Definition

The term vaginal bleeding describes any bleeding that occurs in the area of the vagina. This can include menstruation or bleeding unrelated to menstruation, such as due to medical conditions or injury. Bleeding between periods or outside of the menstrual cycle is considered abnormal vaginal bleeding. This type of bleeding can occur randomly, be difficult to predict, and may be accompanied by pain or other symptoms.

Non-menstrual vaginal bleeding can be caused by various factors, including medical conditions, medications, pregnancy, hormonal changes (such as menarche or menopause), injury, or infection. Abnormal vaginal bleeding can occur at any age. When a girl first begins menstruating, the cycle may not always be regular.

If you want to know more about the first and last menstruations, you can read them here: Menarche & Menopause - Understanding, Causes, Symptoms, and Treatment.

Causes

There are many causes of vaginal bleeding outside of menstrual periods. Consult with a doctor to determine the cause of the bleeding. Some common causes include medical conditions, hormonal factors, and pregnancy complications.

Medical Conditions

• Cancer in the reproductive system: includes cancer of the uterus, cervix, endometrium, or fallopian tubes.
• Blood clotting disorders. Problems with the blood clotting process can occur due to inherited conditions such as hemophilia or von Willebrand disease, low platelet levels, vitamin K deficiency (which aids in blood clotting), or as a side effect of medications (like blood thinners).
• Hypothyroidism. An underactive thyroid gland can also disrupt the menstrual cycle.
• Myoma is a benign tumor that develops from muscle tissue in the uterus. The size, number, growth rate, and location within the uterus can vary.
• Adenomyosis is a condition where a tumor appears in the uterine wall, causing pain during menstruation.
• Endometrial polyps are growths of cells within the uterine lining. Polyps are generally not cancerous.
• Severe cervicitis. Cervicitis is inflammation or infection of the cervix.
• Endometrial hyperplasia is a condition where the uterine lining (endometrium) becomes too thick, often due to an imbalance between estrogen and progesterone. This condition is not cancerous but can sometimes lead to uterine cancer.

Hormonal Factors

• Anovulation. Disruption or failure of ovulation that can result from a uterine disorder or a problem with the communication between the brain and the glands regulating ovulation.
• Oral contraceptives. Some people may experience bleeding when taking oral contraceptives. This issue usually resolves on its own.
• Polycystic Ovary Syndrome (PCOS). A hormonal imbalance that can cause irregular menstrual cycles, weight gain, acne, and excessive hair growth.
• Pregnancy Complications
  • Ectopic pregnancy: A pregnancy where the fertilized egg grows outside the uterus
  • Placental abruption: Separation of the placenta from the uterine wall
  • Placenta previa: A condition where the placenta attaches to the lower part of the uterus and partially or completely covers the cervix
  • Premature birth: Birth that occurs before 37 weeks of pregnancy
  • Miscarriage

Other Possible Causes

• Contraceptive devices. The use of contraceptive devices such as IUDs can cause blood spotting
• Hormone replacement therapy to reduce menopause symptoms
• Infection
• Injury
• Endometrial or cervical biopsy

Risk Factor

• Age. It occurs in women who have just started menstruating and those approaching menopause.
• Hormonal imbalance
• May result from conditions like thyroid disorders, polycystic ovary syndrome (PCOS), and infertility or lack of ovulation.
• Hormonal imbalance can also result from taking birth control pills or other hormonal medications that alter hormones.
• Hormonal imbalances caused by excess weight can also result in irregular uterine bleeding.
• Uterine structure: abnormalities in the uterus, such as polyps, fibroids, and adenomyosis.
• Cancer: conditions like vaginal cancer, uterine cancer, cervical cancer, and endometrial hyperplasia can increase the risk of abnormal uterine bleeding.
• Infections like trichomoniasis, chlamydia, gonorrhea, endometritis, and vaginitis can also be transmitted sexually.
• Other health conditions:
• Kidney failure and liver failure
• Pelvic inflammatory disease
• Leukemia or platelet disorders

Symptoms

Symptoms of abnormal vaginal bleeding such as:

• Bleeding or patches between menstrual periods
• Bleeding after having sex
• Heavy bleeding
• Bleeding that occurs more than usual or more than 7 days
• The menstrual cycle is less than 28 days (which generally occurs) or more than 35 days
• Bleeding even though you have gone through menopause
• Heavy bleeding is associated with anemia

Diagnosis

A doctor will ask several questions about your symptoms and medical history, such as:

• When did the bleeding start?
• Is the bleeding during your menstrual period?
• Does the bleeding occur during sexual intercourse?
• How many pads do you use per day?
• The duration of the last menstrual period.
• The interval between menstrual cycles.
• Medications you are taking.
• Previous surgeries or other medical procedures.
• The possibility of pregnancy.

Next, the doctor will perform a physical and pelvic exam, as well as other recommended tests, such as a pap smear, urine test, thyroid function test, blood test, pregnancy test, and imaging tests like ultrasound, MRI, and hysteroscopy.

Management

The treatment and therapy for vaginal bleeding depend on the cause, your age, and whether you plan to become pregnant in the future. If caused by hormonal imbalance, your doctor may suggest lifestyle changes such as a healthy diet, reducing stress, and losing weight. In some cases, medication or surgery may be needed to treat vaginal bleeding.

Medications

• Hormonal birth control pills can reduce menstrual blood flow and help regulate the menstrual cycle.
• Contraceptive devices. Some specific IUDs can be used as birth control and to reduce or stop bleeding.
• Gonadotropin-releasing hormone agonists. These medications reduce the release of gonadotropins, hormones that stimulate the uterus; they are used to stop the menstrual cycle and reduce fibroid size.
• Tranexamic acid works to stop excessive menstrual bleeding.
• NSAIDs, such as ibuprofen, reduce the severity of pain during bleeding.
• Antibiotics: Used for bleeding caused by infections.

Procedures

• Endometrial ablation: this procedure aims to destroy parts of the uterus that cause bleeding, reducing or stopping the bleeding. Discuss this procedure with your doctor if you plan to become pregnant in the future
• Dilation and curettage involve scraping or suctioning tissue from the uterus.
• Uterine artery embolization: a treatment for fibroids by closing blood vessels in the uterus that supply blood to fibroids
• Myomectomy: removal of myoma
• Hysterectomy: removal of the uterus
• Surgery to remove benign tumors

Complications

In some cases, abnormal vaginal bleeding can resolve on its own. However, in some women, if the cause is unknown, treatment may be needed. If left untreated, it can worsen the problem and lead to infections, cancer, or other serious conditions that may be life-threatening.

Prevention

In general, abnormal bleeding occurs beyond your control and is not caused by any wrongdoing. Regular check-ups and discussions with your doctor about your health are important, especially if you experience symptoms that could potentially lead to vaginal bleeding.

When to See a Doctor?

Contact your doctor if you experience symptoms of vaginal bleeding that require special attention, such as:

• Changes in your menstrual period (e.g., longer or shorter than usual).
• Changes in the amount of blood during the menstrual cycle (e.g., much more or much less than usual).
• Bleeding after sexual intercourse.
• Bleeding (even slightly) before puberty or after menopause.
• Bleeding after starting a new medication or hormone therapy.
• Bleeding during pregnancy (more than spotting).
• Any bleeding accompanied by pain (especially when not menstruating).
• If accompanied by fever, feeling weak, dizziness, or pelvic pain.

Looking for more information about other diseases? Click here!