Vaginal Bleeding

Vaginal bleeding is a normal part of menstruation. Vaginal bleeding that occurs between periods or in those who do not menstruate is considered abnormal and requires evaluation by a healthcare provider. 

Abnormal vaginal bleeding could signify a serious health condition linked to decreased physical and mental health. There are several possible causes of vaginal bleeding, including hormonal imbalances, pregnancy complications, and chronic health conditions. 

This article will provide an overview of the common causes of vaginal bleeding and how to treat them. 

Symptoms of Vaginal Bleeding

Symptoms of abnormal vaginal bleeding include:

• Bleeding that is heavier than usual
• Bleeding for more days than usual
• Spotting or bleeding between periods
• Bleeding while pregnant
• Bleeding after sex
• Bleeding before puberty
• Bleeding after menopause

Causes of Vaginal Bleeding

There are many causes of abnormal vaginal bleeding, including hormonal, reproductive, pregnancy, and more.

Hormonal

Birth control options like intrauterine devices (IUDs) and hormonal birth control pills may cause spotting and breakthrough bleeding. Breakthrough bleeding refers to vaginal bleeding that occurs between periods. Hormone therapy may also lead to vaginal bleeding.

Reproductive

A condition like polycystic ovary syndrome (PCOS) can lead to a lack of ovulation. When this occurs, you may experience heavy menstrual bleeding each month. 

Uterine fibroids and polyps are noncancerous growths that form in the uterus. They can both cause irregular or heavy menstrual bleeding.

Endometriosis occurs when endometrial tissue grows outside the uterus, often leading to heavy menstrual bleeding. Vaginal bleeding may also be a sign that an ovarian cyst has burst. Endometriosis hyperplasia, an abnormality of the lining of your uterus caused by a hormonal imbalance, may lead to abnormal uterine bleeding.

Pregnancy

Vaginal bleeding during pregnancy requires immediate evaluation. Light spotting in the first trimester is usually considered normal. Any bleeding in the second or third trimester could signify a serious complication.

Other reproductive issues that may lead to vaginal bleeding include ectopic pregnancy (when a fertilized egg implants outside the uterus) and miscarriage (losing a pregnancy before 20 weeks of gestation).

Health Conditions

Bleeding disorders may cause vaginal bleeding. When your blood does not clot properly, you may experience heavy menstrual bleeding. Hypothyroidism can lead to a lack of ovulation, causing heavy bleeding during your period. Additional health conditions that may lead to vaginal bleeding include diabetes and infection.

Cancers

Vaginal bleeding is one of the earliest signs of uterine cancer. Abnormal bleeding can also occur with cervical cancer and ovarian cancer.

If you have experienced new-onset vaginal bleeding, especially after menopause, it’s important to see your healthcare provider immediately.

What Medications Can Cause Vaginal Bleeding?

Medications that may cause vaginal bleeding include:

• Oral contraceptives: Birth control pills may cause spotting or breakthrough bleeding.
• Steroids: Long-term use of steroids may cause heavy or irregular periods.
• Anticoagulant drugs: Blood-thinning medications may cause heavy period bleeding.

How to Treat Vaginal Bleeding

To treat vaginal bleeding, it’s important to focus on the underlying cause of the bleeding. Treatment options may include:

• Hormonal birth control: Birth control pills, patches, or vaginal rings may make periods lighter and more regular.
• Intrauterine device (IUD): This may be recommended to reduce or stop bleeding.
• Gonadotropin-releasing agonists: Shrink uterine fibroids and stop menstrual bleeding.
• Tranexamic acid: Used to treat heavy menstrual bleeding.
• Hormone therapy: It may help to relieve heavy menstrual bleeding during perimenopause.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs like Advil (ibuprofen) or Aleve (naproxen) may reduce menstrual bleeding and cramping.

If treatment is unsuccessful, surgical options may be considered:

• Endometrial ablation: A procedure that destroys the uterus lining to stop bleeding. It also lowers one’s ability to get pregnant.
• Dilation and curettage (D&C): A healthcare provider scrapes or suctions tissue from the uterus.
• Uterine artery embolization: Treats uterine fibroids by blocking the blood vessels in the uterus.
• Myomectomy: A surgical procedure to remove uterine fibroids.
• Hysterectomy: A surgical procedure to remove the uterus.

Are There Tests to Diagnose the Cause of Vaginal Bleeding?

To determine what might be causing your vaginal bleeding, your healthcare provider may recommend or perform one of these tests:

• Pregnancy test: A pregnancy blood test is recommended for all individuals capable of pregnancy who are experiencing bleeding.
• Pap smear: A pap smear and HPV screening test for infection.
• Blood tests: To check your thyroid function, iron, and glucose levels.
• Ultrasound: Can detect polycystic ovaries.
• Hysteroscopy: A thin device with a camera is placed through the vagina and cervix to visualize the uterus.
• Endometrial biopsy: Taking a tissue sample from the lining of the uterus (endometrium) and examining it under a microscope.

When to See a Healthcare Provider

See your healthcare provider if you could be pregnant or if you develop any of the following symptoms:

• Change in your menstrual cycle or the amount of period bleeding
• Bleeding between periods
• Bleeding after sex
• Bleeding during pregnancy
• Bleeding before puberty or after menopause 
• Period bleeding that lasts longer than seven days
• Soaking a tampon or pad every two to three hours
• Passing clots larger than 3 centimeters
• Painful periods 

Summary

Vaginal bleeding is a normal part of menstruation. When vaginal bleeding occurs between periods or in those who do not menstruate, it’s important to tell your healthcare provider. Possible causes of vaginal bleeding include hormonal changes, pregnancy complications, chronic health conditions, and certain cancers. Treatment may consist of hormonal birth control methods, medications, or surgery. 

A Word From Verywell 

Because there are several possible causes of vaginal bleeding, ranging from benign to very serious, it can be challenging to determine the cause on your own. Talk with your healthcare provider immediately if you have been experiencing vaginal bleeding or a change in your menstrual cycle. Many causes of vaginal bleeding can be treated successfully.