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Forum Name: Gynecology

Question: Bleeding two weeks after period


 JamieS - Mon Jan 10, 2005 11:22 am

Hello,

I'm 21 years old. My last period started on Dec. 23 and ended Dec. 28. On Jan 8, I started experiencing light bleeding brownish in color. It has been 4 days now and it still hasn't stopped. I am unsure of what might be causing this. I haven't been taking any medicine or oral contraceptives so I might be able to rule this problem out.

I also have considered if it may be due to pregnancy but my ovulation is supposed to start on Jan. 9, and I am not experiencing any other symptoms (nausea, breast tenderness, etc). Can pregnancy be still a reason for the bleeding? What can be the probable cause for this?

Please help? I'm really really worried.
 Dr. Tamer Fouad - Wed Jan 04, 2006 5:56 pm

User avatar Hello,
Abnormal uterine bleeding in the reproductive years should be considered a complication of pregnancy or pregnancy related disorders until proven otherwise. All women of reproductive age should have a urine or serum pregnancy test.[1] Pregnancy related disorders include ectopic pregnancy, gestational trophoblastic disease, placental polyp, spontaneous abortion (threatened, incomplete, missed) and subinvolution of the placental site.[1]

Sometimes early in pregnancy you may have spotting or a brownish discharge at the time your period would normally come. If you have spotting at the time of your normal period rather than your usual amount of flow, and you have had sex without using birth control, you should check a pregnancy test.

The presence of systemic diseases such as cirrhosis, coagulation disorder or hypothyroidism is known to cause abnormal uterine bleeding.[1]

Further examination and testing will be directed at exclusion of abnormalities of the reproductive tract such as benign pelvic lesions (adenomyosis, endometriosis, cervical or endometrial polyps, submucosal fibroids) as well as infection, malignancy (if obese/ other risk factors are present) and trauma.[1] In women with evidence of ovulation, abnormal uterine bleeding should prompt suspicion of benign pelvic lesions.

Evidence of ovulation includes bleeding at regular intervals preceded by premenstrual symptoms (eg, bloating, lower abdominal discomfort) [2], a biphasic temperature curve, a change in cervical mucus, or an endometrial biopsy sample demonstrating secretory endometrium. These patients should undergo thorough endometrial evaluation for pelvic lesions when there is no obvious alternative cause of abnormal bleeding.[1]

Once all these causes are excluded it can be presumed that you have dysfunctional uterine bleeding. Dysfunctional uterine bleeding often occurs when the endometrium, or lining of the uterus, is stimulated to grow by the hormone estrogen. When exposure to estrogen is extended, or not balanced by the presence of progesterone, the endometrium continues to grow until it outgrows its blood supply. Then it sloughs off, causing irregular bleeding. If the bleeding is heavy enough and frequent enough, anemia can result.

Patients with dysfunctional uterine bleeding often present with complaints of amenorrhea, oligomenorrhea, menorrhagia, polymenorrhea, metrorrhagia or spotting.

References:
==========
1. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol 1996;175(3 Pt 2):766-9.
2. Petrozza J, Poley K. Dysfunctional uterine bleeding. In: Curtis MG, Hopkins MP, eds. Glass's office gynecology. 5th ed. Baltimore: Williams & Wilkins, 1999;241-64.

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