Vaginal bleeding is a common aspect of a woman’s reproductive health, encompassing both normal menstrual cycles and instances of abnormal bleeding. This article explores the distinctions between normal and abnormal vaginal bleeding, shedding light on potential causes and available treatments.
Normal Vaginal Bleeding
Normal vaginal bleeding, known as menstruation or menorrhea, is a result of cyclic hormonal changes orchestrated by the ovaries. This process involves the release of an egg from the ovary, followed by the shedding of the uterine lining if pregnancy does not occur. The menstrual cycle typically spans approximately four weeks.
Abnormal Vaginal Bleeding
Abnormal vaginal bleeding deviates from the expected patterns in terms of timing and volume. To assess abnormal bleeding, three key questions are considered:
- Pregnancy: Is the person pregnant?
- Bleeding Pattern: What is the pattern of the bleeding?
- Ovulation: Is ovulation occurring?
Abnormal Bleeding Patterns
- Irregular Bleeding During Pregnancy:
- Early signs of pregnancy may include irregular bleeding.
- Complications like miscarriage or ectopic pregnancy can cause vaginal bleeding during pregnancy.
- Duration, Interval, and Amount of Bleeding:
- Abnormal duration may be hypermenorrhea (too long) or hypomenorrhea (too short).
- Abnormal interval includes polymenorrhea (too frequent) or oligomenorrhea (too seldom).
- Abnormal bleeding volume includes menorrhagia (excessive) or hypomenorrhea (too little).
- Menometrorrhagia is a combination of excessive bleeding and irregular timing.
- Ovulation Assessment:
- Regular ovulation is crucial for menstrual regularity.
- Signs of ovulation include regular menstrual intervals and associated symptoms.
- Anovulation (lack of ovulation) may lead to hormonal imbalances.
Causes of Vaginal Bleeding During/After Intercourse
- Injuries during intercourse, infections (e.g., gonorrhea), lowered estrogen levels, and anatomical lesions (tumors or polyps) can cause bleeding.
Vaginal Bleeding During Pregnancy
- Up to 20-30% may experience some bleeding during pregnancy.
- Causes include miscarriage, placental issues, ectopic pregnancy, infections, and premature labor.
Causes of Abnormal Bleeding in Ovulating Women
- Conditions causing menorrhagia include fibroids, polyps, adenomyosis, IUDs, hypothyroidism, and certain medications.
- Conditions causing polymenorrhea include pelvic inflammatory disease and endometriosis.
- Metrorrhagia may result from cervical polyps, infections, or oral contraceptives.
- Hypomenorrhea can be due to hyperthyroidism, kidney diseases, or oral contraceptives.
Exams and Diagnostics
- Physical examinations, Pap smears, pregnancy tests, blood counts, hormonal tests, and ultrasounds help diagnose the cause.
- Endometrial sampling or biopsy may be done for further evaluation.
Treatments for Abnormal Vaginal Bleeding
- Treatment depends on the underlying cause.
- Medications like progesterone, oral contraceptives, and antibiotics may be prescribed.
- Surgical interventions, such as Dilation and Curettage (D&C) or, in extreme cases, hysterectomy, may be considered.
- Newer procedures are being explored to selectively address blood vessel-related bleeding.
Summary
Understanding the causes and patterns of vaginal bleeding is crucial for informed decision-making. Seeking prompt medical attention, diagnosis, and tailored treatments can help manage abnormal vaginal bleeding effectively. Individuals experiencing irregular bleeding are encouraged to consult with healthcare providers for personalized guidance and care.
References
- Behera, M.A. “Abnormal (Dysfunctional) Uterine Bleeding.” Medscape. Nov. 15, 2015.
- Giuntoli, II, R., et al. “Classification and diagnosis of endometrial hyperplasia.” UpToDate. Nov. 24, 2014. <>.