Irregular menstruation, excessive flow, bleeding before and after menstruation - what is the cause?

Patient's question:

,Single, Not yet had children 28 years old
Current general condition: Irregular menstruation, heavy flow, bleeding before and after periods, ultrasound shows no abnormalities, traditional Chinese medicine regulation ineffective, from the teens to now, what to do?
Previous diagnoses and treatment history and effectiveness: Retroverted uterus, multiple ultrasound examinations showed no abnormalities. Taken Yimucao cream, Zhikang capsules, Ejiao, Huangqi, and various other traditional Chinese medicines. Symptoms recur immediately after stopping medication. Bleeding occurs after activities like running and dancing, sometimes appearing as bloody water with a smell of rotten eggs, accompanied by mild left abdominal pain.
Auxiliary tests: MRI, colonoscopy, blood tests, all normal.

Doctor's answer:

Hello, if there is a small amount of vaginal bleeding a few days before or after menstruation, the possible causes include:
① Gynecological diseases: such as uterine fibroids, especially submucosal uterine fibroids, polyps in the endometrium, cervix, etc.; endometritis and intrauterine contraceptive devices.
② Gynecological endocrine dysfunction, where the ovary may ovulate, but the follicle or corpus luteum function is not.
Premenstrual spotting bleeding is often caused by insufficient corpus luteum function after ovulation, which cannot maintain endometrial growth, leading to premature small-scale necrosis and shedding of the endometrium, resulting in spotting bleeding.
Postmenstrual spotting bleeding occurs because the estrogen secreted by the follicle in the new menstrual cycle is insufficient, so the endometrium cannot be repaired and stops bleeding in time during the menstrual period.
Some patients have vaginal bleeding for a few days during the ovulation period (mid-cycle), with generally small amounts. This is due to a temporary decline in estrogen levels during ovulation, causing endometrial shedding and bleeding.
If the above conditions coexist, it may result in continuous vaginal bleeding.
It is recommended to consult a gynecologist to identify the cause and seek early treatment.