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[Jules]

I had sex for the first time in 10 months and had some bleeding afterwards. I used vagifem and estriol cream for VA. Is this something I need to have checked or could it be little tears in the skin etc. It was pretty uncomfortable during and I forgot my lubricant but up to then I've had no issues, no spotting or bleeding, no irritation. I had a hysteroscopy a year ago and had a tiny polyp removed from inside my cervix. I really don't want to go to the doctor's and start that process again.

[Taz2]

Hi Jules. Although it probably is just VA bleeding after sex is always something that should be checked out. I appreciate that you don't want to go down the same route again but please get it checked. It could be another polyp?

Taz x

[Jules]

Okay. Thanks. I remember bleeding once before after a gap from sex. I didn't pursue it back then. I assumed it was the fragile tissues and I was sore. I am sore today too. Time to retire from it I think!

[Ayesha]

I know you have had lots of checks in recent months and I would say it was the fact you didn't use a moisturiser that caused the bleeding, and polyps do have a habit of returning. 
Its always best to be on the safe side I know but if you had no bleeding before then I wouldn't worry too much here, for me I would wait and see if it happens again before seeking advice.

[Jules]

Okay thanks. I've had a quick peek inside and it doesn't look red. And I used vagifem alternate nights and maybe that's been enough to keep me comfortable but not for the friction of sex. I'm not worried about anything sinister but I hear what you say about the polyp. I hope not. The thought of going through all that again, even an internal exam at present fills me with panic. I'm feeling really down about It all. I know what will happen if I go to my GP. I will be referred to gyny and be told to stop the vagifem and estriol cream.

[bombsh3ll]

What about your cervical screening, is that up to date?

If so, and given your relatively recent negative investigations, I wouldn't rush to the GP with this.

Dry, painful intercourse in the setting of suboptimally treated VA is enough to explain the bleeding - this is different to unexplained postcoital bleeding which would be more concerning.

I would however initiate adequate and consistent treatment of the VA and make an appointment if it persists.

[Jules]

What about your cervical screening, is that up to date?

If so, and given your relatively recent negative investigations, I wouldn't rush to the GP with this.

Dry, painful intercourse in the setting of suboptimally treated VA is enough to explain the bleeding - this is different to unexplained postcoital bleeding which would be more concerning.

I would however initiate adequate and consistent treatment of the VA and make an appointment if it persists.

I'm beyond the age for cervical screening.  I've had no other symptoms prior to this. It was a pinkish discharge and I found a blood stain on the sheet this morning. I've still got a very slight pinkish discharge but it is petering out. I do feel sore inside though like it's caused abrasion.

[Jules]

My other question is that if I decide to get it checked out, and I'm told I've to stop my vagifem etc, has anybody else been told the same?

[bombsh3ll]

There's no medical reason for you to have to stop your vaginal estrogen, in fact your symptoms are almost certainly due to insufficient treatment.

Systemic estrogen doesn't even need to be stopped pending investigation for bleeding.

Please don't let this worry stop you from seeking care IF it continues, which is unlikely if you use the treatment as liberally and regularly as needed.

[Jules]

I am in agreement with you but when I had a bleed a year ago I was told to stop using vagifem for 6 weeks or she would refer me to gyny.. In the end we agreed 4 weeks and I could continue using estriol externally but that was running out and they wouldn't prescribe more because it was against the guidance. I ended up with a scan and hysteroscopy and tiny polyp removed by which time it d gone without vaginal treatment for about 6 weeks. I really don't want that again.  I had been up and about after the event last night and it was just a slight pink discharge then so I'm a bit puzzled as to why I then had small bleed in the night enough to go on the bed. I'm going to use the vagifem every night for a while.

[bombsh3ll]

It's a shame you had that experience.

Whilst guidelines previously (but no longer) advised stopping systemic estrogen pending investigation for bleeding, this has never applied to vaginal estrogen.

Even if someone had a malignancy, the use of vaginal estrogen for the few weeks it takes to get an urgent endometrial scan and biopsy would be neither here nor there with regard to their outcome.

If you do have to see someone, I would try and find out if there's another GP in the practice who's more up to date around women's health and menopause.

Alternatively in some areas there are NHS sexual health clinics that you may be able to access without a referral - they are often more knowledgeable in this field.

[Jules]

I wish I could find that to quote it. I saw two different doctors and both said the same. It was very stressful. It has made me hesitant of reporting bleeding now. Not to mention the agonising hysteroscopy. I'm going to think about It. I will struggle to even contact the surgery on a Monday anyway. Thanks for the heads up though

[Jules]

I've contacted the doctor surgery stating firmly I'm not going through that process I did last year nor stopping the treatment. They've said it's likely the atrophy but for peace of mind they'll check and I can increase the vagifem to nightly. I'm okay with that plan.

[bombsh3ll]

Good, I hope you feel better with that plan and that the increase in estrogen helps.

[Jules]

Good, I hope you feel better with that plan and that the increase in estrogen helps.

I do. I was going to just leave it and wait, as suggested but a check might be helpful in knowing how I'm doing with the vagifem and making sure all is well. They're more likely to prescribe more vagifem as I was told by a different GP to reduce to twice a week.