Don't ignore abnormal vaginal bleeding.

Many girls may have had a similar bewildering experience:

When I get up in the morning to go to the toilet,

I found a dirty brown stain on my underwear.

Then in the following time

This shade of brown may gradually deepen.

It may also stop.

It returned to normal the next day.

At this point, many people's imaginations ran wild...

Could I have some terminal illness?!

Could I have miscarried?!

In TV dramas, doesn't a miscarriage always start with bleeding?

...

A flood of fearful thoughts rushed in...

I'm telling you this now,

Don't let melodramatic plots in TV dramas blind you.

I keep thinking I have a terminal illness...

But we must also sound the alarm.

Abnormal vaginal bleeding can be a sign of certain diseases!

Today's article aims to answer these questions for women of all ages: What causes this unexplained irregular bleeding, how can we distinguish it from menstruation, and how can we prevent and treat this bleeding?

1

How to distinguish between menstruation and abnormal vaginal bleeding?

The following section lists the characteristics of non-menstrual vaginal bleeding and menstrual bleeding to help differentiate between the two types of bleeding.

Characteristics of menstruation

The timing of occurrence is regular: the length of a woman's menstrual cycle may vary, but most women's menstrual cycles are stable and unchanging.

Predictable bleeding patterns: Every woman's menstrual bleeding has its own characteristics. Most women's menstrual bleeding starts with spotting, increases in amount within one to two days, then gradually decreases, and finally ends with spotting.

Stable bleeding duration: Menstrual bleeding usually lasts 5 to 7 days and does not last for a whole month; however, women with hormonal imbalances or other health problems may experience spotting for a month.

Menstrual bleeding is often accompanied by other symptoms: hormonal changes about a week before menstruation can trigger symptoms such as breast pain and headaches; and some women experience cramps in the lower abdomen, ranging from mild to severe, as uterine contractions expel the lining of the uterus as blood.

Menstrual bleeding is usually red or dark red, which helps distinguish between menstrual bleeding and non-menstrual bleeding. However, the blood may be brown at the beginning or end of menstruation, and a large number of blood clots can be observed during menstruation, which is also a basis for identification.

Characteristics of abnormal vaginal bleeding

Irregular bleeding timing: Bleeding outside of menstruation may occur intermittently, such as spotting for a day, stopping, and then starting to bleed again after a while.

It may be related to a stable menstrual cycle: some women experience spotting for one to two days during their monthly ovulation period, while some spotting is irregular.

It may be related to vaginal damage or other symptoms, including abdominal pain, etc.

The color of non-menstrual bleeding differs from that of normal menstrual bleeding: some non-menstrual bleeding is brown, and the texture, viscosity, and odor of the bleeding are also different.

Possibly related to hormonal contraceptives: Starting a new hormonal contraceptive may change the timing and amount of bleeding.

2

What are the causes of abnormal vaginal bleeding?

■ Taking hormonal contraceptives

Taking hormonal contraceptives is a common cause of abnormal vaginal bleeding, usually occurring only during the first three months of use. The use of intrauterine devices (IUDs), contraceptive patches, vaginal rings, oral contraceptives, and implanted contraceptives can also cause vaginal bleeding outside of menstruation.

This abnormal vaginal bleeding is called breakthrough bleeding, a side effect of oral contraceptives, but it doesn't occur in everyone. Breakthrough bleeding occurs because of endometrial malnutrition leading to tissue degeneration. There are two types of breakthrough bleeding:

★Women with low estrogen levels that remain at the threshold level for a long time often experience intermittent light bleeding that lasts for a long time, and the endometrium repairs slowly.

★★Those with high estrogen levels that can be maintained at an effective concentration often experience a prolonged period of amenorrhea. However, due to the absence of ovulation and the lack of progesterone to counteract the effects, the endometrium is not firm and is prone to large-scale shedding, resulting in acute breakthrough bleeding with a large amount of blood loss.

Breakthrough bleeding is not related to the occurrence of uterine cancer, so there is no need to worry excessively about the bleeding. The bleeding will disappear naturally during the course of medication. If the bleeding is heavy outside of menstruation or lasts for more than 3 months, you should seek medical attention promptly. Adjusting your contraceptive method may help improve the bleeding.

■ Emergency Contraception

Using emergency contraceptive pills can also cause bleeding. Vaginal bleeding after taking emergency contraceptive pills is clinically called withdrawal bleeding. This bleeding is generally not considered menstruation. If taken during the first half of the menstrual cycle, it may significantly disrupt a woman's menstrual cycle, increasing the likelihood of vaginal bleeding; if taken during the second half of the menstrual cycle, it will have less impact on menstruation. If the bleeding is similar to a normal menstrual period, it can be considered a menstrual period, and regular contraception should be resumed immediately after the bleeding stops. If the bleeding is very light, no treatment is necessary, but contraception should still be used until the next menstrual period.

The most common emergency contraceptive pills on the market generally contain a large amount of progestin as their main ingredient. The amount of hormones ingested from a single use is equivalent to that in an 8-day course of regular short-acting oral contraceptives. High doses of hormones can easily cause endocrine disorders and changes in the menstrual cycle in women. Therefore, it is recommended that emergency contraceptive pills be used no more than three times a year, and no more than once a month.

■ Ovulation bleeding

Ovulation bleeding refers to abnormal uterine bleeding that occurs during ovulation in women. It is a common type of mid-cycle bleeding in women of reproductive age. Taking a 28-day cycle as an example, ovulation occurs between day 14 and day 16. If a small amount of bleeding occurs during this period, sometimes accompanied by abdominal pain, it is very likely ovulation bleeding, which is a sign of ovulation. Normal ovulation bleeding is generally nothing to worry about and has no other impact on the body. If the bleeding is light and short-lived, it's best to let it pass. However, if the bleeding is heavy and prolonged, it's advisable to have a diagnostic curettage (D&C) performed first, as there may be other underlying issues.

■ Implantation bleeding

Implantation bleeding refers to the spotting of red or pinkish blood that some women experience after the fertilized egg implants in the vagina. This symptom doesn't occur in every pregnant woman, so it's not a clear sign of pregnancy. Implantation usually happens about 6 days after fertilization, at which time most mothers don't experience any noticeable symptoms. This condition doesn't require treatment; simply maintaining cleanliness is sufficient, and it won't affect embryonic development.

■ Miscarriage

Abnormal vaginal bleeding is also an early sign of miscarriage. Miscarriage can occur at any time during pregnancy, and sometimes it may happen before you even realize you are pregnant.

■ Sexually transmitted infections

Sexually transmitted infections (STIs) can cause abnormal vaginal bleeding. Chlamydia infection is a typical example. Sexually transmitted chlamydia infection can cause vaginal bleeding in women during or after sexual intercourse.

■ Damage to vaginal tissue

Damage to the skin or other tissues of the vagina can also cause bleeding, most commonly seen in women experiencing vaginal dryness during penetrative intercourse. The body produces a natural lubricant to prepare the vagina for penetration. Vaginal dryness can be caused by many factors, including lack of sexual desire, menopause, hormonal changes due to diabetes or cancer treatment.

■ Before menopause or menopause

Menopause typically occurs between the ages of 45 and 55. The perimenopausal period is the time before a woman's menopause ends. Due to unstable changes in hormone levels, women may experience premenopausal symptoms, which can lead to irregular periods, spotting, or heavy bleeding.

■ Cervical polyps or vaginal polyps

Cervical or vaginal polyps can also cause bleeding, and may need to be removed to stop the bleeding.

■ Cancer

Abnormal vaginal bleeding may indicate certain types of cancer.

(1) Cervical cancer: Cervical cancer can occur in women of any age, but is most common in women aged 30 to 45. Bleeding outside of menstruation or bleeding after intercourse is usually the first symptom of cervical cancer. Other early symptoms include pain or discomfort during intercourse or vaginal discharge with an abnormal odor.

(2) Uterine cancer usually occurs in women over the age of 50, and vaginal bleeding is also an early symptom of this type of cancer. Unexplained vaginal bleeding in postmenopausal women may indicate the occurrence of uterine cancer. Other adverse symptoms include painful intercourse or abdominal pain.

■ Endometriosis

Chronic diseases affecting the uterus, such as endometriosis or adenoma, can cause abnormal vaginal bleeding, and may also cause abdominal cramps outside of menstruation or increased abdominal pain and bleeding during menstruation.

3

How to prevent and treat abnormal vaginal bleeding?

If abnormal vaginal bleeding is heavy or lasts for a long time, you should tell your doctor about any other symptoms besides bleeding to help them make a diagnosis.

Women taking hormonal contraceptives should strictly follow their doctor's instructions. If bleeding occurs outside of menstruation during the course of treatment, and the bleeding does not stop after 3 to 6 months or the amount of bleeding is too heavy, they should seek medical attention promptly and change their contraceptive method to resolve the bleeding problem.

Sexually transmitted infections (STIs), as the name suggests, can be transmitted through sexual intercourse. If you suspect that you are experiencing vaginal bleeding due to STIs, seek medical attention promptly and explain the situation to your doctor. Most STIs can be cured with antibiotics.

Prevention and treatment of abnormal vaginal bleeding

(1) Recording non-menstrual vaginal bleeding, including the time of bleeding, duration, and amount of blood loss, can help doctors diagnose the cause.

(2) Regular cervical cancer screening. The American Cancer Society recommends that women start cervical screening at age 21.

(3) Vaginal dryness can cause tissue damage and bleeding during intercourse. Use lubricant before intercourse to prevent damage to the vagina during sexual activity.