Abnormal Bleeding



What is normal vaginal bleeding?

Normal vaginal bleeding is the periodic blood that flows as a discharge from the woman's uterus. Normal vaginal bleeding is also called menorrhea. The process by which menorrhea occurs is called menstruation.


Unless pregnancy occurs, the cycle ends with the shedding of part of the inner lining of uterus, which results in menstruation. Although it is actually the end of the physical cycle, the first day of menstrual bleeding is designated as "day 1" of the menstrual cycle in medical jargon.

The time of the cycle during which menstruation occurs is referred to as menses. The menses occurs at approximately four week intervals, representing the menstrual cycle. Menarche is the time in a girl's life when menstruation first begins. Menopause is the time in a woman's life when the function of the ovaries ceases. The average age of menopause is 51 years old.

What is abnormal vaginal bleeding?

Bleeding in any of the following situations is abnormal:
  • Bleeding after periods
  • Bleeding after sex
  • Spotting anytime in the menstrual cycle
  • Bleeding heavier or for more days than normal
  • Bleeding after menopause

Menstrual cycles that are longer than 35 days or shorter than 21 days are abnormal. The lack of periods for 3-6 months (amenorrhea) also is abnormal.

At what age is abnormal uterine bleeding more common?

Abnormal uterine bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. They may not occur on schedule in the first few years after a girl has her first period (around age 9-16 years). Cycle length may changes as a woman nears menopause (around age 50 years). It also is normal to skip periods or for bleeding to get lighter or heavier at this time.

Excessively heavy menstrual bleeding (menorrhagia)

Heavy or prolonged menstrual periods, or menorrhagia, are the most common type of abnormal uterine bleeding from the uterus. Periods are considered heavy if there is enough blood to soak a pad or tampon every hour for several consecutive hours.

Other symptoms of a heavy period can include:
  • Nighttime bleeding that requires getting up to change pads or tampons
  • Heavier than usual flow
  • Passing large blood clots during menstruation
  • A period that lasts longer than 7 days

Causes of menorrhagia

There are many possible causes of heavy menstrual bleeding. They include:
  • Hormonal imbalances, particularly in estrogen and progesterone
  • Miscarriage or ectopic pregnancy
  • Do you feel any pain when having sex? Is there any bleeding after sex?
  • Use of blood thinners
  • Problems with a non-hormonal intrauterine device (IUD) used for birth control
  • Pelvic inflammatory disease (PID) – an infection of the uterus, fallopian tubes, or other organs of the reproductive system
  • Uterine, ovarian, and cervical cancer; these are rare but possible causes
  • Other medical conditions that can prevent normal blood clotting

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

Treatment depends 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.
  • An enlarged uterus, which could indicate a pregnancy or fibroids
  • 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 urgent 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 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. A hysteroscopy may be needed to look into the uterus or a procedure called an endometrial ablation or a Novasure Ablation (attach link here) may need to be done. Please ask your provider what treatment plan works best for you.