Vaginal bleeding

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Definition

Abnormal vaginal bleeding is any vaginal bleeding unrelated to normal menstruation. This type of bleeding may include spotting of small amounts of blood between periods — often seen on toilet tissue after wiping — or extremely heavy periods in which you soak a pad or tampon every one to two hours for two or more hours.

Normal vaginal bleeding, or menstruation, occurs every 21 to 35 days when the uterus sheds its lining, marking the start of a new reproductive cycle. A menstrual period may last for just a few days or up to a week. Your flow may be heavy or light and still considered normal. Menstrual cycles tend to be longer for teens and for women nearing menopause, and menstrual flow may also be heavier at those ages.

Causes

Abnormal vaginal bleeding can relate to an issue with your reproductive system (a gynecologic condition) or to other medical problems or certain medications. If you have reached menopause — defined as 12 consecutive months, give or take, without a menstrual period — subsequent vaginal bleeding may be a cause for concern and should be evaluated.

Possible causes of abnormal vaginal bleeding include:

  • Cervical cancer
  • Endometrial cancer (uterine cancer)
  • Endometrial hyperplasia
  • Ovarian cancer
  • Uterine sarcoma
  • Vaginal cancer

Endocrine system factors

  • Hyperthyroidism
  • Hypothyroidism
  • Polycystic ovary syndrome (PCOS)
  • Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)

Fertility and reproduction factors

  • Ectopic pregnancy
  • Fluctuating hormone levels
  • (before the 20th week of pregnancy)
  • Pregnancy
  • Random ovulatory cycles
  • Sexual intercourse
  • Perimenopause
  • Vaginal atrophy (genitourinary syndrome of menopause)

Infections

  • Cervicitis
  • Chlamydia
  • Endometritis
  • Gonorrhea
  • Pelvic inflammatory disease (PID)
  • Ureaplasma vaginitis
  • Vaginitis

Medical conditions

  • Celiac disease
  • Severe systemic disease, such as kidney or liver disease
  • Thrombocytopenia
  • Von Willebrand disease (and other blood clotting disorders)

Medications and devices

  • Forgotten (retained) tampon
  • Intrauterine device (IUD)
  • Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)
  • Tamoxifen side effect

Noncancerous growths and other uterine conditions

  • Adenomyosis
  • Cervical polyps
  • Endometrial polyps
  • Uterine fibroids
  • Uterine polyps

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