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Ask the doctor: Should I be worried about brown period blood?


Brown period blood could be a perimenopausal symptom

Brown period blood could be a perimenopausal symptom

Brown period blood could be a perimenopausal symptom

In the past year, I have noticed that I bleed about five days to a week before my period. It isn’t much, but enough to make me think that my period’s job is done. It is usually brown blood. I am 46 but I don’t have any symptoms of perimenopause. Do you think this is anything to worry about?

I presume there is no chance that you are pregnant. I also presume that your cervical smear test is up to date and the most recent smear test was reported as normal. Given that you are 46 and the only symptom you have noticed over the past year is brown blood in the week leading up to your menstrual period, I suspect this is most likely your first perimenopausal symptom.

Brown blood usually means it is old and has taken a long time to slowly shed from the lining of the womb. It could actually mark the start of your menstrual period which is now more prolonged and begins light, getting heavier during the second week.

The list of perimenopausal symptoms can be exhaustive but I will mention them just in case you might recognise one or two more. The emotional symptoms associated with the perimenopause include poor memory, poor concentration (brain fog), low mood, anxiety, panic attacks, mood swings, bursts of anger and loss of confidence.

The genito-urinary symptoms include vaginal dryness/discharge, loss of libido, pain during sexual intercourse, recurrent urinary tract infections and even urinary incontinence. Lastly, the physical symptoms include hot flushes, night sweats, sleep disturbance, insomnia, fatigue, headaches, dry skin/eyes, acne, increased chin hair, hair loss, weight gain, breast tenderness/cystic change, palpitations, gastro-intestinal changes/abdominal bloating, joint aches and pains.

An obvious thing to rule out is the possibility of a retained foreign body such as a condom, tampon, vaginal contraceptive device like the diaphragm or ring or a cervical cap. Generally, there is an accompanying bad odour to the brown blood or discharge. In your case, your symptoms are cyclical — occurring with every monthly menstrual cycle — therefore the possibility of retained foreign body is unlikely.

In terms of other potential medical reasons for your brown blood, an important thing to consider is the possibility of a sexually transmitted disease (STD) such as chlamydia or gonorrhoea. All sexually active men and women should attend for routine STD screening as so many of them go undetected without symptoms for months and even years.

Other symptoms of an STD include pain during intercourse, bleeding after intercourse, bad odour from a vaginal discharge or burning sensation during urination. A long-standing infection may cause pelvic inflammatory disease as the infection travels up from the cervix into the uterus (womb) and beyond.

At this point, women can experience fever, persistent pelvic and even abdominal pain. Lastly, brown blood can also be associated with polycystic ovarian syndrome. If you feel any of the above-mentioned medical conditions may apply to you then you should book an appointment with your GP.

It would be reassuring to have a few simple blood tests and physical examination and possibly arrange a transvaginal ultrasound scan. Your doctor will then be able to give you further clarification as to the exact cause of your brown blood.

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Dr Jennifer Grant is a GP with Beacon HealthCheck

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