The SM-Clinic gynecologist explained whether menstruation can occur during pregnancy

Is the appearance of bloody discharge in an expectant mother a reason to consult a doctor or is this normal for early pregnancy?
Let's figure it out. Tatyana Vladimirovna Grigorieva, obstetrician-gynecologist at SM-Clinic (@smclinic), told Letidora readers about what the menstrual cycle is, as well as about menstruation during pregnancy. Tatyana Vladimirovna Grigorieva, obstetrician-gynecologist at SM-Clinic

Can menstruation guarantee that pregnancy has not occurred?

First, let's remember what the menstrual cycle is.
This is the alternation of menstruation itself (lasts 3-7 days), the follicular phase, ovulation and the luteal phase. During menstruation, the lining of the uterus is shed. The process is accompanied by bleeding (this happens at the end of the ovulatory cycle). If there was no ovulation, then the bleeding is called menstrual-like. It is extremely rare for two eggs to mature in one cycle (but it happens!): one is fertilized, and the second is rejected by the body and causes the onset of menstruation.

Normally, there can be no menstruation during pregnancy.

However, do we always understand the nature of vaginal bleeding without medical diagnosis? If during the expected menstruation a woman notices bloody discharge, but its character is different from the usual menstruation (the discharge is scanty, ends quickly, has a brown or bright scarlet color) and you remember that unprotected sexual intercourse took place - this is a reason to do take a pregnancy test and consult a doctor.

Pathological discharge

Scarlet bloody.

When they appear a few days before menstruation, they indicate erosion of the cervix, after sexual intercourse - about trauma to the vagina, and during pregnancy - about the threat of termination2. In some cases, such discharge is associated with endometriosis, uterine fibroids, and endometritis4,5.

Smearing brown.

They are a sign of hormonal disorders2,3 and/or endometrial hyperplasia6.

Foamy, abundant, yellow-green2,7.

Indicate infection of the vagina, fallopian tubes, ovaries or other organs of the reproductive system. May be one of the symptoms of sexually transmitted diseases.

Thick purulent3.

They are a sign of purulent cervicitis and can worsen with stress or during bowel movements. Unlike normal white discharge after menstruation, it has a more viscous consistency.

Pinkish with an unpleasant odor2.7

. May indicate the development of endometritis. Usually appear before menstruation.

Watery, dirty gray color 2.7

. This is a symptom of diseases such as endocervicitis, endometritis. They are observed both before and after menstruation. Dirty gray mucus with a strong fishy odor may indicate vaginal dysbiosis.

Curdled white 2.7.

Heavy white discharge after menstruation and during other phases of the cycle may be a sign of vaginal candidiasis (thrush). They may be accompanied by the appearance of a white coating on the external genitalia, itching, and burning.

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What can periods mean during pregnancy?

After the fertilization of the egg and the onset of pregnancy, menstruation does not occur throughout the entire process of gestation.
It should be remembered that the appearance of any bloody discharge from the vagina during a confirmed pregnancy (positive urinary pregnancy test, ultrasound data, hCG levels) indicates possible pathologies. For example, when there is a threat of miscarriage and termination of pregnancy (spontaneous abortion that has begun), placenta previa (low, marginal, complete).

Scanty spotting during the first days of pregnancy may represent nothing more than implantation bleeding. Implantation of a fertilized egg (blastocyst) into the endometrium occurs 7-10 days after conception, that is, essentially around the days when menstruation should come in case of late ovulation.

The penetration of the blastocyst is accompanied by the destruction of capillaries, and, consequently, a small amount of blood is released. But, unlike true menstrual bleeding, implantation bleeding does not last long: in most cases, a day, or even less.

Causes of age-related bleeding

Bloody discharge that occurs in puberty women a week after menstruation indicates deviations in the regulation of the reproductive system.

The main factors causing DMC during this period:

Disorder of the hormonal function of the ovaries.
The pathology is caused by the presence of a cyst or a dominant follicle that has not been released;
Neoplasms in the uterus
.
Neurosis.
After prolonged, severe psycho-emotional shocks in girls during puberty, the production of follicle-stimulating and luteinizing hormones is disrupted, which provokes bleeding.

In the category of women of reproductive age, spotting a week after menstruation is most often due to the presence of gynecological diseases.

After 45 years, the pituitary gland stops producing the hormone gonadotropin. Irregular production of this substance can cause bleeding 5-7 days after menstruation.

What effect does progesterone have on the mucous membranes of the uterus?

Progesterone is the most important hormone throughout pregnancy. It is involved in preparing the endometrium for implantation of a fertilized egg, fetal development, and prevents premature birth. The cause of bleeding from the vagina, including on days when a woman previously had menstruation, may be a lack of this hormone.

Hormonal bleeding left unattended can lead to spontaneous abortion.

However, in most cases, with timely treatment, it is possible to relieve the deficiency condition and minimize risks.

Classification of dysfunctional uterine bleeding (DUB)

Age is a key factor in accurately determining the causes of bloody discharge a week after your period. There are juvenile, reproductive and menopausal pathologies of intermenstrual discharge.

Juvenile uterine bleeding
. They are observed in girls during puberty. Accompanying the disease are copious discharge mixed with blood, dizziness, pallor and general malaise. In pediatric and children's gynecological practice, this pathology is recognized as the most dangerous, as it is associated with inflammation of the pelvic organs, causes anemia and negatively affects future pregnancy.
Reproductive uterine bleeding.
Women aged 18 to 45 years most often experience pathological intermenstrual discharge that occurs a week after menstruation. Their pathology is caused by the lack of ovulation in the middle of the cycle. The level of the hormone progesterone at such moments is negligible. This type of DUB is a consequence of dysfunction of the ovarian or adrenal glands that produce hormones.
Menopausal uterine bleeding.
Occurs in women during menopause. The occurrence of pathology is due to blood clotting disorders and other age-related problems.

Could spotting indicate an ectopic pregnancy?

An ectopic pregnancy is when a fertilized egg deviates from its intended path and implants in the wrong place - outside the uterine cavity.
The appearance of bloody discharge from the genital tract is not uncommon during an ectopic pregnancy. Unlike menstrual bleeding, they have a thicker consistency and darker color.

It should be remembered that in the early stages, the signs of ectopic (ectopic) pregnancy are very similar to the signs of normal pregnancy (delayed menstruation, swelling of the mammary glands, positive urinary pregnancy test).

Any suspicion of an ectopic pregnancy is an indication for emergency hospitalization, as this is a life-threatening condition.

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Any vaginal discharge is associated with the functioning of the secretory organs of the reproductive system in a woman. They have a protective and moisturizing function, protecting against infection and creating a normal environment for the healthy functioning of organs.

When does discharge occur?

Discharge appears in growing girls several months before the onset of menstruation. Secretion may vary in properties and quantity, since there is a dependence on the general hormonal background, the onset of sexual activity, and the stage of the cycle. In the middle of the menstrual cycle, when ovulation occurs, the amount of secretion can increase significantly. The same thing happens just before menstruation.

One of the main symptoms indicating the presence of a gynecological disease is pathological discharge. However, it is impossible to characterize the discharge and establish a diagnosis on this basis.

How to distinguish normal discharge from pathological ones

Characteristic differences of pathological discharge:

Discomfortable sensations accompanying discharge of different shades during any cyclic period. Itching, unpleasant odor, mild pain in the pelvic organs appear;
Leucorrhoea appears - a cheesy discharge of predominantly white, yellowish or pinkish tints. They are stronger and thicker in comparison with the usual properties of the secretion;
Bloody discharge of different shades that occurs during any period except the current menstruation;
Excessive bleeding during menstruation.

The listed types of discharge are symptoms of diseases of various origins, acute and chronic inflammation, and developing formations. Diseases can be related to gynecology, or they can be of a completely different nature, unrelated to the reproductive system.

The difference between normal discharge is the absence of discomfort, no burning sensation, no negative reaction from the genital organs. In the study of smears for flora, lactobacilli predominate, leukocytes are normal. The secretion of a healthy woman resembles mucus of normal nature and transparency, without an unpleasant odor or inclusions. The second half of the cycle may be characterized by stronger discharge, pain both in the pelvic area and in the external organs of the reproductive system.

Types of discharge

They are divided according to location.

Vaginal. The most common type. Should be present in small amounts in a healthy vagina. A large volume can be caused by pathology, for example, colpitis. The cause is determined through examination.
Uterine. They indicate the course of pathology in the area of the uterine mucosa (fibroids, endometrial diseases, neoplasms).
Pipe. They are rare. Indicate inflammation in the fallopian tube.
Vestibular. They have the appearance of leucorrhoea, localized in the outer part of the genital organs, involving the vagina.

The purpose of diagnosis in the presence of secretions is to determine the source of the secretion and analyze its nature. Preliminary analysis is carried out by abundance, consistency, color. Full analysis - based on laboratory research.

The most common types of discharge:

Normal transparent mucous membranes, observed outside of menstruation;
Curdled white or purulent greenish - evidence of inflammation, infectious disease;
Bloody spotting of different shades in the middle of the cycle indicates a hormonal imbalance and the presence of erosion.

An alarming symptom should be the appearance of bloody discharge in the middle of the cycle, accompanied by severe pain, dizziness, decreased blood pressure, palpitations, and increased sweating. This is the basis for calling an ambulance.

If there are sharp pains with contractions in the lower abdomen, dizziness, severe weakness, this may indicate internal bleeding. Urgent assistance required.

It happens that vaginal discharge is the only sign of an ongoing disease. They are irregular and appear periodically. Laboratory testing is required to make a correct diagnosis. Regular preventive examinations with a gynecologist with tests according to the main list (general urine and blood, smear) help to identify hidden diseases that are asymptomatic.

Discharge in gynecological diseases. Causes and treatment

In women with constant hormonal imbalance, as well as those suffering from infertility, continuous discharge that is not inflammatory in nature is observed.

The following types of discharge are characterized as pathological and require treatment:

In the form of a curdled mass, or in the form of a film or plaque: thrush (candidiasis);
Transparent mucus with white inclusions, appears at the end of the cycle: erosion, inflammatory process in the cervix;
Dirty white, in the form of layered films, having a strong unpleasant odor: vaginal dysbiosis;
In the form of a bubbling yellowish substance: trichomoniasis (infectious disease);
Abundant green and yellow, uniform consistency: inflammation of the ovaries (exacerbation), inflammation of the fallopian tubes;
Purulent, thick, worsening after any effort: purulent cervicitis;
Weak yellowish and greenish, homogeneous: infection with bacterial flora, chronic disease;
Weak bloody dark colors: endometriosis, polyps;
Pink with blood inclusions, with a strong odor: chronic pathology in the uterus;
Dark liquid discharge immediately after menstruation: chronic endometrial disease;
Large clots during the current menstruation: pathology of blood clotting, polyps, cervical inflexion. The reason may be an intrauterine device;
Mild bloody, suddenly appearing during pregnancy: placental abruption;
Immediately after artificial termination of pregnancy, the nature of the discharge varies. Ultrasound guidance is required.
If, after the abortion procedure, purulent discharge joins the bloody discharge, we can talk about the onset of an infection. The danger is the accompanying pain and high temperature. You should not hesitate to visit a doctor. However, prolonged scanty discharge (sometimes more than a month) can be considered normal.

Based on an examination of the discharge and the diagnosis, the gynecologist prescribes adequate treatment.

Prevention of pathological discharge as a consequence of acute and chronic diseases of a gynecological and other nature is personal hygiene, regular medical examinations, protected sexual intercourse, and timely response to secondary symptoms of the disease.

It should also be taken into account that taking certain medications affects the course of the cycle and may cause minor discharge. Hormonal contraceptives have the same property.

When do menstrual-like discharge still occur and what does it mean?

In most other cases, bleeding during early pregnancy (in the first trimester) is an alarming symptom.
For example, it may indicate that the placenta is located in the lower part of the uterus and blocks its internal os (this can be interpreted as a threat of termination of pregnancy).

In the second and third trimester, the appearance of bloody discharge may indicate uterine rupture (for example, it can occur if there is a scar on the uterus after a previous birth), premature abruption of a normally located placenta, and other problems.

Bleeding during pregnancy is a sure sign for the expectant mother that she urgently needs to see a doctor.

It is important to remember that periods during pregnancy are not normal. In case of any bleeding, the help of a specialist is needed in this case.

Treatment of postmenstrual uterine bleeding

A gynecologist treats pathologies. To maintain the functionality of the reproductive system, self-medication is strictly contraindicated.

Based on a set of diagnostic procedures, the specialist will select individual therapy aimed at improving hormonal levels and eliminating the causes of intermenstrual bleeding.

Depending on the pathology, the following treatment may be prescribed:

When hormonal levels are destabilized, hormone therapy is prescribed.
If there are pathological formations on the cervix or uterus, curettage or removal using one of the gentle methods is prescribed.
To stop bleeding, drugs that normalize blood clotting and increase the elasticity of capillaries are used.
If there is physical trauma to the genitals, treatment will consist of stitches, bed rest, cold compresses and antibiotics.
If uterine bleeding associated with contraception recurs within 2 months, the drugs are replaced.
If the cause is stress and nervous tension, therapy will consist of sedative medications.

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How often do periods occur during pregnancy?

15–20% of pregnancies end in spontaneous abortion in the early stages.
However, it is important to understand that although bloody vaginal discharge against the background of a live intrauterine pregnancy is designated by doctors as a “threat of miscarriage,” in a large number of cases, despite the dire diagnosis, such a pregnancy is successfully carried to term. If an interruption does occur, in most cases (overwhelming) we are talking about genetic abnormalities of the fetus that are incompatible with life. Other reasons include infectious diseases in the early stages, hormonal imbalances, physical overload, and so on.

How to stop heavy bleeding during menstruation

Bleeding during menstruation is often difficult to bear and is accompanied by weakness, nausea, pain and other unpleasant phenomena.

In some cases, heavy bleeding during menstruation is normal, but most menstrual irregularities are associated with pathologies of internal organs and require competent medical intervention.

The cause of severe blood loss during menstruation is usually an infectious disease of the reproductive system, hormonal imbalance, fibrous tumors, uterine and endometrial polyps, cancer, abnormal position of the intrauterine device, blood diseases that impair coagulation.

With short and irregular heavy discharge, such periods can be considered an isolated deviation. If bleeding during menstruation continues for more than 5 days, it is better to promptly determine the cause by contacting a gynecologist, and find a way to stop menstrual bleeding as soon as possible.

How to distinguish periods from bleeding

Pathological uterine bleeding is a consequence of dysfunction of the organs that regulate the menstrual cycle. Dysfunctional bleeding can be caused by fibroids, adenomyosis, polyps, miscarriage, ectopic pregnancy, hypothyroidism, and iron deficiency. Miscarriage and early ectopic pregnancy can cause bleeding. Taking anticoagulants and inserting an intrauterine device can cause uterine bleeding as a complication.

A sign of uterine bleeding may be heavy bleeding during menstruation, especially if it lasts more than a week. A large number of blood clots, weakness, a feeling of fatigue, sharp and aching pain in the lower back and lower abdomen, anemia also indicate the presence of dysfunctional bleeding. Bleeding between periods clearly indicates pathology.

If fibroids are present, uterine bleeding can only be stopped through surgery. For polyps, drug treatment is also impossible; hysteroscopy is performed for treatment.

How to stop heavy bleeding during menstruation

When abnormal bleeding occurs or during heavy periods, hormonal and non-hormonal hemostatic agents are often used. Medicines whose action is based on changes in hormonal levels are recommended to be taken as prescribed, since only a specialist will be able to develop an individual dosage regimen that will prevent complications and recurrent bleeding. Self-medication with hormonal drugs often causes additional pathologies, fertility disorders and complications during pregnancy and childbirth.