What could cause prolonged menstrual bleeding/constant spotting?

August 10, 2012 1:07 PM

What could cause prolonged menstrual bleeding/constant spotting?

So, I've been spotting since May. Between May and June it was primarily a few extra days here and there of spotting, or an extra week of spotting before my period. Now, for the past month, I've been bleeding nonstop. It's as heavy as the first few days of my period and bright red (too much info, but clots included). It's gotten to the point where I can only wear my ugly underwear because I figure it's not healthy for me to be wearing the DivaCup (menstrual cup) for that long. I've recently bought and started to wear pantyliners on a daily basis that need to be changed a few times.

I've been complaining to my new family doctor about this since May and she's done a papsmear and the regular vaginal testing stuff (STIs etc.) and everything's turned up normal. I also went to the hospital when it got more severe and they redid the testings and again, everything was normal. My doctor seems unphased by this and just tests me if I'm pregnant (I'm not sexually active) and put me on a low-dose birth control pill (Alesse). I've been on the pill 2 months now and it's not helping and if anything, it's getting worse.

I don't have cramping that I've noticed. My periods are generally relatively painless (in high school I was tested for endometrisosis b/c of painful periods, but those went away with age, I'm 27 now).

I'm a PhD student and finishing up my studies... I'm under a significant amount of stress, however that's been a normal part of my life for years. For the past three years prior, I had a normal period with little spotting just before/after my period. I eat relatively well (I began vegetarianism in April, but this week ate fish b/c I wondered if maybe I was lacking something). I'm fit, but not overly fit (ie. I work out 3x per week but my bodyfat is still in the normal range for women. I mention this b/c I've read that women with super low bodyfats lose their periods, this isn't my scenario). I drink between 2-4L of water a day and ensure I get healthy fats, healthy carbs and enough protein.

The only times I've noticed major changes in my period the last several months is I had sex once, and the bleeding stopped for 2 days. It seems to also bleed a lot more in the mornings and evenings than throughout the days. I take the birth control pill at noon every day. I haven't forgotten pills this month (finishing the whole pack tomorrow, starting my period Sunday).

I'm currently in the process of bugging my doctor to send me to a specialist but I'm not sure if she will. She seems to think she can do it all herself but clearly isn't doing anything to stop this nuisance. I'd like to wear white pants, wear cute undies and potentially fool around with men without this pesky constant annoyance.

After google searches, it doesn't seem like I have any of the other symptoms. I'm exhausted lately, but it's likely b/c I'm losing too much blood/iron.

Thanks for any insight!

Oh, and during the 3 non-spotting years, I was dating a woman and I seemed to sync up to her. My period was always the week before hers and I didn't really have problems with my period. That relationship ended in April, however I was miserable for the last year with her and happy now that I'm not with her, so there really hasn't been added stress being single b/c it's what I like and wanted.

Sorry for the very extended explanation! Phew!

posted by anonymous to health & fitness (25 answers total)

I see that you've gone to your family doctor, but have you gone to a GYN? I'd be VERY concerned, all that blood loss may leave you anemic. (as you've noticed.)

You might have a cyst or a tumor. I'd ask about trans-vaginal ultra-sound to rule out any abnormalities.
posted by Ruthless Bunny at 1:10 PM on August 10, 2012

Is this your GP you're talking about? First thing you need to do is get a new GP, then you need to see a gynecologist if you haven't seen one yet, or see a different one. I know this is easier said than done in most places but if your current provider isn't helping you or doesn't care, then you need to find one who will.

I had a problem with constant bleeding once that turned out to be because my hormones got messed up from the birth control I was using, which doesn't sound like it applies here. But it was very frustrating how my doctor at the time didn't see it as much of a problem or anything to spend too much thought on. I got a new doctor.
posted by bleep at 1:13 PM on August 10, 2012 [1 favorite]

I get that when I'm stressed, which is exactly when I DON'T need it. A couple years ago on a stressful camping trip I was bleeding for 2 weeks straight, til I got home. I haven't ever had it for a whole month, though.
posted by small_ruminant at 1:22 PM on August 10, 2012

Get your ass to a gyno now.

1. Tell them the other doctor isn't concerned enough to get to the bottom of this and that is really not acceptable.
2. if you are experencing symptoms that are not being taken seriously, get a new doctor.
3. Don't freak out, there are a million things that can mess with that stuff... but bleeding for a month straight is not something that your doctor should just poopoo it away.
posted by Blisterlips at 1:24 PM on August 10, 2012 [3 favorites]

Abnormal bleeding can indicate a number of conditions -- some benign, some serious -- but all of them require the competent care of a gynecologist for diagnosis and treatment. If your doctor hesitates any further to refer you, you need to switch primary care docs and/or take it up with your medical group or insurance. (Depending on your insurance, you may even be able to "self-refer" to a gynecologist -- many insurance plans recognize how essential is is for women to have regular OB/GYN access, and therefore don't even require a referral from a primary care physician.)

If she won't be an advocate for your health, then you'll have to be your own advocate. There is no legitimate reason for your doctor to refuse to let you see a gynecologist under these circumstances. None.
posted by scody at 1:28 PM on August 10, 2012 [4 favorites]

Fibroids?
posted by Melismata at 1:28 PM on August 10, 2012 [1 favorite]

Thanks everyone. I'm in Canada so we need a referral to a gynecologist and the doctor at the hospital said that they would put in a request but that they'd likely need my GP's approval for it. I'm still waiting on that, but I had planned on going to see my GP in the meantime. She doesn't seem overly eager to send me to specialists, but I plan on firmly requesting one! I'm also going to ask for bloodwork b/c they haven't checked for any deficiencies in vitamins/minerals/etc. either. I've also put my name into list for a new doctor as well. Thank you again for the advice.
posted by DorothySmith at 1:30 PM on August 10, 2012

My mother had something similar and it turned out to be fibroids. That might be something to look into.
posted by DrGirlfriend at 1:31 PM on August 10, 2012

Uterine polyps. I had a small one that the dr removed via an outpatient surgery.
posted by cass at 1:32 PM on August 10, 2012

That's actually why I went to the hospital because I had heard that they could refer a patient to a specialist without their GP, but the ER doctor was hesitant and also seemed annoyed I came there for a 'non-serious' issue (which I get, and completely understand considering there are others bleeding from probably far more serious places!).
posted by DorothySmith at 1:32 PM on August 10, 2012

Would fibroids have been visible during the physical/papsmear? Hmm. I'll definitely make an appointment on Monday. I've only been putting it off b/c I didn't have the energy to argue with her that I need a specialist. I'll grow some ovaries and insist on Monday :)
posted by DorothySmith at 1:34 PM on August 10, 2012

Ask about supplemental estrogen ONLY - the progesterone in your pill may be adding to the bleeding problem, not helping it. It has been observed for a while that some types of birth control cause irregular bleeding in a minority of users, rather than making bleeding shorter or non-existant.
posted by slow graffiti at 1:36 PM on August 10, 2012

BTW, in my completely unscientific opinion, based on everything I've seen it shouldn't be a big deal to wear a DivaCup for extended periods (no pun intended...) like this. It's nonporous, though you should obviously wash it and stuff, so you shouldn't be at risk for TSS or anything like that.

I'm just glad you're using one of those so it is hopefully at least a LITTLE more manageable.

Added bonus: the lines on the cup should help you monitor how much you're actually discharging.
posted by Madamina at 1:43 PM on August 10, 2012 [2 favorites]

I had the same experience with my GP. And almost the same reaction from her. In my case, it ended up being fibroids, but they weren't found until I had a vaginal ultrasound (and I had to practically beg have one done). Then I had to go to a gyn anyway for treatment.
posted by kimdog at 2:08 PM on August 10, 2012

Please do not wait to see a gynecologist. Please do insist, as in, do not leave the office or get off the phone until you get the necessary referral. To your question, one other thing not yet mentioned that can cause prolonged heavy bleeding is endometrial hyperplasia, which is often precancerous; I had it, and the abnormal bleeding was my only symptom. Of course your bleeding could be many other things -- but you need to get to the bottom of it. Fran Drescher has a valuable story about how/why her uterine cancer went undetected so long. I'm wishing you very good health, and relief from your symptoms very soon!
posted by argonauta at 2:24 PM on August 10, 2012 [2 favorites]

I'm having a similar problem (and contemplating an Ask), and this is convincing me to make that appointment with my gyn, so thank you for asking this, anon.
posted by gingerbeer at 2:41 PM on August 10, 2012 [2 favorites]

1) Your doctor sucks and you should report her poor conduct to the governing body for doctors in your area.

I don't know who that is because I don't know what area you're in, but it's probably called "The College of Medical Doctors of YourProvince" or something similar enough that Googling those terms will find it for you. It is very clear that this is a problem she's not competent to deal with; otherwise she would have done more for you by now. She won't neccessarily get a reprimand, but they'll investigate the matter and hopefully it will at least scare her into treating her patients better. You've been complaining about this since MAY and she just keeps repeating the same tests? It's been long enough to determine that the b/c isn't an effective solution. And you say I'm currently in the process of bugging my doctor to send me to a specialist but I'm not sure if she will. She seems to think she can do it all herself but clearly isn't doing anything to stop this nuisance... you shouldn't have to "bug" the doctor for a referral. It's her job.

YOU SHOULD NOT be bleeding for a fucking month straight and having her do so little for you, especially if you've been having menstrual problems in the past. I'm sorry to get so worked up, but I've known several women with this same problem who got brushed off by their doctors, and it pisses me the fuck off because it is goddamn unacceptable.

This symptom can be caused by tumors and other scary-ass stuff, and even if it's totally benign, there is no reason that you should have to put up with constant bleeding, without even knowing what's wrong, unless all available tests have been done and it's still a mystery.

You're Canadian? You've already paid for proper medical care with your tax dollars; you deserve to get what you've paid for. It is not unreasonable for you to want this dealt with immediately. In addition, depending on where you live, the waiting list to get in to see someone could be very long. If you have to wait another month to get looked at, it's better to get on the list as soon as possible.

That doesn't mean that you should freak out, of course. If your PAPs are coming back normal, I imagine the likelihood of cancer is pretty small. But you deserve to speak to someone who is going to take your concerns seriously and help you.

so

2)yes, insist on a referral to a specialist. Go somewhere else and get a second opinion and get them to give you the referral if she won't. Go to a walk-in clinic or hassle-free and get them to do it if you must. Do whatever you have to do to get the help you deserve.

3)I really hope you get better soon... and I'm sure it will turn out to be nothing, but you deserve to know for sure!

4)I'm glad to hear that you're going to get a different family doctor. Yours sounds, as I said, appaling.
posted by windykites at 4:47 PM on August 10, 2012 [3 favorites]

By the way, you can remove yourself from your current doctor's care while you're waiting for a new doctor- you can be doctorless. This isn't always a good thing, but it can be helpful for getting immediate referrals from clinics, etc., because they don't need to run it past your doc first.
posted by windykites at 4:50 PM on August 10, 2012

In the short-term, take some iron pills to help with potential anemia.
posted by emkelley at 5:46 PM on August 10, 2012

Not sending you to a GYN (ideally one who specializes in diagnosing and treating fibroids and endometrioses) is a shocking lapse in the standard of care. If she will not complete the referral, go over her head. If her practice head will not complete the referral, I would contact Health Canada about this lapse.

Constant vaginal bleeding can be a sign of a number of issues, fibroids and endometriosis being probably the two most common. Yes, it might be just a blip in your cycle that will fix itself, but you know who can tell the difference? A GYN, is who.
posted by Sidhedevil at 6:53 PM on August 10, 2012

I'm echoing the people saying cysts or fibroids. Both of those will show up on an ultrasound. Please insist on going to a gynecologist. The easiest way to get a referral may be to call your doctor's office (repeatedly if necessary) and try to get it over the phone instead of waiting for an appointment to ask.
posted by entropyiswinning at 8:13 PM on August 10, 2012

Here is a list of anemia symptoms.

There is nothing wrong with going to the ER with heavy bleeding. I found out after the fact that sometimes it's called for. It hadn't even occurred to me to do so, bleeding being natural, but really heavy bleeding is not. It can be dangerous to bleed too much. I wish I had known this. The ER docs can do various things to slow or stop the bleeding, including IV hormones.

I too would encourage you to be very firm with your doctor. Make sure you get to see an OB/GYN. It could be a cyst or fibroids, endometrial hyperplasia, or many other things.
posted by annsunny at 8:49 PM on August 10, 2012

I would not start taking iron supplements to cover any possible anemia until after you've been diagnosed as anemic for the simple reason that when you finally manage to get a blood test it will be read as normal if the iron supplement is working, leading the doctors to believe that you're exaggerating about the amount of blood loss - you can't be bleeding as excessively as you claim if your blood count is normal.

I know things are different in Canada, but you need to be seen by a GYN, period. Just tell your doctor that you feel it's time now to get to the bottom of this so you'd like to be referred to a gynecologist, please. And thank you very much. Just stand there and refuse to budge and wait for the doctor to give you a referral - don't back down and don't listen to any "let's try this" crap. Clearly your doctor is useless in this situation.
posted by aryma at 11:03 PM on August 10, 2012

Perhaps a workaround for the referral is to go to a walk in clinic and ask a doctor there. I'm Canadian and I often have to go to a walk in because my doctor has crappy hours, in fact I was having issues with my family doctor and went almost exclusively to walk in clinics for a while. It's better than spending the resources of emergency, and if you go in and tell them your situation (including that you are looking for a new doctor), I don't see why they wouldn't make the referral for you.
posted by smartypantz at 11:55 PM on August 10, 2012

I know this post is oldish now, and I'm hoping you got some better answers from your GP or were referred. I thought I'd address one of the questions asked in here for future reference: you asked if fibroids would show up during a pap; another poster said hers were revealed through ultrasound. Mine were very large but weren't fully revealed until I'd had an ultrasound, MRI and exploratory hysteroscopy. They ended up being even larger than the gyno thought--and he had seen the results of the ultrasound and MRI.

Fibroids can definitely cause symptoms like the ones you described, so if they pop up again, do ask about getting screened for fibroids. Many women have them without problems, but they can cause issues if they grow too large.
posted by Secret Sockdentity at 8:31 PM on April 29