|
|
|
|
|
|
 |
Abnormal Menstrual Bleeding Without BCPs
From
Woman's Diagnostic Cyber
Frederick R. Jelovsek MD
   
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.
|
Support for Bleeding Problems
Healthshare at wdxcyber
Differential Diagnosis of
Menstrual/bleeding abnormalities
Related Educational Articles
What is a Microscopic Cancer of the Uterus?
Continuous Bleeding on Birth Control
Post Tubal Ligation Syndrome
Polycystic Ovarian Syndrome
Lap assisted vaginal hysterectomy
Prolactin hormone and anovulation
Expected Bleeding from HRT
Saline Infusion Sonography
Postmenopausal Bleeding
Related Books
Perimenopause
Fibroids
D&C
Menopause
Breastfeeding
Postpartum
Related Home Tests
Pregnancy
Ovulation
Other Related Products
Organic Cotton
Tampons w applicator-regular
Tampons w applicator-super
Tampons-manual-regular
Tampons-manual-super |
|
|
|
|
|
|
| Medical Symptons | Contact Us | Advertise With Us | Resources | Suggest A Resource | About us | Privacy | Forums | Site Map |
|
|
Copyright 2008© wdxcyber.com.
All rights reserved. |
|
|
