Vaginal Bleeding: Possible Causes and When to See a Doctor
Sex and gender exist on spectrums. To reflect language used in source materials, this article uses “female” and “women” to refer to people assigned female at birth.
The term vaginal bleeding refers to bleeding that occurs outside of your regular menstrual cycle. Typical menstrual bleeding occurs every 21–35 days and lasts about a week.
Situations when vaginal bleeding may not be normal include:
- heavy period bleeding, defined as menstrual bleeding that lasts more than 7 days or soaks through one tampon or pad in less than 2 hours
- menstrual bleeding that includes passage of large blood clots around the size of a quarter or bigger
- bleeding that occurs between periods
- bleeding after vaginal penetration
- bleeding after menopause
- irregular periods, both in their frequency and duration
Learn more about symptoms and causes of heavy periods.
Going several menstrual cycles without ovulation can cause the uterine lining to become thicker than usual. This can result in abnormal bleeding.
Irregular ovulation can occur in people who:
- recently started menstruation
- are in perimenopause
- have polycystic ovary syndrome (PCOS)
- have low thyroid function, known as hypothyroidism
Other symptoms associated with irregular ovulation include:
- missed periods
- tender breasts
- bloating in the lower abdomen
- mood changes
Not all fibroids cause symptoms, but when symptoms do occur, they can be very disruptive.
In addition to vaginal bleeding, which may be heavy, symptoms of uterine fibroids can include:
- painful periods
- swollen or enlarged lower abdomen
- feeling of fullness in the pelvis
- pain during vaginal penetration
- frequent urination
- low back pain
Learn more about symptoms, causes, and treatments for uterine fibroids.
Endometriosis occurs when the tissue that makes up the uterine lining begins to grow outside of the uterus.
Nearly 10% of females in their reproductive years have endometriosis.
Endometriosis can cause heavy period bleeding or bleeding between periods, along with symptoms including:
- very painful menstrual cramps that may worsen over time
- vaginal bleeding after sex
- lower abdominal pain
- pain in the intestinal area
- painful urination or painful bowel movements during your period
- difficulty getting pregnant
Cervical polyps are small growths that extend out from the wall of the cervix into the cervical canal. Nearly all polyps are benign growths, meaning they are not cancerous.
Cervical polyps do not always cause symptoms. When they do, you may experience certain types of vaginal bleeding including:
- heavy period bleeding
- bleeding between periods
- bleeding after menopause
Conditions that affect the blood’s ability to clot can cause heavy vaginal bleeding. A condition called von Willebrand disease is the most common type of bleeding disorder in females.
In addition to vaginal bleeding, symptoms of bleeding disorders can include:
- heavy bleeding during surgery
- heavy bleeding after childbirth
- frequent or long-lasting nosebleeds
- bleeding gums after dental work
- easy or frequent bruising
- blood in your urine or stool
PID is an infection of the female reproductive system. It may affect the cervix, uterus, fallopian tubes, or ovaries.
PID typically occurs due to a sexually transmitted infection (STI).
Along with vaginal bleeding, PID can cause symptoms including:
- lower abdominal pain
- vaginal discharge that has a bad odor
- a fever of 100.4ºF (38ºC) or higher
- burning during urination
- pain or bleeding during or after vaginal penetration
Learn more about PID symptoms, diagnosis, prevention, and treatment.
However, heavy bleeding or bleeding that occurs later in pregnancy could be a sign of a complication that requires prompt treatment.
Conditions that can cause vaginal bleeding during pregnancy include:
- Ectopic pregnancy: This is a medical emergency that results from an embryo implanting somewhere other than the uterus. It can pose a risk of rupture.
- Miscarriage: This is the loss of a pregnancy before 20 weeks of gestation.
- Abortion: This is a termination of a pregnancy through medication or a surgical procedure.
- Placenta previa: This occurs when the placenta partially or completely blocks the birth canal.
Learn more about uterine cancer, including stages, treatment, and outlook.
Contact your OB-GYN if you have unusually heavy bleeding during your period or if you experience vaginal bleeding between periods. These could be signs of an underlying condition that needs prompt treatment.
If you are pregnant, contact your OB-GYN or nurse midwife if you experience bleeding that:
- is heavy or does not go away
- occurs with belly pain or cramps
- occurs with dizziness or lightheadedness
- occurs with a fever of 100.4ºF (38ºC) or higher
Treatment for vaginal bleeding will focus on treating the condition that is causing your symptoms.
If you are not currently experiencing symptoms, your doctor may recommend waiting and monitoring your condition before suggesting treatment.
Some treatments such as hysterectomy can affect fertility. Your doctor will discuss your treatment options with you in the context of your reproductive goals.
Hormones and medications
As a short-term treatment for heavy bleeding, your doctor may recommend certain hormone medications. These can include oral contraceptives, estrogen, or progestin to help stop vaginal bleeding.
You may also receive medication that helps improve blood clotting, such as tranexamic acid.
For treatment of fibroids, doctors may recommend gonadotropin releasing hormone agonists (GnRHa), which can help shrink fibroid growths.
Myolysis destroys fibroids with focused energy, such as a laser or heat. This is a minimally invasive procedure that may be as effective as hysterectomy, with fewer complications.
Uterine artery embolization (UAE)
This fibroid treatment injects medications into the arteries of the uterus to prevent blood flow to fibroid tissue.
Benefits of UAE include shorter hospitalization time and faster recovery.
This treatment for endometriosis removes or destroys tissue in the uterine lining. There are a variety of techniques for doing this, and your doctor will explain your options to you.
It is not possible to become pregnant after endometrial ablation.
Hysterectomy is the removal of the uterus.
After hysterectomy, it is no longer possible to get pregnant. If you have not yet started menopause, removal of your uterus will stop your periods regardless of your age.Hysterectomy is the most invasive treatment for many conditions that cause vaginal bleeding. Doctors only consider hysterectomy if other treatments have not been effective.
Causes of vaginal bleeding can include endometriosis, uterine fibroids, bleeding disorders, or hormonal birth control.
Contact your OB-GYN for any abnormal vaginal bleeding. They can evaluate you to provide an accurate diagnosis and begin prompt, effective treatment.