Q: I am a 22 years old woman having continuous bleeding for almost more than a month. I consulted the doctor and got the Beta HCG test done, which was found to be 2.9. This confirmed that I wasn’t pregnant. What could be the cause for this bleeding?

A:What I understand from your query is that you are a 22 years old non-pregnant female and have bleeding per vaginum for the last > one month. I also assume that you have had a proper menarche and did not have problems with respect to your menstruation till about last month back. Since the beta HCG levels are normal, you have virtually ruled out an ectopic pregnancy, which usually is one of the primary causes. The other important cause is dysfunctional uterine bleeding: This can be caused by:

• Primary ovarian disorders,
• Polycystic ovaries – causes include - Obesity, Hirsutism, Chronic anovulation.
• Other causes are:

1. Trauma including: Sexual abuse, – vigorous consensual sexual behaviour, hydrostatic pressure i.e. water-skiing, waterslides, fall, etc.
2. Tumours like: Fibroids, uterine leiomyomata, polyps, – Usually seen on exam or U/S or rarely at your age – Malignant tumours.
3. Inflammation/Infections, Intra Uterine Devices.
4. Some systemic illnesses can also be the causative factors. These include: thyroid disorders,
5. Hepatic disorders - May affect coagulation and can change metabolism of oestrogen, leukaemia and myeloproliferative disorders, thrombocytopaenia, coagulopathies, von Willebrand’s disease, Factor IX deficiency, etc.

Therefore, a proper local examination followed by a systemic evaluation is mandatory. Subsequently investigations directed to a specific ailment will be needed including a proper hormonal evaluation and if indicated an ultrasound and endometrial biopsy. What you need is a consultation with a good Gynaecologist and subsequent elaborate investigations / evaluation. Following this any specific treatment will be worthwhile.