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There are several possibilities. Despite the tabal ligation, it is always a good idea to be sure there is nothing pregnancy related even though the chance is small. It's the first thing we just need to make sure of to move on to other possibilities.
It is common for women to have a single episode of strange bleeding at the wrong time or heavy under times of stress. If the lbeeding is not terribly heavy and pregnancy test is negative, it would be fine to keep an eye on it for a few days and see if it continues into the next 1-2 cycles.
If it's persistent, then investigation is a good idea. Testing for thyroid disease is often the first test done.
It is also important to have an exam to check for any cervical polyps (usually non-cancerous, pretty common) or erosions of the cervix. Pap smear should be up to date and cervial cultures taken too if it seems like there is a risk of infection or exam seems like its a possibility.
Next an ultrasound is performed. Often we will order the ultrasound to be done with saline infusion to check for small polyps or fibroids along the lining that can cause such bleeding.
An ultrasound would also pick up larger fibroids throughout the uterus that can also cause bleeding like this.
Usually once we've gotten through this much work-up, we have a diagnosis.
If still no diagnosis and the abnormal bleeding persists, we would move on to investigation for less likely causes. This would involve perhaps doing an endometrial biopsy to look at a sample of the lining under the microscope. Sometimes an infection gets set into the lining that can cause such bleeding. Quite rare at age 30 would be precancers or the lining but this would also be detected with biopsy.
Additional blood tests would certainly be for liver function studies and blood coagulation function studies.
Additionally, there are some medications and supplements that can cause abnormal bleeding. I wouldn't expect someone at 30 to be on any such medications. Doses of supplements causing abnormal bleeding would have to be very high and include garlic, ginseng and others.
Questions so far?
If heavy bleeding persists, testing for anemia is also done.
No, no questions. you have been very helpful! My regular doc just tested my thyroid last month and it was normal. I will get a pregnancy test just to make sure, and then make a doctor appointment. Thank you so much for your help :)
ok, glad to help. I try to be as complete as possible:)