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What Causes Heavy Vaginal Bleeding While Coughing?
Question: I am 44 yrs old female with endometrosis. Over the past month I have been developed light bleeding between periods and even heavier periods than usual. I also have bronchitis. My dr did blood work on blood count, prolactin, thyroid hormones. prolactin was 31 and T3 was slightly above normal but all else was pretty good. my dr wants to do schedule a D&C. We agreed to wait til I am over bronchitis unless bleeding gets crazy. I have noticed when I cough hard my bleeding increases. 1) should I mention to my Dr the heavier bleeding when coughing to help figure out why all of sudden my periods/bleeding between period is worse? 2) Do you recommend I wait til my bronchitis is over to do the D&C
Brief Answer:
antifibrinolytics should be given first..explained
Detailed Answer:
Hello,
Thanks for contacting healthcaremagic.
In a case of diagnosed endometriosis, it is prudent that bleeding episodes during menses are also accompanied by dysmenorrhoea ( pain during menses).
In your case your concern is heavier bleeding during menses and also intermenstrual bleeding . One of the theories for development of endometriosis is Estrogen excess and decreased progesterone ( the commonest one being Samson's theory of retrograde flow into tubes during menses). Now in Estrogen excess theory , the endometrium proliferates under estrogen but due to less estrogen doesnt mature into secretory phase, so the thickness of the endometrial lining keeps increasing beyond ovulatory period and such that it reaches a point where progesterone so produced is in sufficient to maintain the lining and it breaks and causes spotting and then reheals and causes spotting again...( especially in day 20 -25 of cycle). So that is one sign of endometriosis.
Secondly heavier bleeding episodes are also common as endometrium is thickened and tissue is more as compared to a non endometriotic lady, hence the more the tissue- heavier the menses.
Thirdly , you mentioned that when you cough, you bleed more. Thats because during coughing intra-abdominal pressure increases which causes increase pressure over uterine wall and it contracts harder pushing out more blood or sloughed endometrium which otherwise would come out over a period of time.
Fourthly your concern about bronchitis and D&C. I feel if your bleeding is heavy, you should first be placed on antifibrinolytics like Tranexaminic acid , then after reducing the flow - an ultrasound pelvis should be done to find out the endometrial thickness and if it is more than 5 mm and still you are bleeding heavy then D& C should be thought off. Reason is in patients of endometriosis , chances of Ashermans syndrome are higher following endometriosis ( intrauterine adhesions), especially where fertility is a concern.
Bronchitis is not a contraindication for antifibrinolytics or D& C , but Misoprostol is contraindicated which is given in some cases after D& c where bleeding still doesn't stop even following D&C.
An ultrasound pelvis is a must before any intervention.
regards,
Dr.Sameer Kumar
antifibrinolytics should be given first..explained
Detailed Answer:
Hello,
Thanks for contacting healthcaremagic.
In a case of diagnosed endometriosis, it is prudent that bleeding episodes during menses are also accompanied by dysmenorrhoea ( pain during menses).
In your case your concern is heavier bleeding during menses and also intermenstrual bleeding . One of the theories for development of endometriosis is Estrogen excess and decreased progesterone ( the commonest one being Samson's theory of retrograde flow into tubes during menses). Now in Estrogen excess theory , the endometrium proliferates under estrogen but due to less estrogen doesnt mature into secretory phase, so the thickness of the endometrial lining keeps increasing beyond ovulatory period and such that it reaches a point where progesterone so produced is in sufficient to maintain the lining and it breaks and causes spotting and then reheals and causes spotting again...( especially in day 20 -25 of cycle). So that is one sign of endometriosis.
Secondly heavier bleeding episodes are also common as endometrium is thickened and tissue is more as compared to a non endometriotic lady, hence the more the tissue- heavier the menses.
Thirdly , you mentioned that when you cough, you bleed more. Thats because during coughing intra-abdominal pressure increases which causes increase pressure over uterine wall and it contracts harder pushing out more blood or sloughed endometrium which otherwise would come out over a period of time.
Fourthly your concern about bronchitis and D&C. I feel if your bleeding is heavy, you should first be placed on antifibrinolytics like Tranexaminic acid , then after reducing the flow - an ultrasound pelvis should be done to find out the endometrial thickness and if it is more than 5 mm and still you are bleeding heavy then D& C should be thought off. Reason is in patients of endometriosis , chances of Ashermans syndrome are higher following endometriosis ( intrauterine adhesions), especially where fertility is a concern.
Bronchitis is not a contraindication for antifibrinolytics or D& C , but Misoprostol is contraindicated which is given in some cases after D& c where bleeding still doesn't stop even following D&C.
An ultrasound pelvis is a must before any intervention.
regards,
Dr.Sameer Kumar
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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