Abnormal Vaginal Bleeding

Is it Normal to Bleed When You Are Not on Your Period?

Picture of a woman consulting with her doctor
Abnormal vaginal bleeding can have a number of different causes.

What Is the Definition of Abnormal Vaginal Bleeding?

The medical definition abnormal vaginal bleeding is any bleeding that occurs outside of the vagina, expect during your period.for excessive or prolonged vaginal bleeding that occurs at the regular time of the menstrual cycle is known as menorrhagia. Metrorrhagia is the term used to refer to uterine bleeding at irregular intervals, particularly between periods. Menometrorrhagia is the combination of the two, that is, excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals. Abnormal vaginal bleeding is a symptom of another disease or condition that causes vaginal bleeding.

Is it Normal to Bleed In Between Your Periods?

A woman's normal menstrual cycle involves a complex series of hormonal events. An egg is released from the ovary; either the egg is fertilized by a sperm and implants in the uterus, or the lining of the uterus is shed each month as the menstrual period. This shedding causes normal menstrual bleeding. A woman's normal menstrual cycle involves a complex series of hormonal events. An egg is released from the ovary; either the egg is fertilized by a sperm and implants in the uterus, or the lining of the uterus is shed each month as the menstrual period. This shedding causes normal menstrual bleeding.

How Long Does the Menstrual Cycle Last?

A normal menstrual cycle is 28 days plus or minus 7 days. A menstrual period generally lasts from 2-7 days and has a typical volume of blood and fluid loss of about 2 to 8 tablespoons. This corresponds to about eight or fewer soaked pads per day with usually no more than 2 days of heavy bleeding.

Talk to your doctor or another healthcare professional if you have any abnormal vaginal bleeding, exept during your period.

What Are Signs and Symptoms of Abnormal Vaginal Bleeding?

A woman may see blood on her underwear or bed clothes. She might find blood on toilet tissue after urinating. Her menstrual period may be exceptionally heavy, causing her to soak through more pads or tampons than she normally does.

What Causes Dysfunctional Uterine Bleeding?

When bleeding is not caused by your menstrual cycle, it is called abnormal or dysfunctional uterine bleeding. This is the most common cause of abnormal vaginal bleeding during a woman's childbearing years. Up to 10% of women may experience excessive bleeding at one time or another. African American women tend to have more episodes. When the complex hormonal processes of the menstrual cycle are interrupted, resulting in estrogen and progesterone levels that are out of balance, excessive vaginal bleeding may occur. This bleeding is related to irregularities of your menstrual cycle without any disease.

The diagnosis of dysfunctional uterine bleeding is a diagnosis of exclusion, which means that all other causes for the bleeding (including trauma, tumors, or diseases) have been considered and determined not to be the cause of the bleeding. Depending on the female adolescent or woman's age, there are different reasons for the person to have dysfunctional uterine bleeding.

Dysfunctional uterine bleeding is commonly associated with no ovulation in one cycle. No ovulation occurs when a menstrual cycle occurs that does not result in the release of an egg from one of the ovaries. In some cases, dysfunctional uterine bleeding can occur with ovulation or the release of an egg from an ovary. When a woman does not ovulate, there is still stimulation of the uterus from the hormone estrogen. Progesterone, a very important hormone produced by the ovary after the release of an egg, is absent. Therefore, the lining of the uterus becomes unusually thick and enlarged. Irregular shedding of the uterine lining and heavy bleeding occurs. The woman then experiences heavy, irregular vaginal bleeding (usually painless).

The most common cause of dysfunctional uterine bleeding in a female adolescent is anovulation. In the first two years of a female adolescent having a menstrual cycle, 85% of the menstrual cycles can occur without the release of an egg. As the female adolescent gets older, the percentage of cycles that are anovulatory decreases, and she is more likely to experience normal periods. By the time the a woman has had a menstrual cycle for six years, fewer than 20% of cycles will occur without an egg being released from one of the ovaries.

What Causes Uterine Bleeding During Menopause?

Vaginal Bleeding and Menopause

Older women who are approaching menopause may also experience dysfunctional bleeding due to the hormonal changes that accompany the transition.

Diseases of the Female Reproductive Organs May Cause Bleeding

  • A woman may have a harmless (not cancerous) sore (polyp or lesion) on her genitals that can cause bleeding.
  • Cancer of the vagina, cervix, uterus, and ovaries can cause bleeding. Ovarian cysts, cervicitis, endometritis, fibroids, vaginal infections, and other conditions can also cause excessive bleeding.
  • Vaginal bleeding is a particular concern in women older than age 50 years (or after menopause). The risk of cancer increases with age. Also, the vaginal walls may be dry from lack of estrogen, which may cause bleeding during or after sexual intercourse.

Other Causes of Abnormal Vaginal Bleeding

  • Certain drugs may cause bleeding, especially if a woman takes anticoagulant drugs (drugs that prevent the blood from clotting).
  • Inherited bleeding disorders (such as von Willebrand disease and hemophilia) may cause excessive or prolonged vaginal bleeding.
  • Trauma is also a cause of bleeding. Some types of IUDs may cause heavier periods (slight bleeding is usually normal; pay attention to heavier bleeding). Injury (trauma to the vaginal wall) from sexual intercourse may be a cause of vaginal bleeding.

What If You Are Bleeding While You Are Pregnant?

In women of childbearing age (around 18-40 years), the most common cause of abnormal uterine bleeding is pregnancy and its complications, such as ectopic pregnancies or miscarriages. Anovulation can be a cause of bleeding in women of childbearing age. However, anovulation occurs in fewer than 20% of women in this category, so all other causes, including pelvic inflammatory disease and uterine fibroids, must be ruled out.

Many women experience some degree of vaginal bleeding during the first trimester of pregnancy and go on to have a healthy baby. However, vaginal bleeding can also be a sign of miscarriage or pregnancy complications, so vaginal bleeding during pregnancy should always be evaluated by a health-care professional.

Which Type of Doctor Treats Abnormal Vaginal Bleeding?

A gynecologist is a specialist in conditions of the female genital tract and can evaluate and treat vaginal bleeding. Primary health-care providers may also manage vaginal bleeding.

When Should You Call a Doctor for Abnormal Vaginal Bleeding?

A woman should see a health-care professional for any abnormal vaginal bleeding. It is not always necessary to go to a hospital emergency department for this problem. An office visit to a gynecologist (a doctor who specializes in female reproductive organs) is usually sufficient if she is bleeding, but does not have any other symptoms.

If a woman is having abnormal vaginal bleeding with other symptoms, such as lightheadedness, severe abdominal pain, or fevers, she should be evaluated as soon as possible. This includes being seen in an emergency department if her regular doctor is unavailable. An ambulance should be called if she passes out from blood loss.

What Procedures and Tests Diagnose the Cause of Abnormal Vaginal Bleeding?

The your doctor or another healthcare professional will take a medical history. You will be asked questions about any other medical issues and other general questions in regard to your health. This episode of vaginal bleeding, your last known normal menstrual cycle, any previous episodes of abnormal bleeding, if you may be pregnant, any previous pregnancies, and the outcome of those pregnancies, current sexual activity, birth control use, number of sexual partners, medications, over-the-counter (OTC ), or illicit drugs that you taking, history of problems with clotting or bleeding disorders, and recent surgeries or gynecological procedures.

The doctor also will perform a complete physical examination, including a thorough pelvic exam. A pelvic exam includes a careful inspection of the external genitalia, urethra, and anal area. The vaginal walls and cervix or birth canal are inspected for any abnormalities or retained foreign objects. Sometimes a tampon or other object is left in the vagina, which can cause abnormal vaginal bleeding. While the doctor is examining the vagina and cervix, he may take cultures (fluid samples) to test for sexually transmitted diseases (STDs) such as gonorrhea and chlamydia. The doctor may take cells from the cervix that will be examined for cancer. This is known as a Pap smear. It is also important for the doctor to place his or her hand into the vagina and sometimes the rectum to detect the shape of the uterus and ovaries as well as to feel for any masses.

Blood tests, urine tests, a complete blood count (CBC), and pregnancy tests are used to diagnose the cause of abnormal vaginal bleeding. A clotting series that includes a prothrombin time (PT) and an activated partial thromboplastin time (PTT) gives information about the ability to form clots in the body to stop bleeding. Abnormal vaginal bleeding may be the first sign that a woman may have of bleeding disorder. Your doctor may also order thyroid tests, which are blood tests that examine the thyroid gland (a gland in the neck responsible for many complex functions of the body).

An ultrasound of the abdomen and pelvis may be performed. This is an imaging test, much like an X-ray. An endometrial biopsy may be performed to take a sample of tissue from the lining of the uterus.

What Home Remedies Stop Abnormal Vaginal Bleeding?

Make sure that the bleeding is coming from the vagina and is not from the rectum or the urinary tract (blood only in the urine). You can insert a tampon into your vagina to confirm that the source of your bleeding is coming from the area of your vagina, cervix, and uterus. If you are bleeding heavily, rest in bed. Keep track of the number of pads or tampons you use so that you and your health-care professional can determine the amount of your bleeding. Avoid taking aspirin because it may prolong bleeding.

What Is the Treatment for Abnormal Vaginal Bleeding?

For hormonal irregularities, effective treatments for dysfunctional uterine bleeding usually involve the use of prescription hormones such as birth control pills to help in the coordination of the menstrual cycle. A specialist such as a gynecologist usually starts this type of treatment. The doctor should check for another cause of bleeding if the patient does not respond to hormonal treatment. If other causes (such as infections or bleeding disorders) are found, treatment is directed toward the underlying cause.

Will Surgery Cure Abnormal Vaginal Bleeding?

If other causes are found, different therapies might be needed, which may include surgical procedures to remove lesions that can cause abnormal bleeding.

What Is the Outlook for a Woman With Abnormal Vaginal Bleeding?

If a your bleeding is caused by irregularities in hormones triggering menstrual periods, you should expect that the menstrual cycles will become more regular in a few months after begining hormonal therapy with birth control pills. If a you begin hormonal treatment make sure to follow up with your doctor to make sure that another more serious and life-threatening reason is not the cause of the bleeding.

Kaunitz, A. M., MD. "Differential diagnosis of genital tract bleeding in women." UpToDate. Updated: Dec 04, 2018.