Vaginal bleeding

Definition

Unusual vaginal bleeding is any vaginal blood that is different from your period. This might include small amounts of blood, also called spotting, between your periods. You might notice this on toilet tissue when you wipe. Or it could include a very heavy period. You know you have a very heavy period if blood is soaking through one or more tampons or pads every hour for more than four hours.

Vaginal bleeding from a period usually happens every 21 to 35 days. This is called the menstrual cycle. The blood comes from the lining of the uterus, which is shed through the vagina. When this happens, a new reproductive cycle has started.

Periods may last for just a few days or up to a week. Bleeding could be heavy or light. Menstrual cycles tend to be longer for teens and women nearing menopause. Also, menstrual flow might be heavier at those ages.

Causes

Unusual vaginal bleeding could be a symptom of an issue with your reproductive system. This is called a gynecological condition. Or it could be due to another medical problem or a medicine.

If you're in menopause and notice vaginal bleeding, see your doctor or other health care professional. It could be a cause for concern. Menopause is commonly defined as having no periods for about 12 months.

You might hear this type of vaginal bleeding also called abnormal vaginal bleeding. Possible causes of unusual vaginal bleeding include:

Cancers and precancerous conditions

• Cervical cancer
• Endometrial cancer (uterine cancer)
• Endometrial hyperplasia
• Ovarian cancer
• Uterine sarcoma
• Vaginal cancer

Endocrine system factors

• Hyperthyroidism (overactive thyroid) also known as overactive thyroid.
• Hypothyroidism (underactive thyroid)
• Polycystic ovary syndrome (PCOS)
• Stopping or changing birth control pills
• Withdrawal bleeding, a side effect of menopausal hormone therapy

Fertility and reproduction factors

• Ectopic pregnancy
• Fluctuating hormone levels
• Miscarriage (which is pregnancy loss before the 20th week of pregnancy)
• Perimenopause
• Pregnancy
• Random ovulatory cycles
• Sexual intercourse
• Vaginal atrophy , also called genitourinary syndrome of menopause

Infections

• Cervicitis
• Chlamydia trachomatis
• Endometritis
• Gonorrhea
• Herpes
• Pelvic inflammatory disease (PID)
• Ureaplasma vaginitis
• Vaginitis

Medical conditions

• Celiac disease
• Obesity
• Severe systemic disease, such as kidney or liver disease
• Thrombocytopenia
• Von Willebrand disease (and other blood clotting disorders)

Medications and devices

• Birth control pills.
• Forgotten, also called retained, tampon
• Intrauterine device (IUD)
• Tamoxifen (Soltamox)
• Withdrawal bleeding, a side effect of menopausal hormone therapy

Noncancerous growths and other uterine conditions

• Adenomyosis
• Cervical polyps
• Endometrial polyps
• Uterine fibroids
• Uterine polyps

Trauma

• Blunt trauma or penetrating injury to the vagina or cervix
• Past obstetric or gynecological surgery. This includes cesarean sections.
• Sexual abuse

When to see a doctor

If you're pregnant, contact your health care team immediately if you notice vaginal bleeding.

To be safe, you should have any unusual vaginal bleeding checked by your doctor or other health care professional. They can tell you if there's cause for concern based on your age and whole health picture.

Be sure to seek care when there is unusual vaginal bleeding in these cases:

• Postmenopausal adults who don't take hormone therapy. Hormone therapy is a treatment that helps with menopause symptoms such as hot flashes. Some bleeding may happen with these treatments. But if you notice any vaginal bleeding after menopause without hormone therapy, see a doctor.
• Postmenopausal adults taking cyclic, also called sequential, hormone therapy. Cyclic hormone therapy is when you take estrogen every day. And then, you add progestin for 10 to 12 days a month. Some withdrawal bleeding is expected with this kind of therapy. Withdrawal bleeding looks like a period. It happens for a few days of the month. But any other vaginal bleeding needs to be checked by a doctor.
• Postmenopausal adults taking continuous hormone therapy. Continuous hormone therapy is when you take a low dose of estrogen and progestin daily. Some light bleeding is expected with this therapy. But if the bleeding is heavy or goes on longer than six months, see your care team.
• Children who don't have any other signs of puberty. Signs of puberty include breast development and underarm or pubic hair growth.
• Children younger than age 8. Any vaginal bleeding in a child younger than 8 is concerning and should be checked by a doctor.

Unusual vaginal bleeding during the following stages is likely OK. But talk to your care team if you're concerned:

• Newborns. Some vaginal bleeding may happen during a baby's first month of life. But bleeding that's heavy or lasts longer should be checked by a provider.
• Teenage years. Menstrual cycles can be hard to track when teens first get their periods. This can go on for a few years. Also, it's common for light spotting to happen in the days before a period.
• Starting birth control pills. Spotting might happen in the first few months.
• Nearing menopause, also called perimenopause. Periods might be heavy or hard to track during this time. Ask your care team about ways to lessen any symptoms.