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abnormal bleeding

Hi, I am 19 years old and in the past (about 13 y.o.) have had such severe periods that I had to have an emergency DNC to stop the bleeding along with many blood transfusions. Since then I have been on seasonale, which has really helped out a lot. There are times when I am on the active seasonale pills and when I reach orgasim it results in severe pain and faily steady bleeding for varied amounts of time. Why is this? I am worried due to my past medical history and it can really throw off my current life style.

Thank you!

Dear luckoftheirish: I would assume that your were worked up as a teenager for any abnormal coagulation disorders. Up to 20% of abnormally heavy bleeding in teens is caused by blood clotting problems. It is also true that in the first two years of menstrual life, many teens have non-ovulatory bleeds which can be VERY heavy and prolonged.

Let's go with the assumption that you do not have a blood clotting disorder such as Von Willebrand's. If this assumption is correct then here is my best GUESS for your current symptoms.

The use of any birth control pill (BCP) has a high potential for creating a thin uterine lining which is easily destabilized. The longer cycle BCPs may have this side effect even more than the usual 28 day formulations. The most common way for an unstable lining to manifest is with breakthrough bleeding (BTB) or spotting. In some women orgasm (strong uterine contractions), heavy exercise, or even intercourse ("jostling" the uterus) can trigger spotting.

Yet you are describing new onset ,severe uterine cramps along with the breakthrough bleeding. This is not typical for "thin lining BTB". One condition which can be linked to both BTB and pain would be an infection of the uterus/tubes/ovaries ("PID") caused by an STD such as chlamydia or gonorrhea. Another might be adenomyosis (endometriosis of the muscular wall of the uterus).

I would suggest that you see your GYN or clinic for a consult about the spotting--and particularly the new pain. Expect to be asked if all forms of orgasm (intercourse, clitoral stimulation) trigger the symptoms, and when the symptoms onset. ...I can understand your concern given the experiences at age 13, but I really doubt this current problem is likely to trigger hemorrhagic bleeding and a need for transfusion.

Yours, Jane