Abnormal vaginal bleeding

Abnormal vaginal bleeding is bleeding unrelated to normal menstruation. This type of bleeding may include spotting of small amounts of blood between periods — often seen on toilet tissue after wiping — or extremely heavy periods in which you soak a pad or tampon every one to two hours for two or more hours.

Normal vaginal bleeding, or menstruation, occurs every 21 to 35 days when the uterus sheds its lining, marking the start of a new reproductive cycle. A menstrual period may last for just a few days or up to a week. Your flow may be heavy or light and still considered normal. Menstrual cycles tend to be longer for teens and for women nearing menopause, and menstrual flow may also be heavier at those ages.

Causes

Abnormal vaginal bleeding can relate to an issue with your reproductive system (a gynecologic condition) or to other medical problems or certain medications. If you have reached menopause — defined as 12 consecutive months, give or take, without a menstrual period — subsequent vaginal bleeding may be a cause for concern and should be evaluated.

Possible causes of abnormal vaginal bleeding include:

  • Cancers and precancerous conditions
  • Cervical cancer
  • Endometrial cancer (uterine cancer)
  • Endometrial hyperplasia
  • Ovarian cancer
  • Uterine sarcoma
  • Vaginal cancer
  • Endocrine system factors
  • Hyperthyroidism (overactive thyroid)
  • Hypothyroidism (underactive thyroid) (underactive thyroid)
  • Polycystic ovary syndrome (PCOS)
  • Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)
  • Fertility and reproduction factors
  • Ectopic pregnancy (in which the fertilized egg implants and grows outside of the uterus, such as in a fallopian tube)
  • Fluctuating hormone levels
  • Miscarriage (before the 20th week of pregnancy)
  • Pregnancy
  • Random ovulatory cycles
  • Sexual intercourse
  • Perimenopause (the transition time before menopause)
  • Vaginal atrophy (genitourinary syndrome of menopause)
  • Infections
  • Cervicitis
  • Chlamydia trachomatis
  • Endometritis
  • Gonorrhea
  • Pelvic inflammatory disease (PID)
  • Ureaplasma vaginitis
  • Vaginitis
  • Medical conditions
  • Celiac disease
  • Severe systemic diseases, such as kidney or liver disease
  • Thrombocytopenia (low platelet count)
  • Von Willebrand disease (and other blood clotting disorders)
  • Medications and devices
  • Forgotten (retained) tampon
  • Intrauterine device (IUD)
  • Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)
  • Tamoxifen side effect
  • Noncancerous growths and other uterine conditions
  • Adenomyosis
  • Cervical polyps — noncancerous (benign) growths on your cervix
  • Uterine fibroids
  • Uterine polyps (endometrial polyps)
  • Trauma
  • Blunt trauma or penetrating injury to the vagina or cervix
  • Sexual abuse

What is considered abnormal bleeding?

Abnormal or irregular menstrual bleeding usually includes situations like:

  • Bleeding between menstrual cycles
  • Periods that come more than 38 days between cycles
  • Bleeding after intercourse
  • Bleeding after menopause
  • Periods that last longer than 7-9 days

What can cause abnormal bleeding?

Abnormal bleeding can sometimes (but not always) be caused by:

  • Undiagnosed or abnormal pregnancies, such as miscarriages or ectopic pregnancies
  • IUDs or Birth Control
  • Thyroid or hormonal imbalances, such as PCOS (polycystic ovarian syndrome)
  • UTERINE FIBROIDs or polyps
  • Precancerous lesions or cancer (particularly uterine or CERVICAL CANCER although rare)

Interestingly, abnormal menstrual cycles are more common in certain age groups. We find that in young girls who are first starting to get their period and in women who are perimenopausal, periods may come more or less frequently.

When should I see a gynecologist?

If you have noticed irregular or abnormal bleeding that you believe is problematic, you should make an appointment with your gynecologist. They can discuss your symptoms and perform some examinations, as well as order the appropriate tests if needed. This might include simple blood tests that can detect hormonal imbalances or early pregnancies. An ultrasound can help identify abnormalities of the uterus or ovaries. Lastly, a biopsy of the uterus can be performed to rule out a pre-cancer or cancer. It’s important to remember that these tests are used in rare instances where abnormal bleeding is caused by a more severe health concern. However, it’s always safe to discuss your concerns with your gynecologist who can make the best recommendation.

Abnormal menstrual bleeding is common and very treatable. Your gynecologist will likely be able to help normalize your bleeding with medication first. Options may include birth control pills, IUD’s, patches, or vaginal rings. If tests find that your bleeding is the result of something more severe, surgery can sometimes be performed. Your gynecologist will make sure you understand your options during an appointment.

Whether it’s problematic or not, it’s important to listen to your body and talk to your gynecologist about bleeding that is abnormal or outside of your regular period cycles.

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