Definition of vaginal bleeding
Abnormal vaginal bleeding is any vaginal bleeding unrelated to normal menstruation. This type of bleeding may include spotting of small amounts of blood between periods — often seen on toilet tissue after wiping — or extremely heavy periods in which you soak a pad or tampon every one to two hours for two or more hours.
Normal vaginal bleeding, or menstruation, occurs every 21 to 35 days when the uterus sheds its lining, marking the start of a new reproductive cycle. A menstrual period may last for just a few days or more than a week. Your flow may be heavy or light and still considered normal. Cycles tend to be longer before age 20 and after age 40, and your flow may be heavier at those ages.
Causes of vaginal bleeding
Abnormal vaginal bleeding can relate to an issue with your reproductive system (a gynecologic condition) or to other medical problems or certain medications. If you’ve gone through the menopausal transition — 12 consecutive months without a menstrual period — any vaginal bleeding is a particular cause for concern.
Possible causes of abnormal vaginal bleeding include:
- Celiac disease
- Placenta previa
- Problems with the cervix, such as a cervical infection, inflamed cervix or growths on the cervix
- Endometrial cancer
- Endometrial hyperplasia
- Endrometrial polyps
- Fluctuating hormone levels
- Hypothyroidism (a thyroid disorder)
- Hyperthyroidism (overactive thyroid)
- Intrauterine contraceptive device
- Miscarriage (before the 20th week) or intrauterine fetal death
- Ovarian cancer
- Ovarian cysts
- Pelvic inflammatory disease (PID)
- Polycystic ovary syndrome
- Random ovulatory cycles
- Severe systemic disease, such as kidney or liver disease
- Sexual abuse
- Sexual intercourse
- Stopping birth control pills or hormone replacement therapy (withdrawal bleeding)
- Tamoxifen side effect
- Uterine fibroids
- Uterine polyps
- Uterine sarcoma
- Vaginal atrophy
- Vaginal cancer
- Vaginal or cervical trauma
- Von Willebrand disease (and other blood clotting disorders)
When to see a doctor
If you’re pregnant, contact your doctor immediately if you notice vaginal bleeding.
In general, anytime you experience unexpected vaginal bleeding, consult your doctor. Whether or not vaginal bleeding is normal depends on your age and the circumstances.
You should contact your doctor in the following situations:
- Postmenopausal women not taking hormone therapy should see a doctor if they experience vaginal bleeding.
- Postmenopausal women taking cyclic hormone therapy may experience some vaginal bleeding. A cyclic hormone therapy regimen — oral estrogen daily plus oral progestin for 10 to 12 days a month — can lead to bleeding that resembles a period (withdrawal bleeding) for a few days out of the month. If you have bleeding other than expected withdrawal bleeding, contact your doctor.
- Postmenopausal women taking continuous hormone therapy — a low-dose combination of estrogen and progestin daily — may experience light, irregular bleeding for the first six months. If bleeding persists longer or heavy bleeding begins, see your doctor.
- Girls who don’t have any other signs of puberty or are younger than age 8 should have any vaginal bleeding investigated.
The following situations are likely normal, but talk to your doctor if you are concerned:
- Newborn girls may have some vaginal bleeding during the first month of life. Bleeding that’s excessive or lasts longer should be checked out.
- Teenagers who have just begun having periods may experience irregular cycles during the first few years. In addition, many girls and women have light spotting for a few days before menstruating.
- Women starting birth control pills may experience occasional spotting the first few months.
- Women nearing menopause (perimenopause) may experience increasingly heavy or irregular periods. Ask your doctor about possible treatments to minimize your symptoms.