Understanding Unusual Bleeding: Causes & What to Do

Question
Hi, i am 33 and have always been very regular with my cycles. Today is the 17th day of my cycle and am bleeding. What is the possible cause? I have never had short cycles, so this is very unusual. One thing though, that may give you a clue... or not sure. Last year i had a miscarriage (anembrionic pregnancy). Should i worry? I don't have kids and want to start trying again this year.  
thanks for our time!

Answer
Dear Salome,

This condition is called metrorrhagia - uterine bleeding at irregular intervals, particularly between the expected menstrual periods. Metrorrhagia may be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids or, QUITE rarely, cancer of the uterus. Typically, if this is not something that occurs regularly and is an isolated incident for you, this would be attributed to a hormonal imbalance.

Approximately 90% of dysfunctional uterine bleeding results from anovulation, and 10% occur with ovulatory cycles. During an anovulatory cycle, the corpus luteum fails to form, which causes failure of normal cyclical progesterone secretion. This results in continuous unopposed production of estradiol, stimulating overgrowth of the endometrium. Without progesterone, the endometrium proliferates and eventually outgrows its blood supply. The end result of this progesterone/estrogen imbalance is overproduction of uterine blood flow.

Causes of dysfunctional uterine bleeding can be:
- Pregnancy-related
- Trauma to the cervix, vulva, or vagina may cause abnormal bleeding
- Related to other Disorders such as thrombocytopenia, hypothyroidism, hyperthyroidism, Cushing disease, liver disease, hypertension, diabetes mellitus, and adrenal disorders.
- Structural disorders, such as functional ovarian cysts, cervicitis, endometritis, salpingitis, and leiomyomas
- Polycystic ovary disease, vaginal infection, uterine polyps, blood dyscrasias, excessive or rapid weight gain, significant change in diet, increased or strenuous exercise, or stress can also cause hormone imbalances and/or dysfunctional uterine bleeding.
- Intermenstrual bleeding may occur secondary to missed BCPs, varied ingestion times, and drug interactions also.

There is really no need to panic with this as metrorrhagia. I would suspect that this is an isolated incident for you related to a hormone imbalance, which the majority or irregular bleeding episodes are. Your cycle will likely return to a more normal pattern with the next couple cycles. However if it does not, since you are trying to conceive again, consult your doctor at that time.

I hope this has helped you and answered your question. I wish you well.

Brenda