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Vaginal Bleeding - When to Consult a Doctor?

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Vaginal bleeding is normal during menstruation and can be abnormal in many situations. Read below to know more about normal and abnormal vaginal bleeding.

Written by

Dr. Asha. C

Medically reviewed by

Dr. Vrinda Khemani

Published At September 9, 2022
Reviewed AtApril 26, 2023

What Is Vaginal Bleeding?

Vaginal bleeding normally happens with menstruation (a cycle that begins in females from puberty) and continues till menopause. Menstrual bleeding may vary in length, timing, or quantity. Abnormal or unexpected vaginal bleeding can also occur apart from the menstrual cycle. It can occur due to various abnormal conditions, including pregnancy complications, hormonal imbalances, infection, trauma, malignancy, and certain medications. However, the underlying causes of abnormal vaginal bleeding are treatable if promptly diagnosed and treated.

What Are the Causes of Vaginal Bleeding?

Menstrual bleeding is normal vaginal bleeding that occurs every 21 to 35 days during menstruation. Usually, the menstrual period may last for a few days or more than a week. Menstrual flow can differ from person to person and also varies in different stages of life, such as teenager and perimenopause. Abnormal vaginal bleeding can occur due to a different cause.

Some common causes of vaginal bleeding include:

  • Birth Control Medications and Devices - Using birth control methods such as birth control pills or intrauterine devices (IUD) can cause irregular bleeding.

  • Bleeding Disorders - These disorders can cause issues with normal blood clotting and can also result from an inherited condition such as von Willebrand disease, hemophilia, thrombocytopenia, vitamin K deficiency (which helps the body in making blood-clotting factors), or as a side effect of medications such as blood thinners.

  • Cancers of the Female Reproductive System - Cancer of the uterus, cervix, or fallopian tubes.

  • Ectopic Pregnancy - When the fertilized egg grows outside the uterus, typically in the fallopian tubes, serious bleeding can happen.

  • Endometrial Hyperplasia - Due to too much estrogen and a lack of progesterone, a hormonal imbalance will happen due to which the endometrium becomes thick. This is not a cancerous condition, but in some people, there is a chance of uterine cancer development.

  • Infection - Any infection in the urinary tract or pelvic cavity can cause bleeding.

  • Hypothyroidism - A decreased thyroid gland production can also interrupt normal menstrual cycles.

  • Hormonal replacement therapy.

  • Miscarriage.

  • Injury - Injury to the vagina, cervix, or uterus can occur due to sexual intercourse, during placement of an IUD contraceptive device, or any uterine surgery.

  • Placental Abruption - Detachment of the placenta from the uterus wall can happen during pregnancy which can cause severe bleeding.

  • Placenta Previa - If the placenta lies low in the uterus and covers the cervix partially or completely during pregnancy, bleeding can occur.

  • Uterine Fibroids - These are non-cancerous growths that develop from the muscle tissue of the uterus. These vary in size, growth rate, number, and location within the uterus.

  • Uterine Polyps - They are overgrowth tissues on the lining of the uterus. Uterine polyps are usually not cancerous, but some have the potential to develop into precancerous polyps.

  • Ovulation Problems - A failure or disruption of the ovaries can be due to an ovarian disorder or an issue in the brain signaling the glands that control ovulation.

When Is Vaginal Bleeding Considered Normal?

Normal vaginal bleeding, that is, menstrual bleeding, varies widely among individuals at different stages of their life. Typically, all women get a menstrual period approximately once a month (every 21 to 35 days), lasting between 3 to 7 days. Adolescence and women reaching menopause usually experience irregular period cycles. It is also common for 30 to 50-year-old women to have heavy periods. The use of contraception pills can also change the frequency and cause heavy bleeding. Sometimes facing stressful life events can skip a period entirely.

Bleeding between periods is also common, and every woman experiences it at some point during their life. However, frequent bleeding in one month or between periods of several months is not considered normal. Bleeding after having sex should always be taken into a note, and consult a doctor, regardless of the age. There are many reasons for bleeding between periods, and most cases are not serious. Light bleeding during the start of the pregnancy is also normal, but if the bleeding is heavy, it is necessary to consult a doctor.

What Are the Symptoms Seen Along With Vaginal Bleeding?

Many symptoms can occur with vaginal bleeding, depending on the underlying disease, disorder, or condition.

Symptoms that occur with abnormal vaginal bleeding include:

  • Fever.

  • Lower back pain.

  • Nausea and vomiting.

  • Pain during intercourse.

  • Pain during bowel movements.

  • Difficulty getting pregnant.

  • Menstrual period symptoms like abdominal cramps, mood swings, and irritability.

  • Abnormal vaginal discharge.

In some women, vaginal bleeding can be caused due to serious conditions, such as pelvic inflammatory disease, miscarriage, or uterine cancer.

Prompt medical care is required if any of the following symptoms occur with vaginal bleeding:

  • Severe pelvic or abdominal pain.

  • Dizziness or feeling faint.

  • High fever.

  • Periods that are longer or heavier than usual.

  • Unusual vaginal bleeding.

  • Vaginal bleeding during pregnancy.

  • Vaginal bleeding after menopause.

What Is Abnormal Vaginal Bleeding?

Abnormal vaginal bleeding is bleeding from the vagina either in inappropriate amounts or at the wrong time during the month. To determine whether bleeding is abnormal and its cause, The duration, interval, and amount of vaginal bleeding must be taken into account.

  • Menstruation - Abnormal menstrual bleeding can happen by either bleeding for too short of a period (hypomenorrhea) or too long of a period (hypermenorrhea). The interval of the menstrual period can also be abnormal such as a woman's menstrual periods can rarely occur (oligomenorrhea) or more frequently (polymenorrhea). The amount of bleeding can also be abnormal; some women may experience too little volume (hypomenorrhea) others may have too much bleeding (menorrhagia).

  • Pregnancy - Abnormal vaginal bleeding occurs during early pregnancy before the women realize she is pregnant. But when vaginal bleeding occurs during pregnancy, it can cause pregnancy complications.

  • Others - Bleeding after menopause, due to intake of medicines, or bleeding between periods are all considered abnormal.

When to Consult a Doctor for Vaginal Bleeding?

Vaginal bleeding between periods is common, but if it occurs more than once or twice, it is important to consult a doctor.

Prompt treatment should be taken if:

  • Periods are too heavy.

  • Older than 45 years and have vaginal bleeding between periods.

  • Bleeding after hormone therapy or new drugs.

  • Bleeding during pregnancy.

  • Bleeding after intercourse.

  • Feeling sick or dizzy due to a period.

  • Abnormal vaginal discharge along with period.

  • High fever and pain with a period.

  • Bleeding after menopause.

What Is the Treatment for Vaginal Bleeding?

The following are the treatment for vaginal bleeding:

Medications -

  • Hormonal Birth Control Methods - This may include patches, pills, or vaginal rings. They help reduce menstrual flow and regularize the periods.

  • Intrauterine Device (IUD) - Certain types of IUDs are used to minimize or stop bleeding.

  • Gonadotropin-Releasing Agonists - These medicines reduce gonadotropin release (a hormone that stimulates the ovaries) and stop the menstrual flow.

  • Tranexamic Acid - Stops excessive menstrual bleeding.

  • Non-steroidal Anti-inflammatory Drugs (NSAIDs) - Can control heavy bleeding.

Surgery -

  • Endometrial Ablation- During this procedure, the lining of the uterus is destroyed, which will reduce or stop bleeding.

  • Uterine Artery Embolization - This treatment blocks the blood vessels that supply the fibroids and restricts their growth.

  • Dilation and Curettage (D and C) - Suctioning and scraping away tissues from the uterus and controlling bleeding.

  • Myomectomy - Removal of fibroids from the uterus helps to stop bleeding caused by fibroids.

  • Hysterectomy - Removal of the uterus will completely stop bleeding.

Conclusion -

Vaginal bleeding is very common during their menstruation. The duration, frequency, and amount of bleeding vary from one person to the other, which is considered normal. But abnormal bleeding should be taken into account because it can be a symptom of underlying diseases or conditions. The gynecologist will provide the appropriate treatment depending on the underlying disease.

Dr. Vrinda Khemani
Dr. Vrinda Khemani

Obstetrics and Gynecology

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