July 10, 2009

Vaginal Bleeding

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. Your menstrual period may last for just a few days or several days and be heavy or light, but still be considered normal.

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 heavy periods in which you soak a pad an hour for several hours. Bleeding that lasts for weeks at a time is also considered abnormal.

Abnormal vaginal bleeding can signal gynecologic conditions and other medical problems. If you have gone through the menopausal transition — 12 consecutive months without a menstrual period — vaginal bleeding is a particular cause for concern.


Possible causes of abnormal vaginal bleeding:

Cervical cancer
Ectopic pregnancy
Endometrial cancer
Endometrial hyperplasia
Fluctuating hormone levels
Hypothyroidism (underactive thyroid)
Menorrhagia (heavy menstrual bleeding)
Ovarian cancer
Ovarian cysts
Pelvic inflammatory disease (PID)
Polycystic ovary syndrome
Sexual intercourse
Stopping birth control pills or hormone replacement therapy (withdrawal bleeding)
Tamoxifen side effect
Uterine fibroids
Uterine polyps
Uterine sarcoma
Vaginal cancer
Vaginal or cervical trauma
Von Willebrand disease

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 might be normal depends on your age and the circumstances:

Newborn girls may experience some vaginal bleeding during the first few days of life — any vaginal bleeding beyond that should be checked out.

In girls who haven't gone through puberty and their first menses, any vaginal bleeding should be investigated.

Adolescents who have just begun having periods may have irregular cycles during the first few years. Many women have light spotting for a few days before menstruating.

Women starting birth control pills may experience occasional spotting the first few months.

Perimenopausal women nearing menopause may experience increasingly heavy or irregular periods. Ask your doctor about possible treatments to minimize your symptoms.

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 — taking 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.

Postmenopausal women not on hormone therapy should see a doctor if they experience vaginal bleeding.

Adapted from: Mayo Foundation for Medical Education and Research