Abnormal Vaginal Bleeding

What is vaginal bleeding?

Vaginal bleeding is usually associated with monthly menstruation. This first occurs when a woman is between 10 and 15 years of age and continues until menopause around age 45 to 55. The frequency, duration, and quantity of bleeding associated with menstrual cycles can vary. Vaginal bleeding can also occur outside of the menstrual cycle.

Here is a list of common conditions that can cause vaginal bleeding:

• Metrorrhagia – A menstrual cycle that lasts less than 21 days (frequent periods). The cycle length is measured from the first day after one flow to the first of the next flow and is typically between 24 and 38 days.
• Oligomenorrhea – A menstrual cycle that lasts more than 38 days but less than 90 days (a few periods).
• Amenorrhea – No menstrual cycle for more than 90 days.
• Menorrhagia – A menstrual cycle that lasts more than seven days or spotting between cycles. This condition is also known as intermenstrual bleeding, where the bleeding continues past the point at which it should stop (typically between three to five days).

Who is more likely to experience vaginal bleeding?

Any age can experience unusual vaginal bleeding. A woman’s first period may not occur regularly for up to two years. This is also true for the years before menopause. The number of days between periods can change or be skipped entirely during perimenopause.

What causes vaginal bleeding?

• Birth control products and devices – Use of birth control devices like the IUD (intrauterine device) or birth control pills.
• Bleeding disorders – A problem in normal blood clotting could be caused by an inherited condition like hemophilia, Von Willebrand Disease, a low platelet count (thrombocytopenia), or side effects of blood thinners.
• Female reproductive system cancers – These include cancers in the cervix and endometrium (linings of the uterus), ovaries, and fallopian tubes.
• Ectopic pregnancy – A pregnancy in which the fertilized eggs grow outside of the uterus, often in the fallopian tubes.
• Endometrial hyperplasia – When the endometrium becomes thicker due to hormonal imbalances from too much estrogen or too little progesterone. Although this condition isn’t necessarily cancerous, it can sometimes lead to cancer of the uterus.
• Hormone Replacement Therapy
• Hypothyroidism – An underactive thyroid gland may cause irregular menstrual cycles.
• Infection – Found in the urinary tract or pelvic cavity.
• Injury – Injuries to the vagina or foreign bodies.
• Miscarriage – Approximately 15 to 20% of pregnancies end in miscarriage; most will occur within the first 12 weeks.
• Ovulation problems – An abnormality in the ovaries or a problem with the brain’s signaling to the glands controlling ovulation can lead to a disruption or failure of the eggs.
• Uterine fibroids – Non-cancerous growths derived from the muscle tissue in the uterus. They can vary in size, location, growth rate, and location within the uterus.
• Uterine polyps – A growth of cells in the lining of your uterus.

What is the best way to treat vaginal bleeding?

It is better to treat vaginal bleeding with medication first, if possible. Surgery may be an option if these fail.

Medications

• Hormonal birth control methods (pills or patches, vaginal rings) – These birth control methods may help reduce the menstrual cycle and make periods more regular.
• Intrauterine devices (IUDs) – Some IUDs can be used as birth control or to reduce or stop bleeding.
• Gonadotropin-releasing agonists (medications that reduce the release of gonadotropin, a hormone that stimulates the ovaries)– Used to stop the menstrual flow and reduce the size of fibroids.
• Tranexamic Acid – Useful for stopping excessive menstrual bleeding.
• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen – Can help to control heavy bleeding.

Surgery

• Endometrial ablation – destroys the lining in the uterus and reduces or stops bleeding. The possibility of a future pregnancy is less likely with this procedure. In addition, this procedure can increase risks should you become pregnant.
• Dilation & curettage (D&C)- Suctioning or scraping tissue from the uterus.
• Myomectomy – Removes fibroids, but not the uterus.
• Hysterectomy– The removal of the uterus. This procedure may be used to treat endometrial carcinoma or when other treatments have failed.

When should you consult a doctor?

A doctor should be notified if you notice the following symptoms:

• Changes in the frequency of menstrual cycles (a significantly shorter or longer period between cycles than normal).
• An increase or decrease in blood volume during menstrual cycles (either more or less than usual).
• Bleeding after sexual intercourse.
• Any bleeding, even a small amount, occurs before puberty and after menopause.
• Bleeding when douching.
• After starting a new medication or hormone treatment.
• Bleeding in the 2nd or 3rd trimester of pregnancy.