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Abnormal Vaginal Bleeding
Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. Vaginal bleeding is considered to be abnormal if it occurs:
- When you are not expecting your menstrual period.
- When your menstrual flow is lighter or heavier than what is normal for you.
- At a time in life when it is not expected, such as before age 9, when you are pregnant, or after menopause.
Causes of abnormal bleeding
Abnormal vaginal bleeding has many possible causes. By itself, it does not necessarily indicate a serious condition.
- Because bleeding can mean a problem with pregnancy, possible pregnancy should always be considered in a woman of childbearing age.
- Spotting to minimal bleeding may be normal. But any bleeding during pregnancy needs to be evaluated by your doctor.
- Heavy vaginal bleeding or bleeding that occurs before 12 weeks may mean a serious problem, including an ectopic pregnancy or miscarriage.
- Heavy vaginal bleeding or bleeding that occurs after 12 weeks also may mean a serious problem, such as placenta previa.
- Ovulation can cause mid-cycle bleeding.
- Polycystic ovary syndrome (PCOS) is a hormone imbalance that interferes with normal ovulation and can cause abnormal bleeding.
- Medicines, such as birth control pills, sometimes cause abnormal vaginal bleeding. You may have minor bleeding between periods during the first few months if you have recently started using birth control pills. You also may have bleeding if you do not take your pills at a regular time each day.
- An intrauterine device (IUD) also may increase your chances of spotting or heavy periods.
- Infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted infections (STIs) are often the cause of infections.
- Pelvic inflammatory disease (PID) causes inflammation or infection of the uterus, fallopian tubes, or ovaries, which can cause abnormal bleeding.
Other less common causes of abnormal vaginal bleeding that may be more serious include:
- Sexual abuse.
- An object in the vagina.
- Uterine fibroids, which are a common cause of heavy periods. For more information, see the topic Uterine Fibroids.
- Structural problems, such as urethral prolapse or polyps.
- Cancer of the cervix, uterus, ovaries, or vagina.
- Extreme emotional stress and excessive exercise. But excessive exercise more frequently causes an absence of menstruation (amenorrhea).
- Other diseases, such as hyperthyroidism or diabetes.
Heavy bleeding during the first few weeks after delivery (postpartum) or after an abortion may occur because the uterus has not contracted to the prepregnancy size or because fetal tissue remains in the uterus (retained products of conception).
If you are age 40 or older, abnormal vaginal bleeding may mean that you are entering perimenopause. In a woman who has not had a menstrual period for 12 months, vaginal bleeding is always abnormal and should be discussed with your doctor.
Treatment of abnormal vaginal bleeding depends on the cause of the bleeding.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Severe vaginal bleeding means that you are soaking 1 or 2 pads or tampons in 1 or 2 hours, unless that is normal for you. For most women, passing clots of blood from the vagina and soaking through their usual pads or tampons every hour for 2 or more hours is not normal and is considered severe. If you are pregnant: You may have a gush of blood or pass a clot, but if the bleeding stops, it is not considered severe.
Moderate bleeding means that you are soaking more than 1 pad or tampon in 3 hours.
Mild bleeding means that you are soaking less than 1 pad or tampon in more than 3 hours.
Minimal vaginal bleeding means "spotting" or a few drops of blood.
Many prescription and nonprescription medicines can cause changes in vaginal bleeding. A few examples are:
- Aspirin and other medicines (called blood thinners) that prevent blood clots.
- Corticosteroids, such as prednisone.
- Hormone therapy.
- Thyroid medicines.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
There is no home treatment for abnormal vaginal bleeding. With some types of vaginal bleeding, it may be okay to wait to see if the bleeding stops on its own. Check your symptoms to decide if and when you should see a doctor. If the bleeding continues or gets worse, see your doctor to find out the reason for the bleeding.
If you are using tampons for abnormal vaginal bleeding, be sure to change them often, and do not leave one in place when the bleeding has stopped. A tampon left in the vagina may put you at risk for toxic shock syndrome (TSS). TSS is a rare but life-threatening illness that develops suddenly after a bacterial infection rapidly affects several different organ systems.
If you are age 40 or older, you may be experiencing perimenopause.
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Abnormal bleeding returns.
- Bleeding increases or becomes severe enough to cause weakness or lightheadedness.
- Fever or pain in the lower abdomen develops.
- Symptoms become more severe or frequent.
You may be able to prevent abnormal vaginal bleeding.
- Maintain a healthy weight. Women who are overweight or underweight have more problems with abnormal vaginal bleeding. For more information, see the topic Weight Management.
- If you are using birth control pills, be sure to take them as directed and at the same time every day.
- If you are taking hormone therapy, take your pills as directed and at the same time every month.
- Learn to practice relaxation exercises to reduce and cope with stress. Stress may cause abnormal vaginal bleeding. For more information, see the topic Stress Management.
- Take a nonsteroidal anti-inflammatory drug (NSAID), such as naproxen or ibuprofen. NSAIDs reduce menstrual bleeding by decreasing the production of substances called prostaglandins. The usual recommended dose of ibuprofen is 400 mg every 6 hours. Begin taking the medicine on the first day of your period and continue taking it until your menstrual bleeding stops. Be sure to follow these nonprescription medicine precautions.
- Carefully read and follow all label directions on the medicine bottle and box.
- Use, but do not exceed, the maximum recommended doses.
- Do not take a medicine if you have had an allergic reaction to it in the past.
- If you have been told to avoid a medicine, call your doctor before taking it.
- If you are or could be pregnant, call your doctor before using any medicine.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What was the date of your last menstrual period?
- Was your previous period normal?
- Do you have regular cycles, such as a period every 25 to 35 days?
- If you have been through menopause, how long ago was your last menstrual period?
- How severe (heavy) is your usual menstrual flow? Keep track of your menstrual flow on a calendar, and take your calendar to show your doctor.
- What is the average length of each period, and how many pads or tampons do you use per day during your period?
- Do you pass many clots, and how big are they?
- Do you change pads or tampons during the night?
- Are you sexually active?
- Do you engage in high-risk sexual behaviors?
- Are you currently using any type of birth control method?
- Have you missed any birth control pills or failed to have your Depo-Provera injection according to schedule?
- Have you done a home pregnancy test? If so, when did you do the test, and what was the result?
- Have you been under increased physical or emotional stress?
- Have you recently changed your diet or exercise habits?
- Have you recently gained or lost weight?
- What prescription or nonprescription medicines are you taking, if any?
- Do you have any other symptoms, such as lower abdominal pain?
- Have you had other similar episodes and, if so:
- What evaluation was done?
- What was the diagnosis?
- What was the treatment?
- What were the results?
- Do you have any health risks?
Current as of: October 19, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
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