Abnormal vaginal bleeding

Abnormal vaginal bleeding can be:

• heavy or prolonged bleeding – you have heavier vaginal bleeding than usual during your period or your period lasts longer than it used to
• irregular menstrual bleeding – your period is not occurring in a predictable or regular cycle
• intermenstrual bleeding – you have vaginal bleeding at any time in between your periods.

Vaginal bleeding after menopause or after sexual intercourse (when you are not having a period) are also considered abnormal and should be checked by a doctor. Read more about post-coital bleeding and post-menopausal bleeding. 

There are many causes of abnormal vaginal bleeding. The cause depends on the type of abnormal vaginal bleeding. 

Heavy or prolonged bleeding

Causes of heavy or prolonged bleeding can include:

• womb-related problems such as endometrial polyps or uterine fibroids, endometriosis, pelvic inflammatory disease (PID), polycystic ovarian syndrome (PCOS), endometrial hyperplasia or endometrial cancer
• medical conditions such as blood disorders, hypothyroidism and liver or kidney disease
• medical treatments such as contraceptives, anticoagulant medicines, chemotherapy drugs or herbal supplements. 

Read more about heavy or prolonged bleeding. 

Irregular menstrual bleeding

Irregular menstrual bleeding refers to periods that are irregular. Young adolescent girls can experience irregular periods for the first few months after they start having periods. This is due to the immaturity of the hormonal system (hypothalamic-pituitary system) and periods will start to normalise after a few months. Similarly, when approaching menopause, hormones can start to fluctuate and cause irregular periods. 

Other causes of irregular menstrual bleeding include:

• stress
• low BMI or weight loss
• excessive exercise
• polycystic ovarian syndrome (PCOS). 

Vaginal bleeding at unusual times

Vaginal bleeding that happens anytime outside your normal periods (known as intermenstrual bleeding). Light bleeding can happen during ovulation, which is about halfway between your periods. This can be very regular. 

Other causes of intermenstrual bleeding include:

• breakthrough bleeding if you are on oral contraception
• cervix problems such as cervicitis, sexually transmitted infections (STIs), cervical polyps or cervical cancer
• womb problems such as polyps or fibroids
• external genitalia problems such as warts or herpes simplex infection 
• vaginal problems such as atrophic vaginitis, injury, sexual assault, foreign bodies or tumours. 

As described above, abnormal vaginal bleeding is any vaginal bleeding that is not usual for you. If you are worried about abnormal bleeding or your usual pattern of periods has changed, see your doctor. 

If you experience heavy or prolonged bleeding, you may lose too much blood and experience symptoms of anaemia (low red blood count). These symptoms can include:

• tiredness and fatigue
• chest pain
• shortness of breath 
• looking pale 
• feeling faint and dizzy
• headaches
• faster heart rate or palpitations. 

Your doctor will ask you questions about your symptoms such as the pattern of your periods and how the bleeding has been affecting your daily life. It can sometimes be helpful to keep a menstrual or period diary(external link) or period tracker app that records the pattern of your vaginal bleeding for at least a few weeks before visiting your doctor. Your doctor will also ask you questions about your family history of breast or ovarian cancer, your sexual history, whether you smoke and any medicines that you have been taking. 

Your doctor will then examine your genitals, perform a vaginal examination, and insert a speculum into your vagina to examine your vagina or cervix. Your doctor may also do a cervical screening test or vaginal swab to look for sexually transmitted infections (STIs). 

Other tests that may be done to find out the cause of abnormal vaginal bleeding include:

• blood tests such as a full blood count, iron levels, thyroid function test, coagulation screen and hormone blood tests
• urine pregnancy test 
• taking a tissue sample (biopsy) if anything abnormal is found on your cervix or vagina during a speculum examination
• an ultrasound scan of your pelvis or lower abdomen
• a pipelle biopsy – a tissue sample of the inner lining of your womb is taken through a small tube (like a straw) that is passed through your vagina and cervix
• dilation and curettage (D&C) – your cervix will be dilated and a tissue sample of the inner lining of your womb is taken by scraping it
• hysteroscopy – a camera is inserted into your womb through your vagina to look at the inside of your womb. 

Not everyone will have all these tests done. You may need to be referred to a gynaecology specialist to get some of them done. Your doctor will let you know which test is needed for you. 

Treatment of abnormal vaginal bleeding will depend on the cause, eg, if you have a sexually transmitted infection (STI), antibiotics will be prescribed. If you are taking any medicines that can cause bleeding, it is likely you will need to stop taking them or change them. 

Treatments are also available to stop or manage heavy or prolonged bleeding. There are non-hormonal and hormonal options. Some are also used as contraceptives so you will need to discuss with your doctor the best option for you, depending on your general health and whether you wish to conceive (get pregnant). 

Non-hormonal medicines:

• tranexamic acid (tablet)
• non-steroidal anti-inflammatories (NSAIDs)

Hormonal treatments:

• Levonorgestrel (Mirena) IUD
• progestogens, which include Depo Provera (injection), Desogestrel (Cerazette) (tablet), norethisterone (tablet), medroxyprogesterone acetate (tablet)
• combined oral contraceptive pill 

If you develop complications such as iron deficiency anaemia due to heavy bleeding, treatment such as iron supplement, iron injection or blood transfusion is sometimes needed. 

Surgery may be needed for certain conditions such as fibroids, polyps or cancers. Your doctor will advise what treatment is needed for your condition. 

Some of the self-care measures you can do if you have abnormal vaginal bleeding include to:

• get plenty of sleep 
• eat a well-balanced diet 
• do gentle exercise
• keep a menstrual or period diary(external link)
• place a warm water bottle or wheat bag on your tummy to ease pain 
• take over-the-counter pain relief medicines such as paracetamol or ibuprofen
• try relaxation techniques. 

Apps reviewed by Healthify

You may find it useful to look at some Women's health apps.