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Vaginal Bleeding

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Abnormal Vaginal Bleeding Quick Overview

  • Abnormal vaginal bleeding is any bleeding that occurs outside of the expected time of menstruation.
  • Abnormal vaginal bleeding can include
    • excessive or heavy bleeding,
    • prolonged periods,
    • bleeding or spotting between periods,
    • menstrual periods that occur too frequently,
    • bleeding after sex,
    • bleeding after menopause, or
    • vaginal bleeding during pregnancy.
  • Women who are not ovulating regularly may have abnormal vaginal bleeding.
  • There are many causes of vaginal bleeding, and treatment depends upon the underlying cause.
  • It is important to visit a health-care professional for any abnormal vaginal bleeding.
  • Women approaching menopause may have irregular periods or may miss periods. This can begin several years prior to actual menopause.

What is abnormal vaginal bleeding?

Unexpected bleeding is always a concern for a woman at any stage of life. Bleeding other than a normal menstrual period and even an abnormally heavy period can be a cause for alarm. The medical term 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 the expected menstrual 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.

It is important to understand exactly what is causing the bleeding, its origin (uterus, vagina, or some other organ or tissue), and to make decisions about how to control or stop the 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.
  • 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.

What are causes of abnormal vaginal bleeding?

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 an anovulatory cycle. Anovulation 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.

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 are abnormal vaginal bleeding symptoms?

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 kind 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.

What about vaginal bleeding during pregnancy?

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.

When should you seek medical care 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.

How is the cause of abnormal vaginal bleeding diagnosed?

The health-care professional will take a careful medical history. The woman will be asked questions about the following issues and other general questions regarding her health:

  • This episode of vaginal bleeding
  • Last known normal menstrual cycle
  • Previous episodes of abnormal bleeding
  • If she may be currently pregnant
  • Previous pregnancies
  • Outcomes of previous pregnancies
  • Present sexual activity
  • Use of any form of birth control
  • Number of sexual partners
  • Any medications, over-the-counter, or illicit drugs she is taking
  • History of problems with clotting or bleeding disorders
  • History of recent surgeries or gynecological procedures

The doctor also will perform a complete physical examination, including a thorough pelvic exam.

  • The exam includes careful inspection of the external genitalia, urethra, and anal area.
  • The vaginal walls and cervix or birth canal are inspected for the presence of any abnormalities or retained foreign objects. Sometimes a tampon or other object is left in the vagina, which can cause bleeding.
  • While the doctor is examining the vagina and cervix, the doctor may take cultures (fluid samples) to test for sexually transmitted diseases (STDs) such as gonorrhea and Chlamydia.
  • The doctor may also 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 that may be present.

Diagnostic tests that may be performed to help ascertain the cause of abnormal bleeding include the following:

  • A pregnancy test needs to be done to make sure that pregnancy or a related complication is not the cause of the woman's bleeding.
  • Blood will be taken to check for anemia (low red blood cell counts) or low platelet count.
  • 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 are home remedies for 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.

What about surgery for 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 woman's bleeding is caused by irregularities in hormones triggering menstrual periods, she should expect that the menstrual cycles will become more regular in a few months after starting hormonal therapy with birth control pills.
  • If a woman begins hormonal treatment, follow-up with a health-care professional.
  • The woman should make sure that another more serious and life-threatening reason is not the cause of the bleeding.

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