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Bleeding on Provera. Only spotting no heavy bleeds. What can be done?

Mar 2013
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Practicing since : 1998
Answered : 5970 Questions
Dr XXXXXXX XXXXXXX can you please review our past discussions, last initiation was on the 9th of August so we can discuss the latest.PS: Im bleeding on Provera approx day 30 to 35 and spotting in between though no heavy bleeds like previously( before Provera). Is this normal? Also sexual activity with my long term partner also hurts and i bleed afterwards on some occassions.
Posted Sun, 20 Oct 2013 in Pregnancy
Answered by Dr. Aarti Abraham 6 hours later
Brief Answer:

Detailed Answer:
Hi again XXXXXXX
Its good to hear from you again.
Hope you have been keeping well.
As long as you are taking Provera, you should NOT be bleeding.
Bleeding or a period can occur only once you properly stop Provera.
Spotting in between while on Provera is normal, and can occur once in a while and is of no worry.
AM happy to learn that your heavy periods are no longer there now.
However, I wish to ask you if these symptoms of painful intercourse and bleeding after intercourse are new, or were present previously also ?
Typically, these two point towards a diagnosis of polyps again.
Polyps are notorious for recurrence unfortunately.
Also would you please tell me since how long ( in days exactly ) you have been taking Provera now ?
It would help me a lot if you upload the ultrasound scan ( latest ) too.
I know I am asking you a lot of questions, but I wish to have maximum knowledge before I provide you a definite idea.
Take care, XXXXXXX and looking forward to hearing from you again soon.
If you wish to send a query across to me directly anytime, you can do so at the following link -
Above answer was peer-reviewed by
Follow-up: Bleeding on Provera. Only spotting no heavy bleeds. What can be done? 13 hours later
Hi Dr XXXXXXX besides this issue life is good :).

Hope you are well too and am pleased your still on line to provide some guidance or ideas.

Personally concerned as ive had the issue from Oct last year with a couple of treatments eg:as per history D & C in Feb, ok for a few months there after and re occurence in July/August). I won't go into the past history as you are already across this.

I think i have been on Provera since August 10/11th from re collection so it will be 42/43 days. My next specialist appointment is this Thursday, I don't have a recent ultrasound eg in the last 60 days. The pain during intercourse i had back in Feb and it went away after my D & C. Though i have been deterring my partner because of the pain over the last month not to have intercourse. We did try twice in the last month but on both occassions the pain wasn't pleasant felt like abdominal pressure and then bleed as he exits my vagina as much as a half a tea cloth, so we try not to do be intimate till we can get this sorted. With the tests ive had ( if it was uterus cancer they could see it and would have come up in the original polyps tested true?) Or can this be missed?
Answered by Dr. Aarti Abraham 1 hour later
Brief Answer:

Detailed Answer:
Hi again
It is good that you have an appointment coming up on Thursday, as I would have recommended one for you otherwise.
Firstly on Provera, as long as you continue taking it continuously, you should NOT have a proper period ( spotting intermittently is okay ).
Hence, there has to be some reason for the Provera not working as it should.
Reasons could be - inadequate dosage or some other issue apart from the underlying hormonal imbalance.
This reason again could be the polyps which you had.
The fibroid was too small and never caused you trouble.
However another fibroid could have sprung up, or the current one could have increased in size or shifted towards the lining of the uterus ( you mentioned it was in the wall of the uterus ).
Fibroids which are buried inside the wall ( intra mural ) do not cause bleeding complaints, however the ones nearer to the cavity and lining of the uterus ( submucosal ) might.
Once a fibroid increases in size, part of it might protrude inside the cavity, wherein earlier it was not.
Hence these are the possibilities I can think of.
I would go more in favour of a polyp on account of the pain during intercourse.
Only polyps would cause bleeding after attempts at penetration, a fibroid wouldnt.
A repeat XXXXXXX examination ( per vaginum and per speculum ) and a repeat ultrasound are the least that should be done.
This time I would request you to get the ultrasound and upload it for my perusal too.
Do not worry about uterine cancer again, if it would have been there, it would have shown up on XXXXXXX examination, as well as on the hysteroscopy and the D and C.
When the polyps were removed, were they sent for histopathological examination ( biopsy ).
Am sure they were, it is standard protocol . Please ask for the details of the report .
Am positive this is not uterine cancer, but a recurrence of the polyps / increase in size or number of fibroids.
Please keep me posted once you have a workup on Thursday.
Would be looking forward to hearing from you.
God bless.
Above answer was peer-reviewed by
Follow-up: Bleeding on Provera. Only spotting no heavy bleeds. What can be done? 18 minutes later
Hi Dr XXXXXXX XXXXXXX I will request exactly what you have outlined and up load these to you. Hopefully he will provide me with these, otherwise i will chase my GP to provide me the reports ( he sends these off to my GP too) via email so i can send them to you.

Thank you so very much for your guidance, you make so much sence then my Gnaeo a man of very few words though well respected obstetrician.

I will be in touch Thursday night.

Good nite and god bless Dr XXXXXXX XXXXXXX
Answered by Dr. Aarti Abraham 2 hours later
Brief Answer:

Detailed Answer:
Once again, am overwhelmed by your appreciation and ability to see good around you.
Will be looking forward to hearing from you.
Make sure you use the direct link I provided this time, as these general queries could be picked up by any doctor.
Take care.
Above answer was peer-reviewed by
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