Vaginal bleeding can be characterized as normal or abnormal. Normal vaginal bleeding occurs as part of menstruation or by means of light spotting between periods. Bleeding through the vagina is considered abnormal if that bleeding is not part of menstruation, if characteristics of menstruation are different than in the past, if the bleeding occurs during pregnancy, or if blood is shed in pre-menstruation childhood or after menopause.
Definition & Facts
Abnormal vaginal bleeding is any loss of blood through the vagina which is not part of or related to a normal menstrual cycle. Amount of blood loss as part of abnormal vaginal bleeding can vary from small spots without obvious cause to excessively heavy periods during menstruation.
Many women struggle to identify what is considered normal for bleeding during a regular menstrual cycle. This can vary so widely from woman to woman that patterns within a woman's own cycle can help mark what is normal for her, also flagging her to abnormal changes which may occur. Menstruation before 20 years of age and beyond age 40 is often heavier and longer than between the ages of 20 and 40, so menstrual characteristics during these times may even vary.
Bleeding during pregnancy should always be checked by a doctor. Most often, such bleeding is normal. But bleeding before 12 weeks gestation can indicate problems with the pregnancy, itself. Other conditions causing blood loss can occur throughout gestation, such as Placenta praevia.
For women who are not pregnant, abnormal loss of blood may be caused by any of the following:
- Hormonal imbalances
- Birth control methods
- Intrauterine devices
- Sexually transmitted infections
- Pelvic inflammatory disease
- Sexual abuse
- Foreign object in the vagina
- Fibroids in the uterus
- Urethral prolapse or polyps
- Cervical disease, disorders or polyps
- Celiac disease
- Ovarian disease or disorders
- Cancer of the reproductive organs
- Diseases and disorders of the endometrium
- Extreme emotional stress
- Excessive exercise
- Blood clotting disorders
- Other disease, including diabetes or thyroid disease
Women over age 40 may also experience some abnormal bleeding when entering perimenopause. After women have gone through menopause, if they bleed at any time following more than 12 months without menstruation, they should see a doctor.
When to see a doctor
During pregnancy, any bleeding experienced through the vagina should be addressed through qualified, immediate medical care. The same is true for women who are not pregnant, if the blood loss is not part of a regular menstrual cycle. Age, medications and other factors can weigh in determination of whether the bleeding is abnormal. Any non-menstrual vaginal bleeding accompanied by pain, fever or other symptoms should be checked by a doctor.
Vaginal bleeding in children younger than age 8 years should always be investigated by a doctor. Some bleeding occurs in newborns during their first month of life, but this should not persist or be excessive.
Treatment & Therapy
Treatment for vaginal bleeding will involve seeing a doctor and possibly answering many questions to help the physician determine the cause of the bleeding.
For menstruating women, it is helpful if the patient is able to provide specifics of their periods, including:
- Dates of the last menstrual period
- Whether that period was normal
- How long cycles usually last
- Whether cycles are normal
- How many pads or tampons used per day during an average period
- Whether clots are passed during periods and their size
- Any other issues causing concern during menstruation
Other questions the medical practitioner may ask include:
- Do you presently engage in sexual activity?
- Do you possess any high-risk sexual behaviors?
- Are you using birth control?
- Have you skipped any birth control pills or missed a birth control injection?
- Have you taken a home pregnancy test?
- Are you under increased stress?
- Have you altered your dietary or exercise routines?
- Have you experienced recent weight changes?
- What prescriptions are you currently taking?
- Do you have other symptoms?
- Have you experienced this type of bleeding before?
If pregnancy is definitely not a possibility and lightheadedness, fainting, abnormally pale skin or other serious symptoms of a bigger problem are also present, calling 911 (999 United Kingdom) for immediate treatment may be the right course of action.
Prevention & Prophylaxis
Because medications can be a factor in vaginal bleeding, there are several things to consider when taking birth control or other medications. First, birth control pills and hormone therapy pills should be taken exactly as prescribed. Some of these therapies involve daily pills and others are monthly. Patients should be vigilant in ensuring they follow directions.
Relaxation exercises, meditation and other therapies can help women under extreme stress better cope with that stress. This can prevent physical ramifications, such as vaginal bleeding.
Doctors will sometimes prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to help reduce menstrual bleeding. NSAIDs work by decreasing prostaglandin production by the body, in turn reducing vaginal bleeding. Most patients are directed to take about 400mg of ibuprofen or naproxen every six hours on the first day of their period and every day until menstrual bleeding ends.