Hi Adnan,

Unstoppable bleeding for more than 10 days warrants a physical examination and necessary treatment with pills or injections. I think this is important now. I do not think your doctor can go for HSG scan if you continue to bleed.

I would like to ask you some details about your symptoms to assist you better.
1. Is this the first time you are experiencing vaginal bleeding between periods?
2. Were your periods regular before this?
3. Has the doctor prescribed on any birth control pills to regulate the periods ?
4. Please share with me all the recent reports / tests you had done? Ultrasound of lower abdomen report, Thyroid profile, LH, FSH, Estrogen and Progesterone levels. Also share on which day of your cycle these were done.
5. Medications taken till now.

Vaginal bleeding between periods may occur due to various reasons:

Hormonal imbalances - Very common
Sexually transmitted infections / Pelvic Inflammatory disease - Recurrent infections cause distortion of tubes and makes the Uterus not suitable for implantation of the foetus. HSG test rules out any anatomical defect.
Ectopic pregnancy or miscarriage
Uterine fibroids or polyps-- If you have submucus fibroids then you will have irregular bleeding and depending on size of fibroid the chances of implantation hamper.
Birth control pills -- Since you are trying to conceive I believe you are not on these.
Intrauterine contraceptive device -- I hope you have not used it earlier.
Thyroid dysfunction - Please let me know the thyroid status.
Cervical erosions - It is better to test with a Pap smear.

On receiving further details form you , I would help you with my answers .

Awaiting your follow up

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Hi Afifah

Thanks for replying back with the details .

Spotting between cycles is considered normal, it is due to hormonal changes happening before the commencement of the next cycle .

The history you have given now, having a blood flow two days before the actual periods, could indicate a normal menstrual cycle which has just come earlier .

I suggest you to wait for a couple of days, I feel the flow will reduce by then and stop.

If it does not show any signs of reduction in the amount of bleeding, you may consider seeing the doctor and go for an examination. An ultrasound scan of the abdomen and pelvis may be recommended .

You may require hormones or medicines to stop the bleeding if it continues to be heavier and the HSG may be postponed to your next cycles

Hope this answers your query.

Wish you good health

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Hi and thanks again,

Physiologically, as the menstrual cycle reaches its last few days, the levels of progesterone start dropping. The sudden drop in the levels of both oestrogen and progesterone is responsible for menstrual bleeding. So theoretically yes, your current period disturbance that you have noticed is probably due to progesterone levels dropping.

As far as normal range is considered, progesterone levels are not constant, varying ranges are seen depending on the age, day of menstrual cycle and pregnancy status. Because of these variations in its levels, for routine infertility check ups, hormones (including progesterone, FSH, LH, testosterone and thyroid hormones) are checked on day 2/3 of menstrual cycle - 1st day is considered on the first day that you have your normal period.

You have not mentioned the day when the progesterone levels were done and it is also not clear which thyroid hormones you have been tested for - TSH, T3 or T4. Since these are not clear, I wish not to comment on it.

And as far as HSG treating blocked tubes; HSG (Hysterosalphigogram) is a test in which a XXXXXXX is injected into the uterus and then visualised by Xray's. The test is basically for diagnositic purpose. It has no role in the therapeutic treatment of blocked fallopian tubes.

To summarize our discussion till now:
1. The current disturbances that you had is probably due to hormone disturbance and yes that could be drop in the progesterone levels
2. HSG test is for diagnosis alone - to look if any structural abnormality may be affecting the chance of pregnancy. It has no role in treating blocked tubes or other structural defects.
3. You will need to get the hormone tests done on day2/day3 of menstrual cycles as explained. The levels of the hormones have much higher significance in predicting chances of pregnancy. You could consult one of the infertility specialists and get the test done.
4. Yes, thyroid hormones can cause menstrual irregularities, but it is not clear if you suffer from it.
5. Your current symptom is probably a variant of normal period and probably not a major concern. Wait and watch. If you continue to bleed heavily or if it is lasting for more than a week, then you need treatment.
6. Treatment could either be use of contraceptive pills or D&C procedure.

Hope I have answered your query adequately.

Wish you good health and success!!

Regards

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