Ask Dr Gary: Hormones linked to bleeding

When I had a smear test last month, the nurse warned me I might spot bleed, which I did overnight. The next day I bled more heavily and it went on for a week. I went back to the nurse and swabs and a smear were taken. The results all came back clear, as did a pregnancy test. They did say I would need another smear in a year. I am 33 with four children and have never ever experienced anything like this before. I had my tubes tied four years ago and had finished my last period the weekend before the smear. - J.M.

Irregular or heavy bleeding, disconcerting as it is, is common. Pregnancy and infection are some of the first things doctors worry about, although we know most abnormal bleeding at your age is attributable to hormonal reasons (anovulatory bleeding).

It's unlikely that the smear had anything to do with your heavy bleeding and was a coincidence.

Fibroids, which are muscular non-cancerous tumours, can cause heavy bleeding but that is usually chronic, not sudden. Trauma during sex can cause vaginal bleeding, often from a laceration of the cervix, but that is usually obvious and would have been noted on an internal exam.

Cancer of the cervix is low-risk for your age but not zero risk. Examining your cervix and doing a smear are two ways doctors evaluate for cancerous and pre-cancerous conditions. Getting smears done on schedule cuts women's risk of death from cervical cancer by 80 per cent.

If a woman has a smear and needs another a year later it means the smear wasn't normal but probably low-grade dysplasia, a condition that's normally cleared by the body.

If it does turn out to be anovulatory bleeding, most of the time the body works it out by itself over the course of a few months. If it doesn't, doctors can control the bleeding by giving hormones, such as the birth-control pill.

But again, the first step would be to rule out serious conditions, such as endometrial cancer (cancer of the lining of the uterus). Follow up with your doctor, who will look into the serious stuff. But stay calm knowing that most anovulatory bleeding sorts itself out in time.

Gary Payinda, MD, is an emergency physician who would like to hear your medical questions. Email drpayinda@gmail.com (This column provides general information and is not a substitute for the advice of your doctor.)