Bloody discharge that is not associated with menstruation

Bloody discharge is quite common, but for many women it can cause anxiety. Unexpected stains on your underwear can surprise and even upset you, especially if you have a regular period.

However, there is no need to worry in advance. Remember: in most cases, spotting is not a sign of anything serious and does not require examination or treatment. If they bother you or are accompanied by alarming symptoms, seek advice from a specialist.

Causes of vaginal bleeding

Postpartum period

After separation of the placenta, the uterus is a wound surface, so bleeding is normally observed. In the first days after childbirth, there may be copious brown discharge from the vagina; postpartum women are forced to use special absorbent pads designed for the postpartum period. Gradually, the amount of discharge decreases, it becomes bloody, and by 2-3 weeks it is replaced by leucorrhoea. Prolonged uterine bleeding, discharge with an unpleasant or fetid odor, or streaks of pus should be reported to the treating obstetrician-gynecologist.

Inflammation of the genital organs

A common cause of light brown or “meat slop” colored discharge is inflammatory diseases of various parts of the female reproductive system. Bleeding is associated with erosions and destructive changes in the epithelial layer, damage to small vessels. These diseases are characterized by a combination of brown discharge with other leucorrhoea (cloudy, mucous with a specific odor, purulent). Bloody discharge begins against the background of pain in the lower abdomen and increased body temperature. The symptom is caused by:

• Damage to the uterus
  : endometritis, cervical erosion, endocervicitis.
• Inflammation of the appendages:
  salpingitis, oophoritis, adnexitis.
• Vaginal diseases
  : colpitis (vaginitis), vulvitis.

Pathologies of pregnancy

Bloody vaginal discharge is one of the reliable signs of spontaneous abortion or late miscarriage. The appearance of sanguineous discharge and blood is preceded by discomfort above the pubis, which is gradually replaced by a nagging, aching pain and radiates to the sacrum. Spotting brownish and then bloody discharge usually first bothers you periodically, then if left untreated it becomes constant and can turn into massive bleeding. In addition to abortion, bleeding from the genitals can be caused by:

• Ectopic pregnancy.
  At first, women report spotting brown discharge that occurs due to the cessation of menstruation and aching pain in the lower abdomen. Termination of a tubal or cervical pregnancy is accompanied by massive bleeding with clots.
• Chorionic carcinoma.
  Bloody discharge in 80% of patients begins shortly after birth. When a tumor node is infected, the discharge is purulent and mixed with blood. Bleeding 3-5 weeks after a miscarriage or abortion is typical for a placental polyp.
• Birth injuries.
  The discharge of bright red blood is observed when the genital tract ruptures during the passage of the fetal head. The complication is more common during rapid labor or in the case of a clinically narrow pelvis. Massive blood loss is accompanied by shock.
• Placental abruption.
  Taking into account the age of detachment, the blood may have a scarlet or dark cherry color. In this case, the woman feels severe abdominal pain radiating to the perineum. In severe cases of abruption, the condition may be complicated by the development of Couveler's uterus.

Injuries

The flow of bright scarlet blood from the vagina after falls or bruises of the perineum is caused by damage and ruptures of the genital organs. The symptom is accompanied by sharp pain in the groin, difficulty urinating, and sometimes blood is found in the urine. Bloody discharge occurs with injuries to the genital organs in girls associated with household or sports injuries to the groin area. In teenage girls, heavy bleeding occurs during voluntary or violent sexual activity. Vaginal bleeding can be caused by reasons such as:

• Violent sexual intercourse
  . Minor bleeding is observed due to trauma to the vaginal mucosa. Such bleeding is short-lived and is accompanied by nagging pain in the perineum.
• Vaginal lacerations.
  There is bleeding from the genital fissure, which is combined with swelling and cyanosis of the skin of the labia majora, and sharp pelvic pain. Massive blood loss is typical for damage to the clitoris.
• Perforation of the uterus.
  Perforating damage to the organ associated with curettage or criminal abortion causes profuse, bloody, bright red vaginal discharge. Bleeding develops against the background of the woman’s severe general condition and severe abdominal pain.

Taking oral contraceptives

In 30-40% of women taking hormonal contraceptives, during the first 3 months after the prescription of contraceptives, scanty bleeding from the vagina is observed, usually without any odor. The reasons for their appearance are associated with the body’s adaptation to the supply of hormones from the outside, a change in the synthesis of its own estrogens. Brownish discharge is also noted when the pill regimen is not followed. Heavy bleeding indicates atrophic processes in the uterus due to hormonal imbalances and requires an immediate visit to the doctor.

Endometriosis

Periodic, odorless, spotting brownish discharge occurs in 50-60% of patients with endometriotic growths. Bleeding from the vagina occurs due to hyperplasia of endometrial tissue and damage to the uterine cervix. Scanty bloody discharge appears a couple of days before menstruation, accompanied by intense pelvic pain and discomfort during sexual relations. With diffuse endometriosis, copious bright red discharge is possible. Retrocervical endometriosis is characterized by a combination of vaginal and rectal bleeding.

Benign neoplasms

Most often, patients with uterine fibroids report brown, odorless discharge. This benign neoplasm is characterized by heavy bleeding in the middle of the cycle, which is combined with general symptoms - pain in the lower abdomen, weakness, dizziness. Bloody discharge that occurs against the background of menstrual irregularities is characteristic of atypical endometrial hyperplasia. Spotting brown discharge, mainly after sexual intercourse, is observed with polyps of the uterus or cervical canal. Scanty bleeding occurs with condylomas of the uterine cervix.

Malignant tumors

Oncological diseases are characterized by copious brown discharge with a foul odor, in which individual clots and tissue fragments are visible. With cancer of the vulva and vagina, a triad of symptoms is observed: spotting, periodic mucous leucorrhoea and pain in the perineum. For cervical cancer, moderate bleeding is typical, observed after sexual intercourse, douching, and vaginal examination. Brown discharge also appears with adenocarcinoma and sarcoma of the uterus, germ cell tumors.

Rare causes

• Complicated course of genital infections
  : chlamydia, gonorrhea, trichomoniasis.
• Installation of intrauterine devices
  .
• Iatrogenic factors
  : trauma to the vaginal epithelium or endometrium during diagnostic procedures, consequences of curettage (RDV).
• Emergency contraception.
• Sexual crisis in newborns.
• Pathology of the blood system
  : thrombocytopenia, coagulopathy, vasopathy.

Erosion

Red discharge, but not menstruation, is another sign that you have some kind of disease. Just don’t rush to see a doctor; this is not necessary in all cases. Often the cause of this phenomenon is cervical erosion. It may bleed from time to time. As a result, you may start having red discharge any day.

As practice shows, they are not abundant, smearing, without impurities and mucus. May continue until menstruation. But in some cases they go away on their own. If you suspect erosion, it is best to consult a doctor. It will definitely help you decide whether you have this disease or not. If necessary, you can cauterize the erosion, for example, with radio waves. After treatment, the red discharge, but not your period, will stop.

Diagnostics

A gynecologist is involved in identifying the cause of the development of bloody discharge from the vagina. The woman requires a comprehensive examination using physical and instrumental methods. The diagnostic search is aimed at establishing the root cause of the symptom and assessing general disorders in the body caused by blood loss. The most informative are:

• Gynecological examination.
  The study of the mucous membrane of the vagina and cervix with vaginal speculum is necessary to identify pathological changes, erosions, signs of inflammatory processes or endometriosis. More valuable methods are colposcopy, cervicoscopy and hysteroscopy, which make it possible to detect microscopic foci of epithelial change.
• Ultrasonography
  . Using an ultrasound of the pelvic organs, the uterus and appendages are visualized, voluminous neoplasms, signs of diffuse growth of the endometrium, and other causes that cause odorless or odorless bloody discharge are detected. In difficult situations, when the doctor cannot verify the diagnosis, they resort to diagnostic laparoscopy.
• Visualization methods
  . Tumor growths can be visualized by contrasting the genital tract - hysterosalpingography. To clarify the diagnosis and assess the degree of infiltrative growth of tumors, modern research methods are used - CT and MRI of the pelvic organs.
• Biopsy.
  Identification of altered areas of tissue during instrumental visualization serves as an indication for collecting endometrial and uterine cervical material. Microscopic examination of cells assesses the degree of atypia, the presence of pathological inclusions or signs of malignant growth. Immunochemical analysis of materials obtained during the biopsy is also carried out.
• Diagnostic curettage
  . A total scraping of the mucous membrane of the uterus and cervical canal is a more informative method than a conventional biopsy, since it allows one to obtain a larger amount of material for histological analysis. Separate diagnostic curettage (SDC) is also prescribed for therapeutic purposes.
• Laboratory research
  . To clarify the cause of sanguineous vaginal discharge with an unpleasant odor, it is recommended to analyze a vaginal smear for microflora and culture it on nutrient media. Be sure to evaluate the female hormonal profile. General and biochemical blood tests make it possible to clarify the degree of posthemorrhagic anemia and metabolic changes.

Consultation with a gynecologist for bloody vaginal discharge

Miscarriage

The discharge is red, but not menstrual, accompanied by severe and sharp pain, abundant and sudden, and may be a consequence of a miscarriage. This is exactly how natural termination of pregnancy manifests itself at short notice.

Often during miscarriages you can find some mucus in the discharge. In any case, if you are pregnant, and suddenly there is blood coming from your vagina, there is every reason to panic. Try to remain calm and just go to see your doctor as soon as possible. It is advisable to call an ambulance.

Treatment

Help before diagnosis

The appearance of bloody vaginal discharge that is not associated with uterine involution in the postpartum period or natural menstrual bleeding is an indication for immediate medical attention. Attempts to independently treat the disorder using traditional methods or medications often lead to serious complications in the genital area and other organs. If brown discharge is accompanied by pain, you should not use analgesics from the NSAID group, which increase bleeding.

Conservative therapy

Medical tactics, first of all, depend on the degree of blood loss and the cause of the formation of reddish or brown discharge. For minor brown or bloody discharge, etiotropic therapy for the underlying pathology is indicated; massive blood loss requires the use of specific hemostatic agents. Physiotherapy methods are not recommended. To treat patients with complaints of vaginal bleeding, the following are used:

• Coagulants
  . The medications are designed to stimulate the formation of blood clots and quickly stop bleeding. They are prescribed only for heavy bleeding under the control of coagulogram parameters.
• Hormonal drugs
  . Bloody discharge caused by impaired ovarian estrogen secretion requires specific therapy. Estrogen and progesterone agents are used.
• Anti-inflammatory drugs
  . Reduce the amount of inflammatory mediators. Effectively reduce pain and promote healing of defects in the epithelium of the genital tract.
• Antibacterial agents
  . Indicated for foul-smelling discharge and signs of infection. Depending on the reasons, etiotropic medications are used: antibiotics, antiprotozoal, antifungal.

Surgery

The ineffectiveness of conservative therapy for extensive endometriosis is an indication for excision of endometrial growths followed by cauterization. For ovarian endometriosis and the formation of “chocolate” cysts, surgical laparoscopy and oophorectomy are indicated. For cervical erosions, cauterization is performed using laser coagulation. If polyps of the uterus or cervix are detected, they must be removed. To reduce trauma, endoscopic excision of the polyp is used.

In order to stop uterine bleeding, the main feeding arteries are ligated; if this method is ineffective, the uterus is amputated. Surgical interventions are performed for large benign fibroids to prevent malignancy or profuse bleeding. The method of choice is enucleation of pathological formations with preservation of the organ and restoration of reproductive function. In case of malignant lesion, extirpation of the uterus and appendages may be required, which is combined with antitumor treatment (radiation therapy and chemotherapy).

Intervention

Sometimes you can easily guess why blood comes out of the vagina. The reason for this may be the most common surgical intervention. Various surgeries, abortions, and even the use of an intrauterine device can all cause bleeding.

Usually this kind of phenomenon resembles menstruation. And the bleeding continues for about 5 days. Gradually it becomes less abundant and stops. There is no reason to panic. Just be prepared that after surgery, bloody masses may begin to come out of the vagina. There is also some discomfort. But pain is usually not observed in this case.

Childbirth

During a normal pregnancy, there is usually no red discharge. The maximum is pink, and then only at the very beginning of the process, when the fertilized egg is attached. Only towards the end of pregnancy you may start to bleed from the vagina.

As practice shows, red discharge, but not menstruation, in the last stages of an “interesting situation” most often turns out to be a sign of the onset of labor. Blood can usually be seen along with mucus. Don't be alarmed, this is how it should be. Your water may also break. In principle, the passage of the mucus plug can also be accompanied by blood from the vagina.

If, after a certain period of time after detecting the discharge, you feel cramping pain, call your loved ones or an ambulance - you have begun labor. A completely normal and natural phenomenon. It shouldn't cause you to panic.

Literature:

1. L.E. Radetskaya Mechanisms of uterine bleeding in normal and pathological conditions. Clinical lectures. // Protection of motherhood and childhood. - 2007. - No. 1 (9) pp. 54-59.
2. Kuznetsova I.V. Menstrual cycle in the late reproductive period // Effective pharmacotherapy. Obstetrics and gynecology. No. 2, 18/2013, pp. 32-40.
3. A color-coded guide to vaginal discharge .// MedicalNewsToday / January 10, 2022 / https://www.medicalnewstoday.com/articles/322232
4. Carolyn Kay, MD Ovulation bleeding: What to know // MedicalNewsToday / July 24, 2022 / https://www.medicalnewstoday.com/articles/325847
5. What does the color of period blood mean // MedicalNewsToday / April 1, 2022 / https://www.medicalnewstoday.com/articles/324848
6. The differences between spotting and periods // MedicalNewsToday / January 30, 2022 / https://www.medicalnewstoday.com/articles/317595
7. Aslih, Nardin & Walfisch, Asnat. (2011). Clinical Approach to Pregnancy-Related Bleeding. 10.1007/978-1-4419-9810-1_1.
8. Gynecology. National leadership. Brief edition / ed. G. M. Savelyeva, G. T. Sukhikh, I. B. Manukhina. - M.: GEOTAR-Media, 2013. - 704 p.
9. Ledina A.V. Vaginal discharge: causes, patient management algorithm and modern approaches to treatment and prevention // Obstetrics and gynecology: opinion news, training. 2022. T. 7, no. 3. pp. 107–111. doi: 10.24411/2303-9698-2019-13016.
10. I.A. Apolikhina, E.A. Gorbunova Clinical and morphological aspects of vulvovaginal atrophy / Medical Council No. 9 2014, pp. 110-117
11. Kachalina O.V., Korenkova A.A. Cervical endometriosis - possibilities for solving the problem. Medical advice. 2018; 21: 174-177. DOI: https://doi.org/10.21518/2079-701X-2018-21-174-177.
12. Smetnik V.P. All about menstruation. - Yaroslavl, Litera publishing house, 2005. - 56 p.
13. Solovyova A.N. Inflammation. Fundamentals of pathology // Velikoluksky Medical College - 2022: 13 p.
14. Atrophy // Great Medical Encyclopedia (BME), edited by Petrovsky B.V., 3rd edition (access date 08/25/2021) - https://xn--90aw5c.xn--c1avg/index.php/%D0 %90%D0%A2%D0%A0%D0%9E%D0%A4%D0%98%D0%AF
15. Cytological examination of the cervix based on the Papanicolaou staining technique, screening for cervical cancer. Preanalytical stage V1.3 – 04/02/2019 / https://www.papanicolaou.ru/site_files/publikacii/rukovodstvo-po-preanaliticheskomu-etapu-pap-testa.pdf
16. Cervical intraepithelial neoplasia, erosion and ectropion of the cervix // Clinical recommendations - 2022.