Vaginal Haemorrhage

Vaginal bleeding outside of your normal period can range from light spotting to heavy blood loss that disrupts your daily life. While some instances are harmless, others may signal underlying health problems that need medical attention.

Table of contents

• What is Vaginal Haemorrhage?
• What Causes Vaginal Bleeding?
• Signs and Symptoms
• How is the Cause Diagnosed?
• Treatment Options
• When to Contact Your Doctor

What is Vaginal Haemorrhage?

Vaginal bleeding is any bleeding from your vaginal area. It can refer to bleeding related to menstruation (your monthly period) or bleeding unrelated to menstruation, such as from injury or a medical condition. In most cases, when doctors talk about vaginal bleeding, they mean bleeding that is not related to your normal period^[1].

Bleeding between periods or bleeding outside of a normal menstrual cycle is considered abnormal vaginal bleeding. This type of bleeding can be unpredictable and may be accompanied by pain or other symptoms^[1]. The bleeding can originate anywhere in the female reproductive system, including the vulva (outer genital area), vagina, cervix (lower part of the uterus), uterus (womb), fallopian tubes, or ovaries^[2].

Abnormal vaginal bleeding is a common problem affecting more than 10 million women in the United States each year, meaning about one in five women experiences it^[4]. It can occur at any age, from young girls first starting their periods to women in their 40s approaching menopause^[1].

What Causes Vaginal Bleeding?

There are many causes of vaginal bleeding other than menstruation. You should always work with a healthcare provider to determine the cause of your bleeding. The more common causes include medical conditions, hormonal changes, and pregnancy complications^[1].

Medical Conditions

Several medical conditions can cause vaginal bleeding. Cancers of the female reproductive system, including cancers of your cervix, endometrium (lining of your uterus), ovaries, or fallopian tubes, can result in bleeding^[1].

Bleeding disorders affect your body’s ability to form blood clots. These can result from inherited conditions such as hemophilia or von Willebrand Disease, a low red blood cell count, a deficiency of Vitamin K, or as a side effect of medications such as blood thinners^[1].

Uterine fibroids are non-cancerous growths that develop from the muscle tissue of your uterus. Their size, number, growth rate, and location within your uterus can vary greatly^[1]. Similarly, uterine polyps are an overgrowth of cells on the lining of your uterus. While polyps are usually not cancerous, some can develop into precancerous polyps^[1].

Adenomyosis is a condition where the lining of your uterus grows through the uterine wall^[1]. Endometrial hyperplasia occurs when the endometrium becomes too thick, usually due to a hormonal imbalance of estrogen and progesterone. This condition is not cancerous, but in some cases can lead to cancer of your uterus^[1].

Other medical causes include hypothyroidism (an underactive thyroid gland), severe cervicitis (inflammation or infection of your cervix), and infections of the reproductive organs^[1][3].

Hormonal Causes

Anovulation is a disruption or failure of your ovaries to release an egg. This can be due to a disorder of your ovaries themselves or from a problem in how the brain signals the glands that control ovulation^[1]. Ovulatory dysfunction is the most common cause of abnormal uterine bleeding in women of reproductive age^[5].

Polycystic ovary syndrome is a type of hormonal imbalance that causes irregular periods, weight gain, acne, and excess hair growth^[1]. Hormonal birth control pills can also cause breakthrough bleeding while taking oral contraceptives, though this problem tends to resolve on its own^[1].

Pregnancy Complications

During pregnancy, vaginal bleeding may occur for different reasons. An ectopic pregnancy is when a fertilized egg grows outside your uterus, usually in your fallopian tubes. This is dangerous because the fertilized egg cannot develop properly outside the womb^[1][7].

Placental abruption is the detachment of the placenta from the wall of your uterus. Placenta previa occurs when the placenta lies low in the uterus, near to or covering the cervix^[1][7]. Bleeding can also be a sign of miscarriage, which is when a pregnancy ends before the 24th week^[7].

Other Causes

Other causes of vaginal bleeding include physical trauma to the vaginal area, certain medications such as blood thinners, infections such as sexually transmitted diseases, and changes in exercise routine, diet, or stress levels^[1][4].

Signs and Symptoms

Symptoms of abnormal vaginal bleeding can vary. You may notice bleeding or spotting between periods, bleeding after sex, or bleeding more heavily than usual^[4].

Heavy bleeding might mean passing large blood clots, needing to change your pad or tampon every hour for several hours in a row, or soaking through a sanitary pad or tampon every hour for two to three hours^[4][15]. You may also need to change pads or tampons during the night or double up on pads to control your menstrual flow^[1].

Bleeding that lasts for more days than normal or for more than seven days is considered abnormal. You may also experience menstrual periods that are less than 28 days apart (more common) or more than 35 days apart^[4].

Heavy bleeding can lead to anemia, which is a condition where you have a low red blood cell count. Signs of anemia include feeling tired, lacking energy, or being short of breath^[4][25]. Other symptoms that may accompany vaginal bleeding include pelvic pain, lower back pain, pain during sex, unusual vaginal discharge, and feeling dizzy or lightheaded^[6].

How is the Cause Diagnosed?

To determine the cause of abnormal bleeding, your healthcare provider will ask about your medical history and menstrual cycles. You may be asked to keep a diary to track days with and without bleeding, including information about how heavy your flow was and how many sanitary products you needed^[12].

Your provider will perform a physical exam, including a pelvic exam, to check the cervix and vagina as well as all potential sources of bleeding^[2]. This examination helps determine whether the bleeding is coming from the uterus, cervix, or vagina^[20].

Tests and Procedures

Several tests may be recommended to help diagnose the cause of your bleeding:

• Blood tests to check for anemia, thyroid disorders, bleeding disorders, or hormone levels^[4][8]
• Pregnancy test to rule out pregnancy-related causes^[4]
• Pap test to check for cervical cancer or precancerous changes. Cells from your cervix are collected and tested^[12]
• Tests for sexually transmitted infections^[8]
• Ultrasound of the pelvis to evaluate the uterus, cervix, ovaries, and fallopian tubes. This may include a transvaginal ultrasound, where a small device is inserted into the vagina to produce pictures of the uterine lining and walls^[8]
• Endometrial biopsy to remove and examine a small sample of tissue from the lining of the uterus under a microscope^[8][12]
• Hysteroscopy, which involves inserting a narrow lighted tube with a viewing device into the uterus to look for fibroids, polyps, or other abnormalities^[8]

Sometimes bleeding that appears to be vaginal may actually come from the bladder or bowels. To confirm the source, you can insert a tampon into the vagina and check for bleeding^[4][22].

Treatment Options

Treatment for abnormal vaginal bleeding depends on the underlying cause. Medical management should be the initial treatment for most patients when clinically appropriate^[11].

Medication

Several medications can be used to treat abnormal vaginal bleeding. Tranexamic acid helps your blood to clot, which reduces bleeding. It comes as a tablet that you take during your period and can reduce bleeding by about 40 percent^[17].

Non-steroidal anti-inflammatory drugs (NSAIDs) reduce the amount of prostaglandin in the lining of your uterus, which contributes to heavy bleeding and pain. These come as tablets you take during your period and can reduce bleeding by about 30 percent. They may also relieve period pain but can cause stomach upsets, nausea, and diarrhea^[17].

Hormonal treatments are commonly used. A hormone-releasing intrauterine device (IUD) is a small device that sits inside your uterus and releases a small amount of progestogen. This reduces the thickness of the lining of your uterus, decreasing bleeding by about 95 percent after at least three months of use^[17].

Birth control pills release substances that act like natural hormones and stabilize the lining of the uterus so it does not get as thick. The contraceptive pill can reduce bleeding by about 40 percent, may reduce period pain, helps keep periods regular, and can be used to skip your period entirely^[1][17].

Surgical Treatment

Surgical management should be considered for patients who are not clinically stable, are not suitable for medical management, or have failed to respond appropriately to medical treatment^[11].

Surgical options include uterine fibroid embolization, a minimally invasive procedure where tiny particles are injected through a catheter to block blood flow to fibroids, causing them to shrink^[8]. Endometrial ablation uses heat, freezing, microwave energy, or electrical currents to destroy the lining of the uterus^[8].

Myomectomy is the surgical removal of fibroids. Dilation and curettage (D&C) is a procedure in which endometrial tissue is gently scraped or suctioned from the uterus^[8]. In some cases, a hysterectomy, which is surgical removal of the uterus, may be recommended^[8].

Self-Care at Home

If you experience vaginal bleeding, take pain medicines exactly as directed. If you are not taking prescription pain medicine, ask your doctor if you can take an over-the-counter medicine. Do not take aspirin, which may make bleeding worse^[19].

Eat foods that are high in iron and vitamin C. Foods high in iron include red meat, shellfish, eggs, beans, and leafy green vegetables. Foods high in vitamin C include citrus fruits, tomatoes, and broccoli. Your doctor may recommend iron pills or a multivitamin^[19].

When to Contact Your Doctor

You should contact your healthcare provider if you experience bleeding between periods, after sex, or after menopause. Heavy bleeding that interferes with your daily activities or quality of life should be evaluated^[1].

Call emergency services immediately if you passed out, have severe vaginal bleeding, or are dizzy or lightheaded^[19]. Seek immediate medical care if your bleeding gets worse, you have new or worse belly or pelvic pain, or you think you might be pregnant^[19].

During pregnancy, call your midwife or doctor immediately if you have any bleeding from your vagina. This is especially important if you also have tummy pain, pain in the tip of your shoulder, discomfort when urinating, or dizziness^[7].

If you have heavy menstrual bleeding that requires changing your pad or tampon every hour for several hours, if you need to change pads during the night, or if you bleed for more than seven days, you should be evaluated by a healthcare provider^[25].

Keep a record of your symptoms to bring to your provider. Your record should include when menstruation begins and ends, how much flow you have, bleeding between periods and after sex, and any other symptoms you experience^[4][22].