What Is Abnormal Vaginal Bleeding?

Abnormal vaginal bleeding may be associated with several types of health conditions, including gynecological cancers (cancer of the female reproductive system). Because abnormal vaginal bleeding is not specifically associated with a single disease or condition, medical tests and evaluations are vital for an accurate diagnosis.

In relation to cervical cancer, abnormal vaginal bleeding is a commonly experienced cervical cancer symptom. That being said, most women with cervical cancer do not experience symptoms until the later stages of the disease.

Since cervical cancer usually does not present early stage symptoms, it is vital for women to have a regular Pap smear to detect abnormal changes.

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What Is Abnormal Vaginal Bleeding?

Vaginal bleeding is considered abnormal when a person has heavy menstrual bleeding (either in volume or duration), bleeding between periods, spotting, vaginal bleeding after sex, or bleeding after menopause (when a woman's periods have ceased for 12 months). 

Heavy Menstrual Bleeding

If heavy menstrual bleeding occurs at regular intervals (like every menstrual cycle, which can range from every 24 to 35 days), it's termed ovulatory abnormal uterine bleeding, or menorrhagia. 

How do you know if you are experiencing heavy menstrual bleeding? Women who have heavy bleeding may have to wake up during the night to change sanitary protection or need to use two sanitary napkins to avoid leakage. 

Menstrual flow also may include large blood clots (greater than 1 inch) and/or bleeding may longer than seven days. If you experience a sudden onset of heavy bleeding that requires you to change a sanitary napkin or tampon every one to two hours for a few consecutive hours, alert your doctor immediately. Keep track of the number of pads or tampons you use in a certain amount of time so you can report that to your doctor.

Causes of heavy menstrual bleeding include a bleeding disorder (like von Willebrand's disease), an underactive thyroid, uterine polyps, or fibroids. 

Bleeding Between Menstrual Periods

Heavy spotting (also called intermenstrual bleeding) should be evaluated by a doctor. This can happen for many reasons—from something as simple as contraceptive use to cervical cancer and other types of gynecologic cancer. It can be a sign of cervicitis or injuries to your vaginal opening including infection or varicose veins.

You may see bleeding between menstrual periods in cases of changes in your hormone levels due to stopping or starting contraceptives or estrogens, stress, or an underactive thyroid. If you use an anticoagulant (often called a blood thinner), you may also have spotting. It may also be a sign of ectopic pregnancy or miscarriage.

Vaginal Bleeding During or After Sex

Women may experience vaginal bleeding during and after sexual intercourse for several reasons. Some women chalk it up to having "rough sex," but there are several medical reasons related to the cervix that explain why bleeding may occur. They include:

Other possible reasons for vaginal bleeding after intercourse include sexually transmitted diseases and pelvic inflammatory disease. Trauma including sexual abuse and foreign bodies in the vagina may be other causes of bleeding during or after sex.

Remember that vaginal bleeding after intercourse is not normal and should be reported to your doctor.

A Word From Verywell

If you are experiencing abnormal vaginal bleeding, please see your doctor for a proper evaluation and treatment. While most causes are benign, you want to be sure, and if you do have something serious going on, that it is addressed right away. 

Another tidbit is that if you are not sure if your bleeding is vaginal or urinary, you can insert a tampon to verify that the bleeding is coming from either the vagina, cervix, or uterus. 

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  1. American College of Obstetricians and Gynecologists. Cervical cancer. Updated December, 2018.

  2. American College of Obstetricians and Gynecologists. Abnormal uterine bleeding. Updated March, 2017.

  3. Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal womenAm Fam Physician 2012;85(1):35-43.

  4. Jeanmonod R, Skelly CL, Agresti D. Vaginal bleeding. In: StatPearls. Updated May 23, 2019.

  5. Whitaker L, Critchley HO. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016;34:54-65. doi:10.1016/j.bpobgyn.2015.11.012

  6. Tarney CM, Han J. Postcoital bleeding: A review on etiology, diagnosis, and management. Obstet Gynecol Int. 2014;2014:192087.

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