When vaginal bleeding is not normal

Abnormal vaginal bleeding is any bleeding that happens outside your period. This might include small amounts of blood, also called spotting, between your periods or it could include a very heavy period. You know you have a very heavy period if blood is soaking through one or more tampons or sanitary pads every hour for more than four hours.

Normal vaginal bleeding from a period usually happens every 21 to 35 days. This is called the menstrual cycle. The blood comes from the lining of the uterus, called the endometrium, which is shed through the vagina. When this happens, a new reproductive cycle has started. Periods may last for a few days or up to a week. Bleeding could be heavy or light. Menstrual cycles tend to be longer for teens and women nearing menopause. Also, menstrual flow might be heavier at those ages. Anything that happens that is different to this here described should be seen as abnormal vaginal bleeding.

You should have any unusual vaginal bleeding checked by your doctor or healthcare professional. They can tell you if there’s cause for concern based on your age and health. If you’re pregnant, contact your healthcare team immediately if you notice vaginal bleeding.

ALSO READ: Is it really possible to delay your period?

When to call the doctor

Seek care in these cases:

• Post-menopausal adults who don’t take hormone therapy. Hormone therapy helps with menopause symptoms such as hot flushes. Some bleeding may happen with these treatments. But if you notice any vaginal bleeding after menopause without hormone therapy, see a doctor. This happens commonly in post-menopausal adults taking cyclic therapy. Post-menopausal adults taking continuous hormone therapy may also experience abnormal bleeding.
• Children with no signs of puberty. Signs of puberty include breast development and underarm or pubic hair growth.
• Children younger than eight. Any vaginal bleeding in a child younger than eight is concerning and should be checked out by a doctor.

Unusual vaginal bleeding during the following stages is likely OK, but talk to your care team if you’re concerned:

• Newborns. Some vaginal bleeding may occur during a baby’s first month of life. But bleeding that’s heavy or lasts longer should be checked by a medical professional.
• Teenage years. Menstrual cycles can be hard to track when teens first get their periods. This can go on for a few years. Also, it’s common for light spotting to happen in the days before a period.
• Starting birth control pills. Spotting might happen in the first few months
• Nearing menopause, also called perimenopause. Periods might be heavy or hard to track during this time. Ask your care team about ways to lessen any symptoms.

Causes of abnormal vaginal bleeding

Unusual vaginal bleeding could be a symptom of an issue with your reproductive system. This is called a gynaecological condition. Or it could be due to another medical problem or a medicine. If you’re in menopause and notice vaginal bleeding, see your healthcare professional. It could be a cause for concern.

Menopause is commonly defined as having no periods for about 12 months. You might hear this type of vaginal bleeding also called abnormal vaginal bleeding.

Possible causes include:

• Cancers and pre-cancerous conditions
• Cervical cancer
• Uterine cancer
• Endometrial hyperplasia
• Ovarian cancer
• Uterine sarcoma
• Vaginal cancer
• Endocrine system factors
• Polycystic ovary syndrome
• Stopping or changing birth control pills
• Withdrawal bleeding, a side effect of menopausal hormone therapy
• Fertility and reproduction factors
• Ectopic pregnancy
• Fluctuating hormone levels
• Miscarriage
• Perimenopause
• Pregnancy
• Random ovulatory cycles
• Sexual intercourse
• Vaginal atrophy
• Infections
• Cervicitis
• Chlamydia trachomatis
• Endometritis
• Gonorrhoea
• Herpes
• Pelvic inflammatory disease
• Ureaplasma vaginitis
• Vaginitis
• Medical conditions
• Coeliac disease
• Blunt trauma or penetrating injury to the vagina or cervix
• Past obstetric or gynaecological surgery like caesareans
• Sexual abuse.

Diagnosis methods

For some women, medical history and physical examination are enough for the doctor to diagnose the cause of the irregular bleeding. For other women, a range of tests may be offered including:

• Cervical/pap smear and swabs
• Pregnancy test
• Blood tests
• Ultrasound
• Dilation and curettage (D&C), which involves gently widening the cervix and scraping away the uterine lining.

Treatment

Treatment depends on the cause but may include:

• Anti-inflammatory drugs
• Antibiotics
• Change of contraception
• Hormone therapy
• Anti-bleeding agents such as tranexamic acid
• Surgery to remove fibroids, polyps or cancers
• Treatment for any underlying health problem.

If you have irregular bleeding sometimes with pain, some general home care suggestions include:

• Get plenty of sleep
• Eat a well-balanced diet
• Do some gentle exercise
• Keep a diary of your symptoms to show your doctor
• Rest. Curl your knees up to your chest and lie on your side
• Place a warm pack, such as a hot water bottle or wheat bag, over your abdomen
• Take a warm bath
• Wear loose clothing
• Exercise
• Rub or massage where it hurts
• Take painkillers such as paracetamol, but avoid aspirin.

NOW READ: Meds and weight loss – More people are using diabetes drugs for weight loss