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 10, when you are pregnant, or after menopause.

Causes of abnormal bleeding

Abnormal vaginal bleeding has many possible causes. By itself, it does not necessarily indicate a serious condition.

• Because bleeding can indicate 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 indicate a serious problem, including an ectopic pregnancy or miscarriage.
  • Heavy vaginal bleeding or bleeding that occurs after 12 weeks also may indicate a serious problem, such as placenta previa.
• Ovulation can cause midcycle bleeding.
• Polycystic ovary syndrome (PCOS) is a hormone imbalance that interferes with normal ovulation which 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. For more information on the IUD, see the topic Birth Control.
• Infection of the pelvic organs (vagina, cervix, uterus, fallopian tubes, or ovaries) may cause vaginal bleeding, especially after intercourse or douching. Sexually transmitted diseases (STDs) are often the cause of infections. For more information, see the topic Exposure to Sexually Transmitted Diseases.
• 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.
• 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.
• Breast-feeding.
• Extreme emotional stress and excessive exercise. But excessive exercise more frequently causes an absence of menstruation (amenorrhea).
• Other diseases, such as hyperthyroidism or diabetes.

Heavy bleeding during the first few weeks after delivery (postpartum) or after an abortion may occur because the uterus has not contracted to the prepregnancy size or because fetal tissue remains in the uterus (retained products of conception).

If you are age 40 or older, abnormal vaginal bleeding may mean that you are entering perimenopause. In a woman who has not had a menstrual period for 12 months, vaginal bleeding is always abnormal and should be discussed with your doctor.

Treatment of abnormal vaginal bleeding depends on the cause of the bleeding.

Review the Emergencies and Check Your Symptoms section of this topic to determine if and when you should see your health professional.

• Signs of shock
• Unexpected vaginal bleeding with lower abdominal pain and fainting

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Abdominal pain: Go to the topic Abdominal Pain, Age 11 and Younger or Abdominal Pain, Age 12 and Older.
• Menstrual cramps: Go to the topic Menstrual Cramps.
• Two or more missed periods: Go to the topic Missed or Irregular Periods.
• Bleeding from a cut or scrape that you can see: Go to the topic Cuts or Scrapes.
• Sexual abuse or rape: Go to the topic Sexual Abuse or Rape.
• Vaginal problems: Go to the topic Vaginal Problems.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

There is no home treatment for abnormal vaginal bleeding. With some types of vaginal bleeding, it may be okay to wait to see if the bleeding stops on its own. Be sure to review the Check Your Symptoms section to determine if and when you need to see a doctor. If the bleeding continues or gets worse, a visit to a doctor is needed to determine the reason for the bleeding.

If you are using tampons for abnormal vaginal bleeding, be sure to change them often and do not leave one in place when the bleeding has stopped. A tampon left in the vagina may put you at risk for toxic shock syndrome (TSS). TSS is a rare but life-threatening illness that develops suddenly after a bacterial infection rapidly affects several different organ systems.

If you are age 45 or older, you may be experiencing perimenopause. For more information, see the topic Menopause and Perimenopause.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Abnormal bleeding returns.
• Bleeding increases or becomes severe enough to cause weakness or lightheadedness.
• Fever or pain in the lower abdomen develops.
• Symptoms do not improve within 2 months.
• Symptoms become more severe or frequent.

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 Healthy Weight.
• If you are using birth control pills, be sure to take them as directed and at the same time every day. For more information, see the topic Birth Control.
• If you are taking hormone replacement 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. For more information, see the topic Stress Management.
• 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.

To prepare for your appointment, see the topic Making the Most of 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?
  • When was your previous period? Was it 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? 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? Keep track of your menstrual flow on a calendar, and take your calendar to show your doctor.
• Are you sexually active?
• Do you engage in high-risk sexual behaviors?
• Are you currently using any type of hormonal 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?

• Abdominal Pain, Age 11 and Younger
• Abdominal Pain, Age 12 and Older
• Birth Control
• Cervical Polyps
• Dysfunctional Uterine Bleeding
• Endometriosis
• Exposure to Sexually Transmitted Diseases
• Functional Ovarian Cysts
• Menopause and Perimenopause
• Menstrual Cramps
• Miscarriage
• Missed or Irregular Periods
• Polycystic Ovary Syndrome (PCOS)
• Premenstrual Syndrome (PMS)
• Shock
• Stress Management
• Uterine Fibroids
• Vaginal Problems

When to See a Doctor

See significance of pregnancy if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to any of the following questions.
Yes	Do you have moderate to severe vaginal bleeding, but you do not have signs of shock?
Yes	Do you have vaginal bleeding with other symptoms?

	Call your health professional today if you answer "Yes" to the following question.
Yes	Do you have minimal bleeding or spotting without other symptoms?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of severe bleeding if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Do you have severe vaginal bleeding, but you do not have signs of shock?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Have you had severe vaginal bleeding that has stopped?
Yes	Have you had severe vaginal bleeding that has been evaluated by your doctor, but it is not following the expected course?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of vaginal bleeding that may be caused by sexual abuse if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Do you think vaginal bleeding may be caused by sexual abuse?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of lower abdominal pain if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to any of the following questions.
Yes	Do you have severe lower abdominal pain?
Yes	Do you feel like you may pass out?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Do you have a fever with lower abdominal pain?
Yes	Do you have mild to moderate lower abdominal pain?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of fever if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Note:

If you need information on how to take a temperature, see the topic Body Temperature.

	Call your health professional immediately if you answer "Yes" to any of the following questions.
Yes	Has a rash that looks like a sunburn appeared within 2 days of the start of a fever of 102°F (39°C) or higher?
Yes	Do you have a rash that looks like a sunburn and think that you have a moderate fever but are unable to measure your temperature?

	Call your health professional today if you answer "Yes" to any of the following questions.
Yes	Do you have a fever?
Yes	Do you think you have a fever, but you are unable to measure your temperature?
Yes	Do you have a fever with lower abdominal pain?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of bleeding after intercourse or douching if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Do you have severe vaginal bleeding, but you do not have signs of shock?

	Call your health professional today if you answer "Yes" to the following question.
Yes	Do you have moderate vaginal bleeding, but you do not have signs of shock?

	You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Yes	Have you had minimal vaginal bleeding for 48 hours after intercourse or douching, and you are sure that the bleeding is not caused by your menstrual period?

	You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question.
Yes	Have you had minimal vaginal bleeding or spotting more than one time after intercourse or douching, and you are sure that the bleeding is not caused by your menstrual period?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of hormonal birth control methods if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Do you have severe vaginal bleeding, but you do not have signs of shock?

	Call your health professional today if you answer "Yes" to any of the following questions. Note: If you answer "Yes" to the following questions, your doctor may be able to give you advice over the phone. An appointment may not be needed.
Yes	Do you have moderate vaginal bleeding, but you do not have signs of shock?
Yes	Have you had mild to moderate vaginal bleeding that comes and goes but has not stopped for longer than 7 days?
Yes	Have you had abnormal mild vaginal bleeding for longer than 2 weeks?
Yes	Is your vaginal bleeding different than what you were told to expect?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of bleeding after a hysterectomy, during perimenopause, or after menopause if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

Note:

Some light bleeding or spotting is expected for up to 6 weeks following a hysterectomy. If your vaginal bleeding is heavier or different than what you were told to expect, call your doctor to discuss the problem.

	Call your health professional immediately if you answer "Yes" to the following question.
Yes	Do you have severe vaginal bleeding, but you do not have signs of shock?

	Call your health professional today if you answer "Yes" to the following question.
Yes	Do you have moderate vaginal bleeding, but you do not have signs of shock?

	You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.
Yes	Have you had moderate vaginal bleeding that has stopped?
Yes	Have you not had a period for 3 months, but you now have spotting or mild vaginal bleeding?
Yes	Have your last three or more periods been heavier or lasted longer than what is normal for you?
Yes	Have you had irregular bleeding for more than 3 cycles?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of bleeding before age 10 if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	Call your health professional immediately if you answer "Yes" to any of the following questions.
Yes	Does your child have severe vaginal bleeding, but she does not have signs of shock?
Yes	Do you think your child's vaginal bleeding may be caused by abuse?

	Call your health professional today if you answer "Yes" to the following question.
Yes	Does your child have minimal to moderate vaginal bleeding or spotting?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of medicine causing vaginal bleeding if you need information to help you answer the question below.

Review health risks that may increase the seriousness of your symptoms.

Call your health professional today if you answer "Yes" to the following question.

Yes

Do you think that your vaginal bleeding is caused by a medicine you are taking? Note: If your answer is Yes: Call the doctor who prescribed the medicine to determine whether this is an expected side effect of this medicine. An appointment may not be needed. If you are taking a medicine not prescribed by a doctor, stop taking it. Call your doctor if you feel you need to keep taking the medicine or if you need help to control your symptoms after you stop the medicine.

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of hormone replacement therapy if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.
Yes	Have you had mild to moderate vaginal bleeding for 1 week or longer?
Yes	Have you had mild to moderate vaginal bleeding for two cycles or longer?
Yes	Has vaginal bleeding occurred other than at the expected time of withdrawal bleeding?
Yes	Are you using continuous hormone replacement therapy, and you have vaginal bleeding that has occurred more than one time a month?
Yes	Are you using continuous hormone replacement therapy, and you have intermittent vaginal bleeding that has continued for longer than 6 months after starting therapy?
Yes	Do you have vaginal bleeding that is different than what your doctor told you to expect?
Yes	Have you had any vaginal bleeding while using estrogen replacement therapy without progestin?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.

When to See a Doctor

See significance of minimal to moderate bleeding if you need information to help you answer the questions below.

Review health risks that may increase the seriousness of your symptoms.

	You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question.
Yes	Have you had moderate bleeding for more than 1 week longer than your period usually lasts?

	You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions.
Yes	Have you had minimal bleeding or spotting for more than 2 weeks longer than your period usually lasts?
Yes	Has abnormal vaginal bleeding occurred three or more times, and it has not been evaluated by a doctor?
Yes	Do you have abnormal vaginal bleeding that has been evaluated by a doctor, but it is not following the expected course?

If you have answered "No" to the above questions, go back to Check Your Symptoms and continue to answer the questions to evaluate your symptoms.