went to see the doctor expecting a cyst or tumor (my
mother had a history of fibroid tumors). My exam was normal and my
doctor suspected hormonal imbalance. She then prescribed birth control
pills and I was to take a large dose at first (to stop the bleeding)
that tapered down to the normal one per day. The very day after taking
the first dose of pills the bleeding stopped. I then began to take the
normal dosage of one per day. My doctor gave me three sample packets to
start with, but by the time I reached the second pack I was once again
starting bleeding while still on the "active" pills. One of
the nurses informed me this was normal and it may take me three months
to adjust. Well, three packs later it was still happening so they placed
me on another kind of pill. Unfortunately I had a bad emotional reaction
to those (I have a history of depression) and had to discontinue taking
them. Anyway, I am now on my fourth kind of birth control pill and
always start on average nine days too soon. It is driving me crazy!
Since August I have been on my period more than off. The flow is much
lighter than I experienced without the pills but all in all, I am VERY
unhappy and have not found anyone with this same problem. Most
everything I see are women who experience much shorter or no period at
all. I am desperate! The latest pill I am taking is Lo/Ovral, it has
made me mentally a wreck! I contacted my doctor's office who now want me
to try something called Levelen. If anyone has experienced this or has a
possible solution please contact me.
You've now had almost eight months of abnormal bleeding on pills. It
is time to do some investigative work to see if there is a cause other
than hormonal. Your doctor will probably want to check thyroid status,
possibly a bleeding time (especially if you are an easy bleeder or
bruise easily) and a pelvic ultrasound. If the endometrial lining is
quite thin on ultrasound scan (one half centimeter or less) and the
other studies are normal, you probably need to take a break from the
pills or have supplemental estrogen. If the lining is thicker than one
half centimeter, you may need to have a biopsy or saline
sonohysterogram to make sure there is not a mechanical cause of the
bleeding (polyps, fibroids) even though you are only 26 years old.
Bleeding after treatment
for polyps
I am 30 years old. About a year ago I was diagnosed with
endometrial polyps. I had them removed and my doctor said there were "billions".
After surgery, my irregular bleeding problem stopped. Recently the
problem started again. I experience clumpy bleeding mid cycle and while
exercising. I am now trying to get pregnant and I wonder if the polyps
will cause problems?
I don't think anyone knows for sure if polyps prevent pregnancy. I
doubt that they do because infertility specialists don't see that
problem in a higher proportion in their infertile patients. I suppose
if there were a lot of polyps it would be possible. If you go more
than 6 months of trying to get pregnant but don't, I think it would be
time for another physician visit.
Spotting after menses
I am a teenager and have been menstruating for four years. Just
recently I have noticed a very light flow of blood coming from me. After
my period ended, it stopped for a day then came right back. I know I
have no thyroid problems (as I found out from semi-recent blood work). I
have no history of cysts or anything else like that, and it doesn't run
in my family. I am sick and tired of the constant bleeding and I am
quite scared of gynecologists, so I am looking for a home remedy. My
email address is shared, so please don't provide a link or send
anything to my address. Please just post this on the site and I'll check
back every so often to see if anyone replied. Thanks.
Post menstrual spotting is a difficult diagnosis. It often occurs
for unknown reasons. However, if it lasts more than 3 cycles in a row,
it would be a good idea to see a gynecologist even if you don't really
want to. The reason is that post menstrual spotting can often be due to
a cervical inflammation (cervicitis) or vaginal irritation. Those are
quite treatable if diagnosed correctly. I don't know of any home
remedies that would even come close to treating this other than to
just do nothing and see if it goes away.
Flooding periods
I am a 29 year-old female who has never had children. I am writing
because I have a very regular but extremely short, heavy period with
a lot of clotting. These periods are disruptive to my schedule, as I am
often tired and light-headed to the point of missing days at work.
Sometimes I will get a migraine headache right before the onset of my
period. My pap smear is normal. I took the pill in order to regulate my
period, but it did not work and made my general mood worse. I would just
like to know what would cause such a heavy period to the point of what I
jokingly refer to as "flooding". Any input would be
appreciated.
It is hard to say what causes heavy periods. Sometimes it can be a "normal"
(80ml or less than 3 oz) amount of endometrial tissue and blood that
comes over a short time (1 or 2 days rather than 4-5 days) or larger
amounts over 4 oz. (120 ml). Sometimes there is just plush but normal
endometrium due to a healthy amount of estrogen from normal ovulation.
Other times there can be excess estrogens (and thus excess
endometrium) from disorders such as polycystic ovarian disease,
adrenogenital syndrome or foods or medicines high in estrogens. There
can also be mechanical or anatomical causes such as polyps or
sub mucosal fibroids although they are not that common under age 30.
Truthfully, most of the time the cause is unknown. If there is a
lowering of your blood count (anemia) then it needs to be diagnosed
and treated. Usually the doctor will check a complete blood count to
see the hemoglobin level and what are called indices to see if your
body is keeping up with the blood loss by forming new blood. If there
is not an anemia, most of the time treatment is symptomatic to try to
reduce the flow. Antiprostaglandins are used such as Ponstel in the
U.S. Hormones can also be used but as you indicated there are often
side effects to those too. There are surgical methods and office
procedural methods to permanently decrease the flow but those are not
usually used unless anemia is being caused by the blood loss and there
has been an investigation that shows no anatomical causes such as
polyps or fibroids.
Pain and vaginal bleeding
after exercise
Today I was at the gym running on the treadmill, and I felt this
sharp pain in my lower abdomen as I ran. When I got home and used the
restroom, there was some blood in my underwear. My period didn't start.
This isn't the first time I have felt that pain but I thought it was
just a side stitch. I am having other problems with my menstrual cycle,
like breakthrough bleeding, and some cramping. I have an appointment
with my gyn, but I'm really starting to get concerned. Any ideas?
Vaginal bleeding brought on by exercise or trauma is usually related
to either disruption of the corpus luteum of the ovary (gland that
forms after egg is ovulated each month) or anatomic abnormality inside
the uterus such as a polyp or fibroid. The sudden pain and then the
bleeding would go along with a ruptured corpus luteum of the ovary or
even mid cycle ovulation if it occurred 14 days or less from when the
NEXT menses was supposed to occur. Bleeding from anatomical causes
would be more likely at age greater than 35. There are other causes
such as local cervical irritation, endometriosis, endocrine bleeding
etc., so you are right to get an exam to put the total picture
together with the other ovulatory problems you describe.
Heavy menses and polyps
I am 38 years old. I have three teenagers. Two were born by C-
section and the third born naturally. My periods have always been normal
other than a lot of cramping the first couple of days. My paps have
always come back normal. Three years ago I was hospitalized for 5 days
with a severe case of pneumonia. I had just started a period the day
before being admitted. It lasted about 5 days which is normal. About a
week later I started again and this time bled for 25 days: heavy the
first week, then light to moderate the other. I was referred to an OB-
GYN who did an endometrial biopsy. It came back clear. He did not pursue
the cause -- just gave me options ranging from estrogen- therapy birth
control pills to hysterectomy. Although I have never been able to handle
birth control pills and he did not seem worried, I took that option
anyway. I was off them in two months. My regular physician tried two
lower doses of which I could handle neither. Nonetheless, my periods
returned to normal. In December of '96 I was over two weeks late.
Thinking I could be pregnant, I tried home tests. Negative. I went to
the doctor. Started that day. Once again everything returned to normal.
After a normal period in June '97, I did not start until August and then
bled for about 22 days. Went back to regular doctor. He prescribed two
hormones (he called it a "chemical D&C"). Normal in
September and October. Started two weeks later in November and bled for
17 days. Started again on December 18 very heavy with lots of clotting.
Due to being fed up with doctors treating symptoms and not causes, I
waited until (yes, almost too late) 30 days of heavy bleeding. When I
went to my regular doctor, my blood volume was at 26.2%. I was referred
to a different OB-GYN. He did another endometrial biopsy and said it was
probably hormone-related but was more worried about my blood count than
what was causing the bleeding. He suggested we try Depo Provera
injections for six months. I stopped about two weeks later. The biopsy
was normal, however, the nurse said the was a polyp but they were not
worried, they probably got it all and polyps are almost always benign.
Three weeks later I started cramping like a period was about to start.
He had told me I should not have a period except maybe a little slight
bleeding. By late the afternoon I began cramping Feb 12, I was pain so
severe it was worse than the labor pains with my last child. I called
the specialist, but since it was almost time for him to go home the
nurse told me to go the the ER. He had told me to call him if I had any
problems. Just as we were about to leave, I felt something "drop"
like about to deliver a baby. I sort of did, I guess. A mass of tissue
(no form to it) that looked to be the size of mid-term fetus fell from
my body. The pain eased to mild cramping but the bleeding was heavy.
Stayed heavy for about a week, then was light. However, I have had some
discolored discharge, then nothing, then some light bleeding for a
couple of hours, back to nothing all in the same day. This is still the
routine. I have not gone back to the doctor because it cost me over $500
to learn my blood count was dangerously low. I knew that at no charge.
My husband and I have recently started our own business and have no
insurance. Doctors here don't get very serious. In fact, most of the
clinics in this area are "meat markets". Doctors have no time
to have a discussion with their patients. I know, I made an appointment
to do so and was rushed out in less than 5 minutes. I am still plagued
that I had no problems until I was in the hospital. How can I find out
the cause of my problem not just the correct treatment of the symptom?
You describe more and more frequent episodes of prolonged vaginal
bleeding known as menorrhagia. While that can often have hormonal
causes, you are getting in the age range where mechanical causes of
bleeding may be more likely. You said one biopsy showed a polyp and it
is likely that there may be more polyps there. It sounds as if you
might have even passed a polyp or sub mucosal fibroid or perhaps just a
large fibrin clot. See the article on our news site about
saline infusion
sonography about diagnosing mechanical causes of bleeding. It
sounds as if it is time for you to have a D&C and hysteroscopy if
this last episode doesn't resolve your heavy bleeding.
Fibroids and bleeding
I am a 39 yr old female. I was diagnosed 17 yrs ago with a
pituitary tumor. For 13 years I did not have a period until I started
taking Parlodel intravaginally. This month I have had what seems to be 2
periods which lasted 5 days and bleeding for 4 days between these "periods".
I was sent for a pelvic ultrasound last Friday that showed fibroid
tumors. My gyn wants to do a D&C because he "suspects" a
fibroid is growing in a place it shouldn't be, causing the bleeding. My
endocrinologist had me come for a Prolactin test. I got the results
yesterday and for the very first time in 17 years it is at 24 - Normal
is 0-25. It has been as high as 200. She said to continue the Parlodel
and that this is not what is causing the bleeding. My question is - If
the prolactin level is down and the pituitary seems to be able to
generate estrogen now, could this irregular bleeding be caused from high
estrogen level? I really do not want this D&C. I want to explore all
my options first. How do I get my gyn to understand that part of my
condition? Please anyone reply. I am scared!!
The bleeding sounds either to be on a functional (endocrine) level
or a mechanical/anatomical cause such as fibroids, polyps,
hyperplasia, or cancer (unlikely). At age 39 we tend to see the
mechanical causes more frequently but fluctuating estrogen levels also
may produce this. It sounds as if your doctor saw possible anatomical
candidates (fibroids) on the ultrasound. Most of the time you can't
see sub mucosal fibroids on a regular ultrasound. A saline
sonohysterogram is an office procedure that can sometimes tell more
definitely if there is an abnormal anatomical growth in the uterus
that might be causing the bleeding. On the regular vaginal probe
ultrasound, if the endometrial cavity is quite irregular, we usually
recommend a hysteroscopy (looking into the uterus with a "scope")
followed by a D&C, all done as outpatient or office surgery. When
you say D&C, I am pretty sure your doctor means hysteroscopy and D&C.
On the other hand, the only serious cause would be a malignancy or
pre malignancy of the endometrial cavity. That could be ruled out by an
office endometrial biopsy. If that were negative, you could wait and
see if the problem persists. An endometrial biopsy usually won't cure
bleeding from a fibroid or polyp and you would eventually end up
having the hysteroscopy and D&C.
To address the listening problem, asking your doctor if an
endometrial biopsy would be sufficient for the time being and then the
further work-up if the bleeding persists would be a tact to take. If
the doctor is highly suspicious of an anatomical cause from the
ultrasound already done, then still going ahead with the hysteroscopy
and D&C is likely to be the primary recommendation. If it is not
so certain that there is a anatomical cause, or there is someone in
the community performing saline sonohysterograms, then temporizing
with just the biopsy is likely to be an acceptable alternative.
Abnormal bleeding and
family history of uterine cancer
I have had abnormal bleeding on/off for the past 3 yrs. I've
mentioned it to my G.P., who brushed it off as stress ("If you were
40, I'd be concerned about uterine cancer"). I told her that my mom
had it when she was 25. She just shook her head. Recently, it has been
worse, mostly just spotting during the month. Besides my mom, her two
sisters have also had uterine cancer, and just recently, my grandmother
has been diagnosed (she is 65, hasn't had a pap in 25 yrs). I'm somewhat
nervous (okay, scared), at facing the possibility that I could also be
afflicted with this disease. I guess I just need a friend! :)
Three years is a long time to have abnormal uterine bleeding and not
have a diagnosis or treatment. You are right to be concerned just on
that basis. How abnormal is the bleeding? What is its pattern?
Uterine cancer can be endometrial (the lining of the uterus),
cervical (abnormal paps etc.) or rarely the muscle of the uterus. Did
everyone in the family have endometrial cancer that you know of? There
are some genetic tendencies toward early endometrial cancer.
While usually endometrial biopsies or D&Cs are not done to rule
out cancer at ages less than 35 or 40, that only applies to initial
presentations of abnormal bleeding. If bleeding persists after
attempts at hormonal therapy it still needs to be evaluated, including
possibly an endometrial biopsy even at age 25.
There are very few drugs or medications known to prevent any cancer
but birth control pills have definitely been shown to prevent
endometrial cancer if taken over a long period of time.
Continuous bleeding for a
month and a half
I have been having bleeding problems for the past month and a half
or so. My periods haven't always been regular but over the past year,
they have straightened out pretty well. My problem is that over the past
48 days, I have been moderately spotting every day and three days ago I
began bleeding VERY heavily and have had HUGE clots, many, many clots. I
am not cramping more than usual but I have been retaining water more
than usual in the past two weeks. I can't afford to have a bunch of
tests run or pay an exorbitant amount of doctors' fees; however, if
that's what I have to do, I will. (I just needed some advice.) I have
been very tired lately and have been feeling weak. I have also been
fighting a headache off for about two weeks. I don't know if it's just
sinuses or a migraine.
48 days is too long. Something needs to be done. Your tiredness may
be from the stress of bleeding so long or actually from blood loss
anemia. Your doctor will want to check your blood count.
How old are you? What the doctor will do next depends upon what age
group you are in and any other signs and symptoms you may have. Are
you on any hormonal medications or any other prescribed drugs or
herbal supplements?
I am 23 years of age. There is no chance in the world that I could
be pregnant -- I am completely celibate and have been forever. I am not
taking any medication currently except for Benadryl (allergies) and
Naprosyn (arthritis in knee).
The most likely cause of the bleeding is a lack of ovulation over
one or two cycles followed by an irregular shedding of the previously
estrogen primed endometrium. Quite often oral contraceptives are used
over two or three cycles to try to stabilize the endometrium and slow
or stop the irregular bleeding. The first month on the hormones you
may not completely stop but by the second and certainly the third
cycle you should straighten out. The pills do not allow you to ovulate
either but after you stop them, hopefully your cycle will get back in
synch.
An alternative is to just wait it out and see if the bleeding
eventually stops and then you go back to cycling on your own. This may
take awhile, however, so the pills are likely to regulate you the
fastest. At your age the doctor will probably not need to do much
testing other than to check your blood count. If you are an "easy
bleeder or bruiser" or you have any family history of members who
have bleeding problems, the doctor may want to get a bleeding time
measurement to make sure you don't have a coagulation problem.
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