Bleeding treated with shot of estrogen
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?
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 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.
I don't think that will make a difference.
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.
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.
Viagra and bleeding
Did you use Viagra or your husband? Are you referring to bleeding after sexual relations? More information is needed.
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
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
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
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
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?
Eight months of irregular bleeding
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 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
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
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
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
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
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
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
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?
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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