What is abnormal vaginal bleeding?

Abnormal vaginal bleeding is bleeding between periods. It is a symptom of abnormal uterine bleeding (AUB). It is not a diagnosis. Abnormal uterine bleeding affects 10-30% of women of reproductive age. It is a common experience in these women and generally is not indicative of a problem. However, it could signal a serious or life-threatening condition.

NOTE: AUB in women older than 40, and especially in postmenopausal women requires prompt evaluation to exclude a gynecological malignancy.

Abnormal vaginal bleeding is:

• Spotting or bleeding between periods.
• Bleeding after sex.
• Bleeding for longer than normal for you.
• Heavier than normal bleeding during your period.
• Bleeding after menopause.

When abnormal bleeding is accompanied by sharp pain or cramping in the lower abdomen, painful intercourse, and/or fever, or symptoms that worsen, it is time to see your gynecologist.

What causes abnormal vaginal bleeding?

There are many things that can cause abnormal vaginal bleeding, but the most common cause is a hormone imbalance. It is common in teens and in women approaching menopause.

Possible causes in women of reproductive age include:

Hormone changes:

• Starting or stopping the use of hormonal birth control, including the pill and a hormonal IUD. Spotting is a side effect of these products. Called “breakthrough bleeding” it usually goes away within 3-6 months as your body adjusts to the hormones. Stopping can cause withdrawal bleeding.
• Polycystic Cystic Ovary Syndrome (PCOS) is a hormone imbalance that causes irregular periods.
• Ovulation
• Extreme emotional or physical stress
• Pregnancy – One out of four pregnant women experience some spotting or bleeding in the first months of pregnancy. However, heavy bleeding it not normal and should initiate a call to your OB/GYN.
• Ectopic pregnancy
• Miscarriage
• Perimenopause can lead to spotting due to reduced ovarian function.
• Vaginal atrophy in perimenopause can cause spotting and painful intercourse as well as urinary symptoms.

Health Conditions:

• Some sexually transmitted infections including chlamydia, gonorrhea, herpes, and pelvic Inflammatory Disease (PID); and cervical polyps.
• An infection of the cervix, uterus or vagina.
• Bleeding and blood clotting disorders.
• Thyroid, kidney, liver or adrenal gland disorders.
• Gynecological cancer.
• Side effects of tamoxifen treatment for breast cancer.

Uterine problems:

• A uterine polyp or fibroid (leiomyoma). A polyp is not cancer. It affects between 8% and 35% of women, increases with age and causes heavy periods.
• Adenomyosis is when the uterine lining grows into the wall of the uterus. There may be no symptoms or painful periods, irregular bleeding, and pelvic pain. Women with this condition and endometrial hyperplasia are at risk for a gynecological malignancy.
• Endometriosis is a condition where uterine tissue grows outside of the uterus.

When to see your OB/GYN?

When you are concerned about abnormal vaginal bleeding, it’s time to contact your OB/GYN. In preparation for your doctor’s appointment, it is helpful to keep a journal of when and how much you are bleeding, how long it lasts and how heavy it is, and any associated symptoms.

How is the cause of abnormal vaginal bleeding diagnosed?

As you can see, there are many causes of abnormal vaginal bleeding. Dr. Dwaita Patel of City OB+GYN must evaluate all potential causes depending on your symptoms. She will take a detailed history and conduct a pelvic exam, lab tests will include a pregnancy test and blood count, and when there is concern about structural problems like polyps, fibroids, endometrial hyperplasia, or cancer, a transvaginal ultrasound.

An endometrial biopsy may be recommended for women with abnormal vaginal bleeding, especially those aged 45 and older. Hysteroscopy allows Dr. Patel to look inside the uterus for any abnormality.

What are the treatment options?

Treatment options depend upon the cause of abnormal vaginal bleeding. Uterine fibroids are common benign tumors in reproductive aged women. Generally, treatment options in this case may include medical and surgical management.

When a structural problem has been ruled out, medical management is the first-line approach. Each patient will receive an individualized treatment plan for medical management.

Contact Dr. Patel to schedule a consultation to receive the correct diagnosis and learn about all your treatment options. You will always be treated with respect and your confidentiality will be protected at City OB+GYN.