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Mid-cycle post-sex bleeding, cramping, endometrial biopsy normal, PAP normal. Should I go to the doctor?

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I am 47 years old. Back when I was just about 37, I started having some mid-cycle post-sex bleeding. My dr did an endometrial biopsy which came back normal. I have had a couple abnormal paps over the years but none have come back HPV positive (except 1 when I was in my mid-20's). Last April, I had noticed a couple times some bleeding after sex again. My dr again did an exam and an endometrial biopsy which came back normal. I think I noticed a tiny bit of bleeding maybe once since then, until today, and I again noticed post-sex bleeding. I am almost exactly mid-cycle. I had some mid-cycle cramping last night (which I notice occasionally). Should I go see my doctor yet again for this bleeding or just assume it is the same problem I have experienced before?
Posted Sun, 29 Apr 2012 in Menstruation and Miscarriage
 
 
Answered by Dr. Rakhi Tayal 3 hours later
Hello,
Thanks for posting your query.
Mild amount of mid cycle bleeding with normal endometrial biopsy and PAP smears is nothing to be worried about. It can happen due to some conditions such as:
1. Local infection or ulcer in private parts
2. Cervical erosion-ulcer like thing on tip of cervix
3. Forceful act
4. Lack of proper arousal which might lead to poor lubrication and friction
at times.
5. Mild mid cycle spotting might occur at the time of ovulation in some individuals.
Please discuss this with your gynecologist and get your self examined once again on your follow up visit.
In mean time please use lubrication and ask your partner to use condom to avoid friction.
Take good healthy diet, XXXXXXX in fruits and salads to maintain over all good health.

Hope this answers your query. I will be glad to answer the follow up queries that you have.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Mid-cycle post-sex bleeding, cramping, endometrial biopsy normal, PAP normal. Should I go to the doctor? 12 hours later
Do you think any other tests are needed (I think they mentioned a hystroscopy the last time I had this happen back in April of this year). Instead they did the endometrial biopsy.

Also, do you think that birth control pills would help at all? I do have somewhat heavy periods.

Thanks.
 
 
Answered by Dr. Rakhi Tayal 19 hours later
Hello.
Thanks for writing again.
Endometrial biopsy is a better diagnostic tool than hysteroscopy for mid cycle bleeding. Some routine blood tests might be needed including clotting factors if your gynaecologist feels it necessary.
Birth control pills might stop this if it is due to ovulation. Otherwise oral pills will help in reducing the overall bleeding during your periods.
Hope my answer is helpful. Write back if you have further queries.
Please accept my answer in case you do not have further queries.
Wishing you a speedy recovery.
Above answer was peer-reviewed by
 
Follow-up: Mid-cycle post-sex bleeding, cramping, endometrial biopsy normal, PAP normal. Should I go to the doctor? 4 hours later
One last question. I did go see my dr yesterday. She did an XXXXXXX exam and ultrasound and she did not find any issues.

As I said before, I am 47 years old and in good health. Both of my parents have had strokes (my mom was a heavy smoker and diabetic, my dad had atrial fibrilation). My doctor gave me 3 options to potentially help with my bleeding but also mostly to help with heavy menstral bleeding:

Birth Control Pill
Mirena IUD
Novasure ablation

For me at my age, which of these options do you think would be best.

Thank you for your help. I will accept your answer as soon as I hear back from you.
 
 
Answered by Dr. Rakhi Tayal 2 hours later
Hello.
To decrease the heavy uterine bleeding without any detectable pathology, the best would be the birth control pills after ruling out the contraindications, next option that should be considered is novasure ablation and Mirena IUD should be the last among the list as IUD insertion itself might result in a heavy bleeding initially.
Take care.
Regards.
Above answer was peer-reviewed by
 
Follow-up: Mid-cycle post-sex bleeding, cramping, endometrial biopsy normal, PAP normal. Should I go to the doctor? 1 hour later
What do you mean by "ruling out contraindications" (for birth control pills)? What pill would you advise?
 
 
Answered by Dr. Rakhi Tayal 6 hours later
Hello.
Nice to hear from you again.
The oral contraceptives are not preferred in a history of heart disease, severe obesity, blood clotting disorders, severe hypercholesterolemia, severe hypertension, chronic smokers, liver dysfunction, etc.
All these will be ruled out by your gynecologist after simple blood tests.
Usually a combined oral pill with both estrogen and progesterone in lowest dose is preferred. Your Gynecologist will choose the one best for you.
I hope you will be able to decide the best for you.
Wishing you a good health.
Above answer was peer-reviewed by
 
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