Abnormal Vaginal Bleeding, Periods

Vaginal bleeding may be considered as abnormal under the following circumstances :

  • Bleeding between periods in a woman with a regular menstrual cycle.
  • Vaginal bleeding after sexual intercourse.
  • Profuse, frequent or prolonged bleeding at the time of periods.
  • Bleeding before the age of 10 years (vaginal bleeding in a child).
  • Vaginal bleeding after menopause.

Changes in the normal menstrual cycle leading to a ‘heavy’ period should not be considered as an abnormal vaginal bleed if it occurs on one or two occasions. However if it is occurs recurrently, then it warrants further gynecological investigation to identify the cause of the abnormal bleed. A scanty menses or a ‘light’ period is also considered as an abnormal vaginal bleed and this should also be investigated.

Abnormal Periods

A profuse or excessive bleed during the menses (‘heavy period’) is known as hypermenorrhea or menorrhagia. This may be assessed by the number of sanitary pads of tampons that has to be changed and used during the course of the period in comparison to the the regular usage.

Prolonged menses is referred to as menorrhagia which is the same term used for profuse bleeding during menses. A normal period lasts for 3 to 7 days and any period than is 8 to 10 days or more will be considered as menorrhagia.

Irregular bleeding between periods is known as metrorrhagia and this can vary from a full bleed similar to a period to a heavy period or light spotting. Light bleeding or spotting may also be referred to as breakthrough bleeding when it is related to the use of hormonal contraceptives. Metrorrhagia may also be referred to as intermenstrual bleed.

Another term related to both metrorrhagia and menorrhagia is menometrorrhagia where there is prolonged or excessive menstrual bleeding which occurs at irregular intervals but is more frequent than would be normally expected.

If the menses is too frequent, then it is known as polymenorrhea. A normal menstrual cycle is between 21 and 35 days and if you menstruate more than once in a 20 day period, then it can be considered as polymenorrhea.

Oligomenorrhea is the term for an abnormally ‘light’ or scanty menses and/or infrequent menstruation. Having less than 10 periods in a 12 month period (menstrual cycle longer than 35 days) may be considered as oligomenorrhea.

Amenorrhea or no period is also considered as an abnormal period.

It is important to understand and identify the type of abnormal vaginal bleed related to menstruation to assist your doctor with a differential diagnosis.

Causes of an Abnormal Vaginal Bleed

Abnormal vaginal bleeding is usually due to hormonal causes however any inflammation, infection, structural abnormalities or tumors may also contribute to bleeding.

Common causes include :

  • Pregnancy related bleeding. In the first 12 weeks, the most common causes are¬† an ectopic pregnancy or miscarriage. Bleeding after 12 weeks may be related to a case of placenta previa or abruptio placentae although other causes should also be considered.
  • Implantation bleed is a sign of pregnancy which occurs when the embryo implants onto the wall of the uterus. It usually appears like a blood-stained discharge.
  • Polycystic ovarian syndrome or other causes of anovulation.
  • Ovulation may at times cause a mid-cycle bleed or mild spotting.
  • Pelvic inflammatory disease which is an infection of the uterus, fallopian tubes and/or ovaries.
  • Contraception including oral and injectable contraceptives or an intrauterine device (IUD).

Less common causes of vaginal bleeding include :

  • Endocrine disorders like hyperprolactinemia, diabetes mellitus or thyroid disorders including hypothyroidism or hyperthyroidism.
  • Infection,¬† injury and/or inflammation of the cervix, vulva or vagina (example – bacterial vaginosis, vaginitis).
  • Gynceological disorders including endometriosis, adenomyosis, cervical or endometrial polyps or uterine fibroids.
  • Cancer of the vagina, cervix or uterus.
  • Foreign objects within the vaginal including remnants of toilet paper or tampons.
  • Allergic reactions which may be caused by foreign objects in the vagina, condom lubricants and spermicides¬† or lubricants for vaginal dryness.
  • Induced abortion, either a surgical abortion involving machine, manual vacuum aspiration or dilation and curettage (d&c), medical abortion or illegal (‘backstreet’) abortion.
  • Sexually transmitted diseases.
  • Violent or forceful sexual intercourse.
  • Drugs including hormone replacement therapy (HRT), the abortion pills (mifepristone and misoprostol), hormone drugs for hormonally responsive breast cancers (letrozole and tamoxifen), anticoagulants (warfarin and dalteparin) and fertility drugs (like antagon and cetrotide). Other drugs may also at times cause abnormal vaginal bleeding as a side effect.
  • Herbal supplements like ginseng (Panax ginseng), black cohosh (Cimicfuga racemosa), chaste tree berry (Vitex agnus castus) and St. John’s wort (Hypericum perforatum). Other herbs may also be responsible for abnormal vaginal bleeding but this cannot always be conclusively ascertained due to the lack of clinical trials for herbal supplements.
  • Bleeding disorders may cause abnormal vaginal bleeding and this could be related to platelet or coagulation disorders.

Please note that any information or feedback on this website is not intended to replace a consultation with a health care professional and will not constitute a medical diagnosis. By using this website and the comment service you agree to abide by the comment terms and conditions as outlined on this page

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  • Maryalice

    I went off birth control in december, to start trying to concieve in feb. In jan. i skipped my period, then i got my period in feb. and it lasted for 2 and a half weeks, march it lasted 2 weeks again. Now it is april and i am on day 13 of my period? is this normal?

    Read more of this question and the answer from Dr. Chris in the article on Irregular Periods After Stopping Birth Control Pill.

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  • mheng dizon

    i stop taking birth control last novemeber,and then the nxt month my menstration was not realy heavy,.and then the nxt month again its regular.but then the nxt month again i dnt hve menstration.and then this month i thought i hve but it was a spot and i just hve it for one day ..

    • Dr. Chris

      Hi Mheng

      First thing you need to do is exclude pregnancy. Do a pregnancy test and see your doctor to confirm. It is not uncommon for the normal menstrual cycle NOT to return immediately after stopping the oral contraceptive. It can take up to 6 months to restore. If however this is ongoing then it needs to be investigated. If you have any other gynecological disorders prior to starting birth control, like PCOS, then this could be a possible cause of the irregular menstruation now that you off the pill.

  • Rebecca Cushing

    I am a 34 year old female. I had a complete hysterectomy without removing my ovaries in March 2013 due to cervical cancer. I have had moderate to severe pain since the surgery. The DR. that did my surgery wouldn’t remove my ovaries because he said I would go into menopause. I recently have been bleeding, not when I urinate or after intercourse though. What could cause this?

    • Hi Rebecca. There are a host of possibilities and this needs to be evaluated by your doctor ASAP. We cannot provide you with a definitive answer. The lack of other urinary symptoms may mean that it is not something common like a urinary tract infection but it still is a possibility. As you can see from the article above there are many possible causes. But the concern here given your history is whether the cancer has spread beyond the area that was surgically removed. It could therefore be the cause of the bleeding. Speak to your doctor as soon as you can.

  • Ashley Nichole Patton

    hello ive been bleeding brown stringy blood for a long time now I just had a baby about 7 1/2 months ago I had one depo shot it lasted 3 months but I never went in for the next injection I have been bleeding since I first got that shot its been about 4 1/2 months on and off like every other day of this brown discharge that is really stringy like jelly any ideas or should I just make an app to clear out possiable cancer

    • Hi Ashley. Yes, it is advisable that you consult with your OBGYN as soon as possible. There is no need to focus solely on cancer at this point. There are many other less serious possibilities that could account for your symptoms but it is difficult to say for sure without further investigation. The fact that you did not return for your contraceptive injection also means the possibility of pregnancy or miscarriage which also needs to be investigated and ruled out. Speak to your family doctor and try to book an appointment with your OBGYN soon.

  • Nicole

    Hi! I’ve been bleeding for months at a time, the longest time off my period in a year was a week but mostly it will stop for a day or so and then start back for 45 days before I get another break. So far this time I’ve been bleeding for a month and two weeks. It is mainly black or brown unless I go to pee and the its brown and bright red, I officially have an odor down there and I dont know what to do. I am constantly in pain from bloating and cramps 24/7 and I’m always pmsing, migraines last for weeks with out relief, and my body weight went from 132 to 160 in two weeks and after 8 months of gaining to 179 I dropped down to 110 in 4 months and in the past two months Ive bumped back to 125, I can’t eat due to always being sick to my stomach, Im fatigued, my back and neck throb all the time, sex is OMG painful, sometimes I feel like I’m giving birth from the pain in my vagina and basically I feel like a 80 year old with a full time period and stomach virus but I’m only 26. I have 2 kids, last one was born in 2012 and my tubes are tied. What’s going on with me?