Vaginal or uterine bleeding - overview

  • Definition
    • Vaginal bleeding normally occurs during a woman's menstrual cycle, when she gets her period. Every woman's period is different.

      • Most women have cycles between 24 and 34 days apart. It usually lasts 4 to 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.

      Many women have abnormal bleeding between their periods at some point in their lives. Abnormal bleeding occurs when you have:

      • Heavier bleeding than usual
      • Bleeding for more days than normal (menorrhagia)
      • Spotting or bleeding between periods
      • Bleeding after sex
      • Bleeding after menopause
      • Bleeding while pregnant
      • Bleeding before age 9
      • Menstrual cycles longer than 35 days or shorter than 21 days
      • No period for 3 to 6 months (amenorrhea)
  • Alternative Names
    • Irregular menstruation; Heavy, prolonged, or irregular periods; Menorrhagia; Polymenorrhea; Metrorrhagia and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding

  • Causes
    • There are many causes of abnormal vaginal bleeding.


      Most often, abnormal uterine bleeding is caused by a hormone imbalance. When hormones are the cause, doctors call the problem dysfunctional uterine bleeding (DUB). DUB is more common in teenagers or in women who are approaching menopause.

      It is not always clear what causes hormone changes that lead to DUB. Hormone changes may be due to:

      • Menopause or perimenopause
      • Changes in birth control pills or hormone medicines


      Pregnancy complications such as:


      Problems with reproductive organs may include:

      • Infection in the uterus (pelvic inflammatory disease)
      • Recent injury or surgery to the uterus
      • Noncancerous growths in the womb, including uterine fibroids, uterine of cervical polyps, and adenomyosis
      • Inflammation or infection of the cervix (cervicitis)
      • Injury or disease of the vaginal opening (caused by intercourse, infection, polyp, genital warts, ulcer, or varicose veins)
      • Endometrial hyperplasia (thickening or build-up of the lining of the uterus)


      Problems with medical conditions may include:

      • Polycystic ovary syndrome
      • Cancer or precancer of the cervix, uterus, or (very rarely) fallopian tube
      • Thyroid or pituitary disorders
      • Diabetes
      • Cirrhosis of the liver
      • Lupus erythematosus
      • Bleeding disorders


      Other causes may include:

      • Use of an intrauterine device (IUD) for birth control (may cause spotting)
      • Cervical or endometrial biopsy or other procedures
      • Changes in exercise routine
      • Diet changes
      • Recent weight loss or gain
      • Stress
      • Use of certain drugs such as blood thinners (warfarin or Coumadin)
      • Sexual abuse
      • An object in the vagina.
  • 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 to 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 blood in the 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 exam, including a pelvic exam. Your doctor will ask questions about your medical history and symptoms

      You may have certain tests, including:

      • Pap test
      • Urinalysis
      • Thyroid functioning tests
      • Complete blood count (CBC)
      • Iron count
      • Pregnancy test

      Based on your symptoms, other tests may be needed. Some can be done in your health care provider's office. Others may be done at a hospital or surgical center:

      • Sonohysterography: Fluid is placed in the uterus through a thin tube, while ultrasound images are made of the uterus.
      • Ultrasound: Sound waves are used to make a picture of the pelvic organs.
      • Magnetic resonance imaging (MRI): In this imaging test, powerful magnets are used to create images of internal organs.
      • Hysteroscopy: A thin device is inserted through the vagina and the opening of the cervix. It lets the provider view the inside of the uterus.
      • Endometrial biopsy: Using a small or thin catheter (tube), tissue is taken from the lining of the uterus (endometrium). It is looked at under a microscope.
  • Treatment
    • Treatment depends on the specific cause of the vaginal bleeding, including:

      Treatment may include hormonal medicines, pain relievers, and possibly surgery.

      The type of hormone you take will depend on whether you want to get pregnant as well as your age.

      • Birth control pills can help make your periods more regular.
      • Hormones also can be given as an injection, as a vaginal cream, or through an IUD that releases hormones.
      • An IUD is a birth control device that is inserted in the uterus. The hormones in the IUD are released slowly and may control abnormal bleeding.

      Other medications given for abnormal uterine bleeding may include:

      • Nnonsteroidal anti-inflammatory drugs (ibuprofen or naproxen) to help control bleeding and reduce menstrual cramps
      • Tranexamic acid to help treat heavy menstrual bleeding
      • Antibiotics to treat infections
  • When to Contact a Medical Professional
    • Call your doctor if:

      • You have soaked through a pad or tampon every hour for 2 to 3 hours.
      • Your bleeding lasts 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.
      • Abnormal bleeding returns.
      • Bleeding increases or becomes severe enough to cause weakness or lightheadedness.
      • You have fever or pain in the lower abdomen
      • Your symptoms become more severe or frequent.
  • 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
    • ACOG Practice Bulletin No. 110: Noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010 Jan;115(1):206-18. PMID: 20027071

      Lobo RA. Abnormal Uterine Bleeding : Ovulatory and Anovulatory Dysfunctional Uterine Bleeding: Management of Acute and Chronic Excessive Bleeding. In: Lentz GM, Lobo RA, Gershenson GM, Katz VL, eds., Comprehensive Gynecology, 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 37.

      Marjoribanks J, Proctor M, Farquhar C, Derks RS. Nonsteroidal anti-inflammatory drugs for dysmenorrhoea. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001751. PMID: 20091521