Abnormal vaginal bleeding is any vaginal bleeding that happens unexpectedly. It is bleeding that occurs outside of your expected menstrual cycle. It can also refer to a menstrual cycle that suddenly becomes heavier, lighter or more erratic than usual.
Signs that vaginal bleeding may be abnormal include:
- Bleeding at unusual times (between periods, after intercourse).
- Heavy menstrual bleeding (ie. soaking through one or more sanitary pads or tampons every hour for several consecutive hours).
- Unusually long periods (ie. periods lasting seven days or longer).
- An inconsistent menstrual cycle.
- Abnormal vaginal bleeding has a number of possible causes and most women will experience at least one episode of abnormal bleeding in their lives. By itself, abnormal vaginal bleeding does not necessarily indicate a serious condition but it is a symptom that should never be ignored. Any abnormal bleeding should always be discussed with your doctor.
Common causes of abnormal vaginal bleeding
Uterine fibroids
Uterine fibroids are non-cancerous growths of the uterus that often appear in women during their reproductive years. In situations where fibroids cause symptoms these may present as heavy menstrual bleeding, severe menstrual cramps or bleeding between periods. Fibroids can be diagnosed with an ultrasound scan and depending on the severity be treated by medication, watchful waiting or in some cases, surgery.
Endometriosis
Endometriosis is a medical condition in which cells that normally line the inside of the uterus (the endometrium) begin to grow on the outside of the uterus instead. Endometriosis can lead to heavy bleeding during your menstrual cycle. Some women may also notice pelvic pain and cramping. Endometriosis can be diagnosed with a scan or by an investigation known as a laproscopy. Treatment options usually involve medication or surgery. The approach you and your doctor choose to take will depend on how severe your signs and symptoms are and whether you hope to become pregnant.
Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS) is a medical condition caused by an imbalance of the reproductive hormones estrogen and progesterone. In PCOS, normal regulation of these hormones becomes disrupted which can lead to symptoms of irregular periods (ie. infrequent, heavy or prolonged menstrual cycle), acne, excess facial and body hair, weight gain or infertility. The treatment for PCOS is specific to each woman. It will depend on your past medical history, medication history and lifestyle.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is the infection of a woman’s reproductive organs. It is a complication often caused by sexually transmitted infections such as chlamydia or gonorrhea. PID is a serious medical condition that should be treated by a doctor as soon as possible. Symptoms of PID include pain in the lower abdomen, a high temperature, burning sensation when passing urine and bleeding between periods.
Sexually transmitted infections
In some cases, Sexually transmitted infection (STIs) such as chlamydia and gonorrhea may cause abnormal vaginal bleeding. If an STI is present, vaginal bleeding may be experienced alongside other symptoms such as abnormal vaginal discharge and itching or rashes in the vaginal area. STIs should always be treated immediately. Untreated STIs can lead to long term complications.
Non-sexually transmitted infections
Infection or inflammation of the vagina, known as vaginitis may cause abnormal vaginal bleeding. Vaginitis is a term used to describe various disorders that cause inflammation or infection of the vagina. Culprits of inflammation or infection range from organisms such as yeast, to irritants like chemicals or sprays.
Cancer
The vast majority of abnormal bleeding events will not be related to cancer. However, in a small number of cases, abnormal vaginal bleeding may be linked to cancer of the uterus, cervix, ovaries or vagina. For this reason, it is important that all cases of abnormal vaginal bleeding be taken seriously and discussed with a medical professional.
Other causes
- Medications – some medications such as birth control pills or hormone replacement therapy can cause abnormal vaginal bleeding.
- Possible pregnancy – women may experience episodes of light vaginal bleeding in the early stages of pregnancy. If pregnancy might be a possibility, a home pregnancy test can be taken.
Diagnosis of abnormal vaginal bleeding
All cases of abnormal vaginal bleeding should always be discussed as a matter of priority with your doctor. Your doctor will take a full medical history and carry out a physical exam to help determine the cause of the bleeding. They may order some diagnostic tests such as a blood test or ultrasound scan to help rule out other possible factors.
Treatment of abnormal vaginal bleeding
Treatment of abnormal vaginal bleeding will be determined by your specific diagnosis. Once a diagnosis is given, treatment options can be discussed with your doctor in detail. Treatment will always be guided by your personal medical history, current medication history and your own unique circumstances.
Special considerations
Post-menopausal women
Post-menopausal women who experience any vaginal bleeding should see their doctor promptly. After menopause, menstrual cycles should come to a complete stop. Therefore, any bleeding after this time should always be investigated by a doctor.
Pregnancy and abnormal vaginal bleeding
Pregnant women that experience any bleeding should seek advice from their doctor as soon as possible. Although not all bleeding that is experienced during pregnancy is harmful, any bleeding episodes should always be discussed with a medical professional.