Abnormal vaginal bleeding

Normally, vaginal bleeding occurs only during a period. Bleeding that occurs outside of menstruation is abnormal. In women under the age of 35, abnormal vaginal bleeding is often the result of starting oral contraceptives. Abnormal bleeding caused by a disorder of the reproductive organs is more common in women over this age.

What are the causes?

Light bleeding between periods, known as spotting, is common in the first few menstrual cycles after starting oral contraceptives or changing to a different type of pill. Spotting is usually brought on by the body adjusting to changes in hormone levels, but this type of bleeding is also associated with using an intra-uterine contraceptive device (IUD).

Abnormal bleeding, especially within a few hours of sexual intercourse, may indicate a disorder of the cervix, such as cervical erosion or cancer of the cervix. In older women, sex may damage the walls of the vagina, which become thinner and more fragile after the menopause, causing bleeding.

Abnormal vaginal bleeding that is not associated with sexual intercourse or contraception may be caused by a disorder such as endometriosis or uterine polyps. Loss of blood from the uterus can also occur in early pregnancy and could indicate a miscarriage. Various disorders of the female reproductive organs may cause post-menopausal bleeding, such as cancer of the uterus.

If you notice abnormal bleeding, you should see your doctor immediately so that the cause can be investigated.

What might be done?

Your doctor may be able to make a diagnosis based on the timing of the bleeding and a physical examination. You may also need to have tests, such as a cervical smear test to check for disorders of the cervix, ultrasound scanning to look for at the uterus, or endoscopy to view the inside of the uterus.

The treatment for abnormal vaginal bleeding depends on the cause. Spotting caused by oral contraceptives may be prevented by changing the dose or type of pill. Hormone treatments can be used to restore the elasticity of fragile vaginal walls in older women. Surgery may be required to treat more serious underlying disorders. In most cases, abnormal vaginal bleeding disappears once the cause has been successfully treated.