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Vaginal or uterine bleeding

Irregular menstruation; Heavy, prolonged, or irregular periods; Menorrhagia; Polymenorrhea; Metrorrhagia and other menstrual conditions; Abnormal menstrual periods; Abnormal vaginal bleeding

Vaginal bleeding normally occurs during a woman's menstrual cycle, when she gets her period. Every woman's period is different.

Many women have abnormal bleeding between their periods at some point in their lives. Abnormal bleeding occurs when you have:

I Would Like to Learn About:

Causes

There are many causes of abnormal vaginal bleeding.

HORMONES

Abnormal bleeding is often linked to failure of regular ovulation (anovulation). Doctors call the problem abnormal uterine bleeding (AUB) or anovulatory uterine bleeding. AUB is more common in teenagers and in women who are approaching menopause.

Women who take oral contraceptives may experience episodes of abnormal vaginal bleeding. Often this is called "breakthrough bleeding." This problem often goes away on its own. However, talk to your health care provider if you have concerns about the bleeding.

PREGNANCY

Pregnancy complications such as:

PROBLEMS WITH REPRODUCTIVE ORGANS

Problems with reproductive organs may include:

MEDICAL CONDITIONS

Problems with medical conditions may include:

OTHER CAUSES

Other causes may include:

Symptoms

Symptoms of abnormal vaginal bleeding include:

Bleeding from the rectum or blood in the urine may be mistaken for vaginal bleeding. To know for certain, insert a tampon into the vagina and check for bleeding.

Keep a record of your symptoms and bring these notes to your doctor. Your record should include:

Exams and Tests

Your provider will perform a physical exam, including a pelvic exam. Your provider will ask questions about your medical history and symptoms.

You may have certain tests, including:

Based on your symptoms, other tests may be needed. Some can be done in your provider's office. Others may be done at a hospital or surgical center:

Treatment

Treatment depends on the specific cause of the vaginal bleeding, including:

Treatment may include hormonal medicines, pain relievers, and possibly surgery.

The type of hormone you take will depend on whether you want to get pregnant as well as your age.

Other medicines given for AUB may include:

Procedures for AUB may include:

When to Contact a Medical Professional

Contact your provider if:

Prevention

Aspirin may prolong bleeding and should be avoided if you have bleeding problems. Ibuprofen most often works better than aspirin for relieving menstrual cramps. It also may reduce the amount of blood you lose during a period.

References

ACOG Practice Bulletin No. 110: noncontraceptive uses of hormonal contraceptives. Obstet Gynecol. 2010;115(1):206-218. PMID: 20027071 pubmed.ncbi.nlm.nih.gov/20027071/.

American College of Obstetricians and Gynecologists. ACOG Committee Opinion No 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Obstet Gynecol. 2013;121(4):891-896. PMID: 23635706 pubmed.ncbi.nlm.nih.gov/23635706/.

Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Auchus, RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Ryntz T, Lobo RA. Abnormal uterine bleeding: etiology and management of acute and chronic excessive bleeding. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 26.

Seller RH, Symons AB. Menstrual irregularities. In: Seller RH, Symons AB, eds. Differential Diagnosis of Common Complaints. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 20.

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Review Date: 12/2/2020  

Reviewed By: LaQuita Martinez, MD, Department of Obstetrics and Gynecology, Emory Johns Creek Hospital, Alpharetta, GA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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