The color of menstrual blood may vary depending on the situation. A dark tint is often benign but can also be a sign of an infection.
While the color of menstrual blood is expected to be red, it may turn brown or even black. This color change can cause concern. However, even if it impresses, the phenomenon is not systematically pathological. When should we be concerned? Le Figaro takes stock with Dr Geoffroy Robin, university lecturer, hospital practitioner in reproductive medicine and medical gynecology at the University Hospital of Lille, secretary general of the national college of French gynecologists and obstetricians.
Why can period blood turn black or brown?
In general, menstruation is a complex phenomenon that causes significant disorganization of the uterine lining, or endometrium. At each cycle, hormonal signals induce mechanisms of cellular self-destruction (apoptosis) and vasoconstriction of vessels (reduction in their diameter), leading to endometrial necrosis. By destroying itself, it is expelled in the menstrual flow which consists of blood, clots and shreds of necrotic uterine tissue. If most of the time, this flow is red in color, it sometimes happens that it takes on a darker color, from light brown to blackish brown. “ A dark color is explained by the fact that small bits of necrotic tissue have stagnated in the uterus and oxidized before being expelled. But oxidative stress is not the main reason for this color, it mostly depends on the structure of the endometrial tissue. In some women the necrosis will be darker than others, much like some people have very purple bruises “says Geoffroy Robin.
“The period is really a cellular, immune and vascular storm in the endometrium. It is enough for one mechanism to predominate over another to cause a color change. But it remains a natural phenomenon and totally benign in the majority of cases. »
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What are the causes of black discharge?
Most of the time, black (brown or brown) discharge is of natural origin and without gravity. They can occur:
- 24 hours before period because at this time, the blood loss is scanty and tends to stay in the vagina before flowing out.
- At the end of the rules while the endometrium is regenerating and some oxidized tissue lingers in the vagina before draining out completely.
- Under hormonal contraception. « The use of progestins modifies the thickness of the mucosa which can become very dense or very thin. This is sometimes accompanied by spotting between periods, metrorrhagia which may look very dark explains Dr. Robin.
- During pregnancy, some women continue to experience bleeding that corresponds to parts of the uterine lining that were untransformed during implantation and remain receptive to hormonal fluctuations. “ These pieces of mucous membranes are naturally evacuated as during menstruation because they are not mobilized in the formation of the placenta. The associated bleeding, usually very light, takes on either a pinkish, brown or black hue, depending on the patient. », Underlines the gynecologist.
More rarely, black rules have a pathological origin :
- In certain chronic inflammatory diseases as chronic endometritisinflammation of the endometrium, linked to bacteria or an autoimmune disease, can cause metrorrhagia (bleeding between periods) with a very dark color.
- Blackish discharge occurring for a period of 3 to 4 days before menstruation (premenstrual metrorrhagia) is also sometimes a sign of pelvic endometriosis. “ This is particularly the case if the endometriosis has reached the vagina. Premenstrual bleeding is then associated with very painful periods “, says Professor Robin.
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When should you consult a doctor in case of black periods?
The black color by itself is rarely a warning indicator if it is not associated with other symptoms such as fever, foul odor and/or menstrual pain. On the other hand, a sudden change is often not insignificant. “ When black discharge is painful and accompanied by fever, a genital infection such as salpingite (an infection of the tubes that connect the uterus to the ovaries) or acute endometritis, especially if associated yellowish and/or greenish vaginal discharge “, explains Professor Robin. It may also indicate the presence of a bacterial vaginosis a sexually transmitted disease or a mycosis, due to an unusual change in the vaginal flora.
Are certain periodic protections to be avoided?
If it is a natural phenomenon, i.e. if the black discharge has always been present during the cycles, the patient is on hormonal contraception and there is no sign of infection, all periodic protections are possible. On the other hand, if other symptoms accompany these losses, “ it is necessary to privilege extra-vaginal protections such as the sanitary napkin and to avoid the tampon or the cup “, advises the gynecologist. “ In a second step, and quite quickly, a gynecological check-up is necessary, “, he insists.
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What are the possible treatments ?
If the black discharge has a natural cause and is not disabling, no treatment is needed. It is simply the endometrium’s response to hormonal fluctuations.
If you suffer from other symptoms at the same time, your gynecologist will carry out a diagnosis which may involve a sample of vaginal secretions, a smear or even an ultrasound examination.
- In case of infection, an antibiotic or antifungal treatment (a local cream and/or a vaginal capsule) will act on the cause.
- If these losses are concomitant with the start of taking or a change in hormonal contraception and they are bothersome because they are daily, “ it is then necessary to think about changing hormonal treatment “, underlines Dr. Robin.