Abnormal Vaginal Bleeding

Topic Overview

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 10, 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 indicate 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 indicate a serious problem, including an ectopic pregnancy or miscarriage.
    • Heavy vaginal bleeding or bleeding that occurs after 12 weeks also may indicate a serious problem, such as placenta previa.
  • Ovulation can cause midcycle bleeding.
  • Polycystic ovary syndrome (PCOS) is a hormone imbalance that interferes with normal ovulation which 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. For more information, see the topic Birth Control.
  • An intrauterine device (IUD) also may increase your chances of spotting or heavy periods. For more information on the IUD, see the topic Birth Control.
  • Infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted diseases (STDs) are often the cause of infections. For more information, see the topic Exposure to Sexually Transmitted Diseases.
  • 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:

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.

Use the Check Your Symptoms section to decide if and when you should see a doctor.

Check Your Symptoms

Home Treatment

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. Be sure to review the Check Your Symptoms section to determine if and when you need to see a doctor. If the bleeding continues or gets worse, a visit to a doctor is needed to determine 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 45 or older, you may be experiencing perimenopause. For more information, see the topic Menopause and Perimenopause.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms 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 do not improve within 2 months.
  • Symptoms become more severe or frequent.

Prevention

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. For more information, see the topic Birth Control.
  • If you are taking hormone replacement 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?
    • When was your previous period? Was it 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?

Credits

Author Jan Nissl, RN, BS
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Tracy Landauer
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Primary Medical Reviewer Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
Specialist Medical Reviewer William H. Blahd, Jr., MD, FACEP - Emergency Medicine
Last Updated July 2, 2009

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