Is abnormal vaginal bleeding a sign of reproductive cancer?

Question

Hi doctor,

I have been bleeding heavily from my vagina for the past five days. It only happens when I either open my bowels or while urinating. I put in a tampon to confirm that the bleeding is coming from my vagina and not from my rectum.

When I am not using the bathroom, there is no bleeding and no blood on my underwear. But, as soon as I urinate and have a bowel movement, I start to bleed. It is not just spotting.

It is a heavy, bright blood to sometimes dark, heavy blood. It reminds me of my heavy days during my period. I am nowhere close to my period now.

I am taking birth control and have been getting my periods correctly each month. This bleeding is not a consistent flow. It only happens when I use the bathroom.

It is like I have a blood pool above my vagina, and the minute I push a little to pee or have a bowel movement, it spills out. I do not have period cramping. But the pain will be like a dull, achy pain, or sometimes a sharp pain, especially when the blood comes out. It radiates all over my pelvis, ovaries, stomach, and back, sometimes to my kidneys.

I did consult a gynecologist earlier today. He pressed on my stomach, where I had some discomfort. He also did a vaginal exam and said there was a lot of mucus with blood. When pressed inside, I felt little discomfort.

He did a swab and sent it out to be checked for infection, and prescribed me some antibiotics just in case it was an infection. He also scheduled me for an ultrasound for next week and wants me back in two weeks. He told me to come back sooner if it gets worse.

He seemed quite concerned. This evening, I have started to become more dizzy and lightheaded. Could this be just an infection or something else?

I do not have itchy or burning vaginal symptoms that you get when you have an infection. I am really worried about this. I am scared of cancer now, as I know that the abnormal bleeding and pain are signs of reproductive cancer.

So, I need a second opinion from another doctor while I am waiting for the results.

Please advise.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

I believe this is the first episode of heavy intermenstrual bleeding or polymenorrhagia for you, and during the mid-cycle. The most likely cause for the same can be irregular shedding, which can occur in case of ER estrogen excess or progesterone deficiency, where endometrial proliferation is unopposed by a deficiency in progesterone. The fact that you are on birth control should not be presented in this manner.

But, in cases of high-dose oral contraceptive pills with higher estrogen content, irregular shedding has been commonly seen. I would like you to let me know the name of the birth control which you are presently using, and for how many months? Secondly, as there was ample mucous discharge mixed with blood on per vaginal examination, it is better to rule out any local vaginal infection, but invariably it will not cause uterine bleeding or endometrial shedding.

So, the possibility can be either an endometrial polyp or a submucosal fibroid, which may have developed over the last few months and is likely to be the cause, or there is a progesterone imbalance, which is a likely cause. Hence, ideally, antifibrinolytics should have been advised to control and reduce the bleeding and follow it up with an ultrasound of the pelvis to look for any polyps, submucosal fibroid, or ovarian cysts indicating an endometriotic cause.

As the pain is diffuse in the lower abdomen and per vaginal examination was painful on deeper examination, endometriosis or PID (pelvic inflammatory disease) should also be ruled out by USG and swab test. You should start yourself on empirical antibiotic treatment, which shall take care of PID or any bacterial vaginosis as well.

If the bleeding is not controlled and remains heavy, causing anemia and dizziness as manifestations, then to stop the bleed, the best way would be to undertake a dilatation and curettage procedure. Through which can remove the endometrium and subject the sample for histopathological exam to rule out any endometrial hyperplasia and accompanying atypia, which may indicate an endometrial cancer depending on the reports.

At present, wait and watch for excessive bleeding for a few more days, and if it does not reduce, then review with ER and get the ultrasound done sooner and further evaluation. Keep yourself well hydrated to maintain the blood volume and avoid dizziness episodes.

I hope this helps you.

Thank you.