Starting today we have an illustrious partnership with Dr. Jaime Filho! I met Dr. Jaime and his passion for his profession, which is so important for us women. Clarifying doubts about the mysterious world of gynecology and obstetrics is the mission of this generous professional who has dedicated his time to help Famivita readers. Welcome, Dr. Jaime! So, let’s get started! The first topic was about unusual menstruation.
Menstruation with different color
Famivita: Some women complain about menstruation with different colors, like pink, watery red, or even rust color. What could be the possible causes for these changes?
Dr Jaime: Actually, the difference in the color of menstruation is related to the concentration of menstrual content, as well as the vaginal secretions a woman has at that moment.
The most common is bright red bleeding during the most intense stage of menstruation. Many patients who have a heavy flow report clots of jelly-like blood. This is nothing more than blood clotted in the vagina that, when expelled, appears in this form1.
At the beginning and end of menstruation, “coffee grounds” type bleeding can occur. This has a darker color, since the bleeding decreases, mixes with vaginal secretions and, due to blood clotting reactions, acquires this hue.
Coffee grounds menstruation
Famivita: Coffee grounds menstruation is a common concern here on the blog. What factors cause this coffee grounds discharge to appear?
Dr Jaime: Coffee grounds menstruation may appear at the extremes of menstruation (beginning and end), and this is normal. However, this coffee grounds discharge can occur in the middle of the cycle, the so-called mid-cycle bleeding, which is caused by hormonal changes in the menstrual cycle. It is usually in small amounts.
Another possibility is its occurrence while using contraceptives. In this case, two situations can occur: if the patient uses continuous birth control pills without pausing, she may present coffee grounds discharge after a few months of uninterrupted use. We call this spotting or breakthrough bleeding.
In these cases, a break of a few days from continuous contraceptive use may be a solution so that the patient menstruates and starts a new cycle of continuous use. Remember, it’s important to use condoms in this case and always talk to your doctor about it!
The other situation is continued breakthrough bleeding in the middle of the pill pack with scheduled pause. In this case, it can happen if the estrogen dose is slightly below the ideal for that patient. This depends on factors such as the patient’s weight and metabolism. A reasonable option would be to report this to your doctor, who will assess whether to change the dose or not2.
Coffee grounds discharge during pregnancy
Famivita: Is coffee grounds type menstrual bleeding during pregnancy dangerous? What should be done if it appears?
Dr Jaime: During pregnancy, especially in the beginning, during the first weeks, it’s not uncommon for a patient to seek the emergency room due to coffee-grounds type bleeding in a small amount.
This can result from the shedding of a small area of endometrium, which is naturally thickened during pregnancy. But it can also happen due to pregnancy-related conditions, such as retroplacental hematoma (a small hematoma that forms between the uterus and the embryo), or even be a sign of threatened miscarriage. For this reason, bleeding at any stage of pregnancy, whether light, like coffee grounds, or in greater quantity, should be investigated and the patient should see her doctor or go to the emergency room.
Long cycle and coffee grounds spotting
Famivita: Can long cycles with spotting only for one day be a symptom of diseases?
Dr Jaime: Cycles with long intervals and little menstruation, what we call oligomenorrhea, can be signs of chronic anovulation. To summarize, the menstrual cycle starts on the first day of the previous menstruation, when the thickening of the endometrium (proliferative phase of the endometrium) begins again, mainly stimulated by the hormone called estrogen (first phase of the cycle).
In the middle of the cycle, ovulation occurs due to changes in hormone levels. After ovulation, progesterone production begins, making the endometrium secretory, preparing it for a possible pregnancy (second phase of the cycle). If pregnancy does not occur, hormone levels drop abruptly and the endometrium begins to shed. In other words, menstruation occurs.
In long cycles, there may be a change in the first or second phase. The most common in our setting is alteration in the second phase of the cycle, caused by anovulation, or lack of ovulation. This is what happens, for example, in Polycystic Ovary Syndrome (PCOS), when the patient remains for long periods without ovulating. This is why she cannot complete the second phase of the menstrual cycle.
Many factors are involved in PCOS, such as increased abdominal circumference, peripheral insulin resistance, metabolic syndrome (high blood pressure, diabetes, high cholesterol, obesity). Therefore, if your cycle is like this, the best thing is to see your gynecologist for adequate investigation, so the best treatment approach can be chosen.
If you want to track or confirm your ovulation quickly and clearly, you can use ovulation tests. For greater effectiveness, you need to know your cycle or at least track it to estimate when to test. You can track it using mobile apps that follow your cycle with the information you provide. This way, you’ll know the right day to start using the ovulation tests, which will indicate whether ovulation is about to occur, is happening, or has already ended.
Variation in menstrual amount and duration
Famivita: What can it mean if your period is different in amount, either volume or days (duration)? Can it be pregnancy?
Dr Jaime: A difference in the number of days of menstruation or the volume of flow (light or heavy periods), what we call menstrual irregularity, can be caused by many factors. Generally, we divide these causes into two groups: anatomical and hormonal causes.
Among the anatomical causes3 are uterine fibroids, endometrial or endocervical polyps, cervical changes, etc. Once anatomical disorders have been ruled out, there are hormonal changes, what we call dysfunctional or abnormal uterine bleeding. This is the most common cause of scant or excessive menstruation leading to menstrual irregularity.
Regarding pregnancy, this is considered when there is delayed menstruation, not in every case of menstrual irregularity. However, pregnancy testing is part of the outpatient investigation of causes of abnormal bleeding, so the best treatment can be determined.
Special bonus for those trying to conceive
Famivita: When can the test be taken? What is the minimum amount of time you should wait before taking a pregnancy test?
Dr Jaime: In case of suspected pregnancy, the test can be done as soon as you notice a missed period. Pharmacy tests can yield false positive or false negative results. For this reason, the best thing to do is a blood Beta-hCG test, which is the hormone produced at the beginning of pregnancy and is detectable in less than 1 week of pregnancy.
My name is Jaime Euclides de Santana Filho, I am 32 years old, I graduated in medicine in 2008 and completed my residency in Gynecology and Obstetrics in January 2012 at the Faculty of Medicine of São José do Rio Preto – SP.
Title of Specialist in Gynecology and Obstetrics in 2012 from Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations). I am a fan of all sports, especially soccer, Formula 1, and tennis, and I value a healthy life with quality, in addition to respect and care for others, especially in medical practice.
You can find Dr. Jaime currently in the city of Santos, his hometown, at the practice at Avenida Ana Costa, 222 suite 59 – Vila Mathias – Phone: (13) 38777900, and also at the Ana Costa hospital, Casa de Saúde de Santos, and other hospitals in the Baixada Santista region (Hospitais São José in São Vicente, Irmã Dulce in Praia Grande, and Municipal de Bertioga).
Readers’ Questions:
My period is different, what could it be?
TF: Every woman menstruates in her own particular way, both in the amount of flow and in the color of menstrual blood and length of period. When you notice any difference in your period, it can be due to several causes, such as hormonal imbalance. Therefore, tests are needed to diagnose the cause.
See also: Coffee Grounds Menstruation: What is It
