Abnormal vaginal bleeding is any bleeding that happens outside your period. This might include small amounts of blood, also called spotting, between your periods or it could include a very heavy period. You know you have a very heavy period if blood is soaking through one or more tampons or sanitary pads every hour for more than four hours.
Normal vaginal bleeding from a period usually happens every 21 to 35 days. This is called the menstrual cycle. The blood comes from the lining of the uterus, called the endometrium, which is shed through the vagina. When this happens, a new reproductive cycle has started. Periods may last for a few days or up to a week. Bleeding could be heavy or light. Menstrual cycles tend to be longer for teens and women nearing menopause. Also, menstrual flow might be heavier at those ages. Anything that happens that is different to this here described should be seen as abnormal vaginal bleeding.
You should have any unusual vaginal bleeding checked by your doctor or healthcare professional. They can tell you if there’s cause for concern based on your age and health. If you’re pregnant, contact your healthcare team immediately if you notice vaginal bleeding.
Post-menopausal adults who don’t take hormone therapy. Hormone therapy helps with menopause symptoms such as hot flushes. Some bleeding may happen with these treatments. But if you notice any vaginal bleeding after menopause without hormone therapy, see a doctor. This happens commonly in post-menopausal adults taking cyclic therapy. Post-menopausal adults taking continuous hormone therapy may also experience abnormal bleeding.
Children with no signs of puberty. Signs of puberty include breast development and underarm or pubic hair growth.
Children younger than eight. Any vaginal bleeding in a child younger than eight is concerning and should be checked out by a doctor.
Unusual vaginal bleeding during the following stages is likely OK, but talk to your care team if you’re concerned:
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Newborns. Some vaginal bleeding may occur during a baby’s first month of life. But bleeding that’s heavy or lasts longer should be checked by a medical professional.
Teenage years. Menstrual cycles can be hard to track when teens first get their periods. This can go on for a few years. Also, it’s common for light spotting to happen in the days before a period.
Starting birth control pills. Spotting might happen in the first few months
Nearing menopause, also called perimenopause. Periods might be heavy or hard to track during this time. Ask your care team about ways to lessen any symptoms.
Causes of abnormal vaginal bleeding
Unusual vaginal bleeding could be a symptom of an issue with your reproductive system. This is called a gynaecological condition. Or it could be due to another medical problem or a medicine. If you’re in menopause and notice vaginal bleeding, see your healthcare professional. It could be a cause for concern.
Menopause is commonly defined as having no periods for about 12 months. You might hear this type of vaginal bleeding also called abnormal vaginal bleeding.
Possible causes include:
Cancers and pre-cancerous conditions
Cervical cancer
Uterine cancer
Endometrial hyperplasia
Ovarian cancer
Uterine sarcoma
Vaginal cancer
Endocrine system factors
Polycystic ovary syndrome
Stopping or changing birth control pills
Withdrawal bleeding, a side effect of menopausal hormone therapy
Fertility and reproduction factors
Ectopic pregnancy
Fluctuating hormone levels
Miscarriage
Perimenopause
Pregnancy
Random ovulatory cycles
Sexual intercourse
Vaginal atrophy
Infections
Cervicitis
Chlamydia trachomatis
Endometritis
Gonorrhoea
Herpes
Pelvic inflammatory disease
Ureaplasma vaginitis
Vaginitis
Medical conditions
Coeliac disease
Blunt trauma or penetrating injury to the vagina or cervix
Past obstetric or gynaecological surgery like caesareans
Sexual abuse.
Diagnosis methods
For some women, medical history and physical examination are enough for the doctor to diagnose the cause of the irregular bleeding. For other women, a range of tests may be offered including:
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Cervical/pap smear and swabs
Pregnancy test
Blood tests
Ultrasound
Dilation and curettage (D&C), which involves gently widening the cervix and scraping away the uterine lining.
Treatment
Treatment depends on the cause but may include:
Anti-inflammatory drugs
Antibiotics
Change of contraception
Hormone therapy
Anti-bleeding agents such as tranexamic acid
Surgery to remove fibroids, polyps or cancers
Treatment for any underlying health problem.
If you have irregular bleeding sometimes with pain, some general home care suggestions include:
Get plenty of sleep
Eat a well-balanced diet
Do some gentle exercise
Keep a diary of your symptoms to show your doctor
Rest. Curl your knees up to your chest and lie on your side
Place a warm pack, such as a hot water bottle or wheat bag, over your abdomen
Take a warm bath
Wear loose clothing
Exercise
Rub or massage where it hurts
Take painkillers such as paracetamol, but avoid aspirin.
