Every girl or woman has had brown discharge at least once in her life. They can begin before and after menstruation, appear in the middle of the cycle or on any other day. In this article we will tell you whether brown discharge in women is dangerous, under what conditions it occurs, and what to do with it.
Brown vaginal discharge in women is not always a sign of disease. Sometimes they are normal. Together with an expert – a gynecologist – we will figure out why the discharge can acquire such a color, in which cases you should not worry, and when you need to urgently consult a doctor.
Such secretions acquire color due to the blood in the composition. Simply put, this is scanty bleeding from a woman’s genital tract. It could have many reasons. They determine the correct one, including by appearance.
Dark brown discharge
This is a slight bleeding, the blood is clotted. Such discharge may accompany the beginning and end of menstruation .
Light brown discharge
A variant of extremely scanty bleeding. Such discharge occurs when the fertilized egg is implanted into the uterus, when there is a threat of termination of pregnancy.
Yellow-brown discharge
They may not be bloody at all, but, for example, inflammatory. In this case, it is necessary to exclude sexually transmitted infections and bacterial vaginosis (dysbacteriosis).
Brown mucous discharge
Brown discharge with mucus often accompanies ovulation (the release of an egg from the ovary in the middle of the cycle). The mucus in the cervix becomes thin and abundant, and hormonal fluctuations characteristic of ovulation provoke scanty bleeding from the uterine cavity.
Red-brown discharge
Severe bleeding may occur during menstruation.
When is brown discharge considered normal?
Bleeding is not always a pathology. Let’s consider situations where brown discharge may be normal.
1. Before menstruation
Sometimes it begins immediately with scarlet bleeding. Sometimes – gradually with brown discharge, this is normal. Important: if the nature of menstrual bleeding has changed, or the period of brown discharge has lasted for an unusually long time, you should visit a doctor.
2. In the middle of the cycle
During the menstrual cycle, hormone levels change repeatedly. Before ovulation, estrogens predominate, after which progesterone levels rapidly increase. In the middle of the cycle, estrogen levels are lower than at the beginning, and progesterone is not yet produced by the corpus luteum of the ovary. This hormonal “failure” can contribute to slight bleeding from the uterine cavity. This is an acceptable situation, but it is better to tell your doctor about it and get a diagnosis.
3. After your period
Maximum blood loss occurs at the beginning of menstruation, then it gradually decreases. The discharge in recent days is usually brown in color. If your period is delayed and its entire period is more than seven days, visit a gynecologist.
Symptoms of pathological brown discharge
There are situations when the symptom of bleeding cannot be ignored.
Itching
This unpleasant sensation in the vulva is rarely accompanied by bleeding. As a rule, it means that there is inflammation or dysbiosis in the vagina, or the skin of the vulva is damaged.
Smell
Brown discharge with a putrid odor is an alarming symptom, especially if there was an intrauterine intervention (any type of abortion or hysteroscopy).
The smell of fish often indicates a concomitant violation of the vaginal flora.
Pain
Nagging pain may accompany menstruation or ovulation in the middle of the cycle. Normally, it should not be accompanied by loss of consciousness. If you always experience pain during menstruation or ovulation, don’t wait, make a scheduled appointment with your doctor. If the pain is unusually severe, appears unrelated to your cycle or is due to a delay in menstruation, contact your gynecologist immediately.
Delayed menstruation
When brown discharge begins due to a delay in menstruation, be sure to take a pregnancy test . Late periods can also begin with brown discharge, but it is important to rule out pregnancy, including ectopic pregnancy. The test is a simple and inexpensive manipulation that can save health.
Possible causes of brown vaginal discharge
In gynecology, a convenient classification of uterine bleeding has been adopted, which includes brown discharge. The classification is called PALM-COEIN (1).
Each letter of the abbreviation means a structural pathology:
- P – polyp
- A – adenomyosis or endometriosis
- L – leiomyoma or simply uterine fibroids
- M – malignant neoplasms
- C – coagulopathy or bleeding disorder
- O – ovulatory dysfunction (for example, with impaired thyroid function, with increased prolactin)
- E – disorders in the endometrium (for example, inflammation)
- I – iatrogenic factor, that is, taking medications or using contraceptives (spirals, subcutaneous implant). Acyclic bleeding often occurs when taking blood thinning drugs and antidepressants.
- N – not classified elsewhere. For example, a scar defect on the uterus after a cesarean section.
Let’s take a closer look at some of the causes of brown discharge.
Endometriosis
This is the growth of foci similar to the mucous membrane of the uterus (the tissue that is rejected during menstruation) in places inappropriate for this: in the thickness of the uterine muscle, on the ovaries, on the peritoneum. In addition to chronic pain, the most common symptom of endometriosis is acyclic bleeding, including brown spotting. Characterized by heavy menstruation, long bleeding before and after menstruation, and intermenstrual bleeding.
Uterine fibroids
This is a benign tumor of the muscular layer of the uterus. It occurs very often. Most fibroids are small, asymptomatic and require only observation. In some cases, symptomatic fibroids also occur. These are either large nodes or nodes located directly in the uterine cavity. Any fibroid may be accompanied by acyclic bloody or brown discharge.
Endometrial pathology
- The endometrium is the lining of the uterus that undergoes cyclic changes. After menstruation, the endometrium is thin (3-5 mm), with each day of the cycle it becomes more voluminous, and by the next menstruation it can reach 2 cm. In such dynamically changing tissue, disorders sometimes occur. Their cause is the influence of hormones and unfavorable factors (stress, cycle fluctuations).
There are several options for pathology in the endometrium:
- A polyp is a local growth of the mucous membrane. Clinically it manifests itself as an increase in the abundance of menstruation, or brown discharge on different days of the cycle.
- Hyperplasia is an increase in the thickness of the entire endometrium or an extended section of it. Hyperplasia can be suspected using ultrasound; the thickness of the tissue in this case does not correspond to the day of the cycle. For example, on day 5-6, the doctor will see the endometrium is voluminous, as if it is the middle of the cycle or its end.
Hyperplasia and polyps are most often benign, but malignant processes in the endometrium also occur. It is especially important to exclude malignancy in women of perimenopausal (transitional) age.
Pregnancy
There is a misconception among women: if there is spotting, it means there can be no pregnancy. But in the case when the discharge does not look as usual, if there is at least some doubt, it is better to take a pregnancy test. A simple urine test from a pharmacy is enough to rule out both intrauterine and ectopic pregnancy.
Early pregnancy is often accompanied by spotting brown discharge . Nausea and abdominal pain may not occur or may occur later.
Infections
Sexually transmitted diseases (chlamydia, trichomonas, genital mycoplasma, gonococcus) may be accompanied by acyclic bleeding. It is important to exclude these infections in all patients who have a chronic problem of brown or red bloody discharge, including those that appear after sexual intercourse.
Pathology of the cervix
Cervical cancer does not show symptoms for a long time, and precancerous processes (dysplasia) have no symptoms at all. Cervical pathology is revealed only during examination by a gynecologist and when undergoing tests.
Screening for cervical cancer and precancer is perhaps the most important test in gynecology. Regular smear tests for abnormal cells, human papillomavirus (HPV) and HPV vaccination can save lives.
Be sure to visit a gynecologist if you have not been examined for more than a year.
There are also benign background processes in the cervix, for example, ectopia of the epithelium. It is not dangerous, but it can manifest itself as bloody or brown discharge, especially after sexual intercourse.
Endometritis
This is an inflammation of the endometrium, the lining of the uterus.
Acute endometritis, thanks to antibacterial therapy, the development of laboratory diagnostics, as well as antiseptic rules, is becoming less common.
Endometritis is especially dangerous after pregnancy (childbirth, miscarriage or abortion). It flows fast and aggressively.
If after the end of pregnancy, as well as after intervention in the uterine cavity (surgery, installation of an IUD), abdominal pain, fever, brown or purulent discharge appear, consult a doctor immediately.
Endometritis can also be chronic. In practice, this diagnosis is often erroneously stated and healthy patients are overtreated. At the same time, the chronic form of the disease has not been sufficiently studied in science. On the other hand, there is the problem of insufficient diagnosis of the disease.
The only study that has an evidence base in the diagnosis of chronic endometritis is immunohistochemistry (search for specific molecules in the endometrial sample).
Diagnostics and tests
To understand the cause of abnormal brown discharge, doctors usually use the following diagnostic steps:
- examination in mirrors and collection of smears:
– cytology from the cervix. Until the age of thirty, it is enough, after which an analysis for the human papillomavirus is added to the cytology;
– smear for sexually transmitted infections (chlamydia, trichomonas, gonococcus, genital mycoplasma). The preferred method is polymerase chain reaction – PCR;
- Ultrasound examination of the pelvic organs. An ultrasound is needed to exclude polyps, endometriosis, uterine fibroids, and neoplasms;
- If you have an irregular menstrual cycle, you may need a blood test for hormones.
In what cases is treatment needed?
Therapy is not required if brown discharge appears briefly at the beginning and end of menstruation and accompanies ovulation. And at the same time they are scanty, and pathologies are already excluded by the doctor at the appointment.
In other cases, treatment is necessary.
For endocrine disorders and endometrial hyperplasia, treatment is often medicinal. For endometrial polyps and high degrees of cervical dysplasia, surgical treatment is more common.
Preventing Unhealthy Brown Discharge
Not all women’s diseases can be prevented, but prevention helps to avoid many.
Here are the important rules:
- To prevent dysplasia and cervical cancer, regularly take a cytological smear. From the age of 30, cytology is taken along with HPV. It is enough to undergo the examination once every 3-5 years;
- Get vaccinated against human papillomavirus. This will significantly reduce your risk of getting cervical cancer. The quadrivalent vaccine can be administered up to age 45;
- Protect yourself from sexually transmitted infections by using condoms or getting tested for infections with your partner before abandoning barrier contraception. Absolute pathogens that are important to exclude: chlamydia, trichomonas, gonococcus, genital mycoplasma, pathogens of syphilis, HIV, hepatitis B and C;
- Use reliable contraception to protect against unwanted pregnancy.
Remember that coitus interruptus, even in combination with the calendar method, is unreliable;
- We most often cannot influence the growth of uterine fibroids, endometrial polyps, as well as the course of some endocrine diseases that can manifest as bleeding. However, identifying the problem in the early stages helps minimize health consequences. Therefore, see your doctor regularly, at least once a year.
Which doctor should I contact with complaints?
If bleeding occurs, you should contact a gynecologist. Many women come for an ultrasound, receive a conclusion about the ultrasound norm, and that’s where the diagnosis ends.
No matter how professional the ultrasound doctor is, not all pathologies can be examined, much less interpreted, using ultrasound. Contact your gynecologist.
Recommendations and advice from a gynecologist
— All bleeding that does not fit into the concept of normal menstruation is usually called abnormal uterine bleeding in gynecology. — explains Nadezhda Misharova, obstetrician-gynecologist at W-clinic . — Here are the criteria for normal menstruation:
- occurs at intervals of 21-35 days (2), according to other sources – 24-38 days (3);
- blood loss is moderate, does not require changing hygiene products more than once every two hours, or overnight, and is not accompanied by large clots (4).
Everything else is abnormal uterine bleeding, even if we are talking about scanty brown discharge outside of menstruation, since in this case the interval for the onset of bleeding is disrupted.
Questions and answers
Obstetrician-gynecologist Nadezhda Misharova answers frequently asked questions.
What can brown discharge accompanied by pain indicate?
Pain is a nonspecific symptom; it occurs in many pathologies.
Before menstruation, brown discharge with pain may be a sign of endometriosis. In the middle of the cycle – a painful form of ovulatory syndrome or even ovarian rupture (apoplexy).
Also in the middle of the cycle, spotting is characteristic of an endometrial polyp. In women with delayed menstruation, pregnancy must be excluded. Pain can occur in both uterine and ectopic forms. Sometimes pain and discharge are difficult to correlate with the menstrual cycle. In this case, it is necessary to exclude inflammatory diseases of the pelvic organs.
Is brown discharge dangerous during menopause?
Yes, spotting after menopause worries doctors. This is a time of estrogen deficiency; the uterine mucosa under such conditions becomes thin and does not undergo cyclic changes, does not grow and is not rejected. Therefore, there should be no bleeding.
If they are present, it is imperative to perform an ultrasound of the pelvic organs to exclude the growth of the uterine mucosa (hyperplasia) and cancer. Alertness regarding malignant processes in the endometrium at older ages is especially high.
What does brown discharge mean in pregnant women?
During pregnancy, there should normally be no bleeding. The exception is scanty mucous membranes streaked with blood when the embryo implants into the uterus. This is the so-called implantation bleeding. If there is bleeding in the short term, the gynecologist will have to rule out an ectopic or non-developing pregnancy. If, according to the results of an ultrasound, the fetus is developing in the uterus, but there is brown discharge, most often, a retrochorial hematoma is observed (an area of detachment of the future placenta from the uterine wall). In most cases, the hematoma disappears, and the pregnancy continues to progress without consequences.
Also, expectant mothers, like women outside pregnancy, may have polyps in the cervix. They often manifest as scanty bleeding. There is no need to do anything with polyps during pregnancy.