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    Vaginal bleeding

    Irregular menstruation; Heavy, prolonged, or irregular periods; Menorrhagia; Polymenorrhea; Metrorrhagia and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding

    Vaginal bleeding normally occurs during a woman's menstrual cycle, when she gets her period. Every woman's period is different. On average, a woman's period occurs every 28 days. Most women have cycles between 24 and 34 days apart. It usually lasts 4 - 7 days.

    Young girls may get their periods anywhere from 21 to 45 days or more apart. Women in their 40s will often notice their period occurring less often.

    Some conditions can cause abnormal vaginal bleeding. This article discusses heavy, prolonged, or irregular periods.

    For vaginal bleeding due to changes in hormone levels, see: Dysfunctional uterine bleeding (DUB)

    Causes

    A change in hormone levels is a common cause of abnormal menstrual bleeding. For information on this cause, see: dysfunctional uterine bleeding

    Other causes of heavy, prolonged, or irregular menstrual bleeding include:

    • Bleeding disorders such as Von Willebrand disease
    • Cancer of the lining of the uterus
    • Changes in birth control pills or hormone medications
    • Changes in exercise routine
    • Diet changes
    • Endometrial hyperplasia (thickening/build-up of the lining of the uterus)
    • Infection in the uterus (pelvic inflammatory disease)
    • Medical conditions such as thyroid and pituitary disorders, diabetes, cirrhosis of the liver, and systemic lupus erythematosus
    • Noncancerous growths in the womb, including uterine fibroids, uterine polyps, and adenomyosis
    • Polycystic ovary syndrome
    • Pregnancy complicationss such as miscarriage or ectopic pregnancy
    • Recent injury or surgery to the uterus
    • Recent weight loss or gain
    • Stress
    • Use of an intrauterine device (IUD) for birth control
    • Use of certain drugs such as steroids or blood thinners (for example, warfarin or Coumadin)

    Symptoms

    Symptoms of abnormal vaginal bleeding include:

    • Bleeding or spotting between periods
    • Bleeding after sex
    • Bleeding more heavily (passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 - 3 hours in a row)
    • Bleeding for more days than normal or for more than 7 days
    • Menstrual cycle less than 28 days (more common) or more than 35 days apart
    • Bleeding after you have gone through menopause

    Bleeding from the rectum or there is blood in your urine may be mistaken for vaginal bleeding. To know for certain, insert a tampon into the vagina and check for bleeding.

    Keep a record of your symptoms and bring these notes to your doctor. Your record should include:

    • When menstruation begins and ends
    • How much flow you have (count numbers of pads and tampons used, noting whether they are soaked)
    • Bleeding between periods and after sex
    • Any other symptoms you have

    Exams and Tests

    Your doctor will perform a physical examination, including a pelvic exam. Your doctor will ask questions about your medical history and symptoms, including:

    • What is your age?
    • When was your last menstrual period?
    • How long do your periods usually last?
    • How many days are there usually between your menstrual periods?
    • Have you passed blood clots?
    • How heavy have they been? How many pads and tampons have you been using per day?
    • How old were you when had your first menstrual period?
    • Do you use birth control?
    • Do you take an estrogen supplement?
    • Do you take aspirin more than once per week?
    • Do you take Coumadin, heparin, or other anticoagulants?
    • Have you recently given birth, had surgery, or experienced trauma on or near the vagina or uterus?
    • Have you recently had a vaginal or uterine infection?
    • What other symptoms do you have?
    • Are you pregnant or could you be pregnant?

    Tests that may be done include:

    • Pap smear
    • Endometrial biopsy
    • Pelvic ultrasound
    • Blood tests such as thyroid function tests, complete blood count, iron count and pregnancy test
    • Urinalysis

    Treatment

    Treatment depends on the cause and may include pain medication, hormonal medications, and possibly surgery. For treatment information, see:

    • Dysfunctional uterine bleeding
    • Endometriosis
    • Uterine fibroids
    • Ectopic pregnancy
    • Polycystic ovary syndrome

    When to Contact a Medical Professional

    Call your doctor if:

    • You have soaked through a pad or tampon every hour for 2 - 3 hours.
    • Your bleeding has lasted longer than 1 week.
    • You have vaginal bleeding and you are pregnant or could be pregnant.
    • You have severe pain, especially if you also have pain when not menstruating.
    • Your periods have been heavy or prolonged for three or more cycles, compared to what is normal for you.
    • You have bleeding or spotting after reaching menopause.
    • You have bleeding or spotting between periods or caused by having sex.

    Prevention

    Aspirin may prolong bleeding and should be avoided if you have bleeding problems. Ibuprofen is usually works better than aspirin for relieving menstrual cramps. It also may reduce the amount of blood you lose during a period.

    References

    Casablanca Y. Management of dysfunctional uterine bleeding. Obstet Gynecol Clin North Am. 2008 Jun;35(2):219-34.

    Lobo RA. Abnormal uterine bleeding: Ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier;2007:chap 37.

    [No authors listed] ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18.

    Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001751.

    Damlo S. ACOG guidelines on endometrial ablation. Am Fam Physician. 2008 Feb 15;77(4):545-549.

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                Review Date: 7/25/2011

                Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.

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