What is abnormal vaginal bleeding?
Unexpected bleeding is always a concern for a woman at any stage of life. Bleeding other than a normal menstrual period and even an abnormally heavy period can be a cause for alarm. The medical term for excessive or prolonged vaginal bleeding that occurs at the regular time of the menstrual cycle is known as menorrhagia. Metrorrhagia is the term used to refer to uterine bleeding at irregular intervals, particularly between the expected menstrual periods. Menometrorrhagia is the combination of the two, that is, excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals.
It is important to understand exactly what is causing the bleeding, its origin (uterus, vagina, or some other organ or tissue), and to make decisions about how to control or stop the bleeding.
- A woman’s normal menstrual cycle involves a complex series of hormonal events. An egg is released from the ovary; either the egg is fertilized by a sperm and implants in the uterus, or the lining of the uterus is shed each month as the menstrual period. This shedding causes normal menstrual bleeding.
- A normal menstrual cycle is 28 days plus or minus 7 days.
- A menstrual period generally lasts from 2-7 days and has a typical volume of blood and fluid loss of about 2 to 8 tablespoons. This corresponds to about eight or fewer soaked pads per day with usually no more than 2 days of heavy bleeding.
Vaginal bleeding facts
- Normal vaginal bleeding is the periodic blood flow from the uterus.
- Normal vaginal bleeding is also called menorrhea. The process by which menorrhea occurs is called menstruation.
- In order to determine whether bleeding is abnormal, and its cause, the doctor must answer 3 questions: Is the woman pregnant? What is the pattern of the bleeding? Is she ovulating?
- Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding.
- There are many causes of abnormal vaginal bleeding that are associated with irregular ovulation.
- A woman who has irregular menstrual periods requires a physical examination with a special emphasis on the thyroid, breast, and pelvic organs.
- Treatment for irregular vaginal bleeding depends on the underlying cause. After the cause is determined, the doctor decides if treatment is actually necessary.
Causes of Vaginal bleeding
In many women, the cause of the irregular bleeding is not found. For others, the cause depends on their age and the site of bleeding. Once pregnancy has been ruled out, some of the known causes include:
- Hormonal changes
- Contraception such as the pill, injection or IUD (intrauterine device)
- Infection in the vagina or uterus
- Fibroids or polyps inside the uterus
- Trauma to the vagina
- Some medications such as anticoagulants or anti-epilepsy drugs
- Underlying health problems such as bleeding or thyroid disorders
- Cancer in the lining of the uterus, the cervix or vagina (rare).
Home Care Treatment
Contact a provider right away if bleeding is very heavy.
Keep track of the number of pads or tampons used over time so that the amount of bleeding can be determined. Uterine blood loss can be estimated by keeping track of how frequently a pad or tampon is soaked and how often one needs to be changed.
Because aspirin may prolong bleeding, it should be avoided, if possible. However, NSAIDS such as ibuprofen can be used to minimize bleeding and cramping.
Vaginal bleeding during pregnancy
In women of childbearing age (around 18-40 years), the most common cause of abnormal uterine bleeding is pregnancy and its complications, such as ectopic pregnancies or miscarriages. Anovulation can be a cause of bleeding in women of childbearing age. However, anovulation occurs in fewer than 20% of women in this category, so all other causes, including pelvic inflammatory disease and uterine fibroids, must be ruled out.
Many women experience some degree of vaginal bleeding during the first trimester of pregnancy and go on to have a healthy baby. However, vaginal bleeding can also be a sign of miscarriage or pregnancy complications, so vaginal bleeding during pregnancy should always be evaluated by a health-care professional.
How is irregular vaginal bleeding treated?
Treatment for irregular vaginal bleeding depends on the underlying cause. After the cause is determined, the doctor decides if treatment is actually necessary. Sometimes, all that is needed is for dangerous causes to be ruled out and to determine that the irregular vaginal bleeding does not bother the woman enough to warrant medication or treatment. If thyroid, liver, kidney, or blood clotting problems are discovered, treatment is directed toward these conditions.
Medications for treatment of irregular vaginal bleeding depend on the cause. Examples are described below:
- If the cause of the bleeding is lack of ovulation (anovulation), doctors may prescribe either progesterone to be taken at regular intervals, or an oral contraceptive, which contains progesterone, to achieve a proper hormonal balance. Such treatment dramatically decreases the risk of uterine cancer in women who do not ovulate.
- If the cause of irregular vaginal bleeding is a precancerous change in the lining of the uterus, progesterone medications may be prescribed to reduce the buildup of precancerous uterine lining tissues in an attempt to avoid surgery.
- When a woman has been without menses for less than six months and is bleeding irregularly, the cause may be menopausal transition. During this transition, a woman is sometimes offered an oral contraceptive to establish a more regular bleeding pattern, to provide contraception until she completes menopause, and to relieve hot flashes. A woman who is found to be menopausal as the cause of her irregular bleeding may also receive menopause counseling if she has troubling symptoms.
- If the cause of irregular vaginal bleeding is polyps or other benign growths, these are sometimes removed surgically to control bleeding because they cannot be treated with medication.
- If the cause of bleeding is infection, antibiotics are necessary. Bleeding during pregnancy requires prompt evaluation by an obstetrician. Endometriosis can be treated with medications and/or surgery (such as laparoscopy).
- Sometimes, the cause of excessive bleeding is not apparent after completion of testing (dysfunctional uterine bleeding). In these cases, oral contraceptives can improve cycle control and lessen bleeding.
- If bleeding is excessive and cannot be controlled by medication, a surgical procedure called dilation and curettage (D&C) may be necessary. In addition to alleviating the excessive bleeding, the D&C provides tissue that can be analyzed for additional information that can rule out abnormalities of the lining of the uterus.
- Occasionally, a hysterectomy is necessary when hormonal medications cannot control excessive bleeding. However, unless the cause is pre-cancerous or cancerous, this surgery should only be an option after other solutions have been tried.
Many new procedures are being developed to treat certain types of irregular vaginal bleeding. For example, studies are underway to evaluate techniques that selectively block the blood vessels involved in the bleeding. These newer methods may be less complicated options for some patients and as they are further evaluated they will likely become more widely available.