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Bleeding during sex 1 week before my period
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An_197715 posted:
I have recently taken myself off birth control, off for almost 6 months. Before the last 3 periods, about 1 week before they are scheduled to start, i bleeding during intercourse. The bleeding is bright red with quite a large volume (similar to a very heavy menstrual flow) and then promptly stops. A year and a half ago I had an abnormal pap smear. I had regular paps every 6 months until i had a normal. Never during that time period did I ever bleed during sex. There is no pain during intercourse. I can only attribute it to a possible hormone fluctuation due to the discontinued birth control. I was on the Nuva-Ring for 2 years. Prior to that I was on Yasmine for 8 years.

Of course I know the most obvious answer is go see you OB/GYN however I am yet to find one that I like. Any suggestions about this condition???
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Jane Harrison Hohner, RN, RNP responded:
Dear Anon: If you have read my recent blog (see sidebar on right) on bleeding after sex you already know that such bleeding can come from either the cervix or the lining of the uterus. In your specific case, if there was a cervical problem (eg abnormal cells that were not picked up on a PAP) the bleeding would likely be more random--such as after sex at any time in your menstrual month.

From what you have shared about the rigid time frame (one week before menstruation) I would wonder if your bleeding had a hormonal etiology. For example, some women will have consistent spotting in the week before flow due to "luteal phase insufficiency". After ovulation a certain level of progesterone production is required to keep the lining stable. If progesterone levels begin to drop before the usual 72 hours before menses a woman can have spotting or early bleeding.

Another POSSIBILITY would be that you have actually missed ovulations over the past few months leading to an unstable lining which will begin to bleed with the stimulus of intercourse. Yet, your bleeding is so strictly confined to a time period that my best GUESS is a premature decline in progesterone levels.

Yes, you should see a GYN, especially with the abnormal PAP smear history. Depending upon your age (eg over 40), weight (obese), and other health history factors they may way to do a biopsy of the lining of the uterus to rule out polyps or abnormal cells. They should be able to give you the most "for sure" diagnosis.

Yours,
Jane


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