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Abnormal vaginal bleeding

Unexpected bleeding other than during the normal menstrual period, or even an abnormally heavy period, can be great cause for alarm for any woman.

It can be linked to the menopause, pregnancy, miscarriage or various medical conditions.

Abnormal or unusual bleeding

The signs of abnormal vaginal bleeding could be blood on underwear or bed clothes, blood on toilet paper after urinating. If a period is very heavy more pads or tampons may be needed than usual.

When bleeding is not caused by the menstrual cycle it is called abnormal or dysfunctional uterine bleeding.

The medical term for excessive or prolonged vaginal bleeding that happens at the normal time of the menstrual cycle is called menorrhagia. Menorrhagia may be experienced with other symptoms, such as menstrual pain or dysmenorrhoea.

Uterine bleeding outside the usual menstrual periods is called metrorrhagia.

Menometrorrhagia is the combination of the two, that is, excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals.

Doctors will want to find out the origin of the bleeding, whether it is from the uterus, vagina or elsewhere, to make decisions about any treatment or tests.

When to seek medical advice about abnormal vaginal bleeding

Seek medical advice about any concerns about any abnormal vaginal bleeding.

If abnormal vaginal bleeding is accompanied by other symptoms, such as light-headedness, severe abdominal pain or fever, urgent medical attention may be needed.

Causes of vaginal bleeding

Pregnancy. Pregnancy and complications of pregnancy are a common cause of abnormal uterine bleeding for women of childbearing age. Ectopic pregnancy or miscarriage may be responsible.

Menopause. Older women approaching the menopause may experience dysfunctional bleeding because of hormonal changes that accompany the menopausal transition.

Growths and cancers. A harmless polyp or lesion of the genitals may cause bleeding. Excessive bleeding may be due to ovarian cysts, cervicitis, endometritis, fibroids, vaginal infections and other conditions. Cancers of the vagina, cervix, uterus and ovaries are other causes of bleeding.

Medication. Some treatments such as anticoagulants that prevent blood from clotting may result in abnormal bleeding.

Haemophilia and other inherited bleeding disorders may cause excessive or prolonged vaginal bleeding.

Trauma or injury, including injury through having sex may cause of bleeding, as may problems with a contraceptive coil or IUD.

Irregular periods and a hormone imbalance may be due to polycystic ovary syndrome (PCOS), extreme weight loss or excessive exercise.

Abnormal vaginal bleeding tests

A doctor will want to know details of the symptoms of abnormal bleeding and look at a woman's medical history and general health. They will want to check if the bleeding is coming from the vagina and not from the rectum or that it is in the urine. A GP may refer a woman to a gynaecologist for a specialist assessment.

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