Black or Brown Menstruation: Should You Worry?

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 Lille University Hospital, secretary general of the national college of French gynecologists and obstetricians.

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 tint 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, a bit like some people have very purple hematomas,” says Geoffroy Robin.

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Most of the time, black discharge (brown or brown) is of natural origin and not serious. They can occur:

More rarely, black periods have a pathological origin:

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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 salpingitis (an infection of the tubes that connect the uterus to the ovaries) or acute endometritis is suspected, especially if there is a vaginal discharge. yellowish and/or associated greenish”, explains Professor Robin. It can also indicate the presence of bacterial vaginosis, a sexually transmitted disease or even a yeast infection, due to an unusual change in the vaginal flora.

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. “Secondly, and fairly quickly, a gynecological check-up is necessary,” he insists.

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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.