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Abnormal Vaginal Bleeding

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 9, when you are pregnant, or after menopause.
    Abnormal vaginal bleeding has many possible causes. By itself, it does not necessarily indicate a serious condition.
  • Because bleeding can mean 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 mean a serious problem, including an ectopic pregnancy or miscarriage.
  • Heavy vaginal bleeding or bleeding that occurs after 12 weeks also may mean a serious problem, such as placenta previa.
  • Ovulation can cause mid-cycle bleeding.
  • Polycystic ovary syndrome (PCOS) is a hormone imbalance that interferes with normal ovulation and 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.
  • Infection of the pelvic organs  (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted infections (STIs) are often the cause of infections.
  • 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:
  • Sexual abuse.
  • An object in the vagina.
  • An object in the vagina.
  • Uterine fibroids, which are a common cause of heavy periods. For more information, see the topic Uterine Fibroids.
  • Structural problems, such as urethral prolapse or polyps.
  • Cancer of the cervix, uterus, ovaries, or vagina.
  • Extreme emotional stress and excessive exercise. But excessive exercise more frequently causes an absence of menstruation (amenorrhea).
  • Other diseases, such as hyperthyroidism or diabetes.

Abnormal Vaginal Bleeding (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 taking hormone 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.
  • 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.
 

Abnormal Vaginal Bleeding - Preparing For 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?
  • Was your previous period 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 behavior?
  • 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?