Abnormal vaginal bleeding is any vaginal bleeding that is unexpected and not part of your regular period.
Key points about abnormal vaginal bleeding
- The definition of normal is different for everyone. Normal period cycle length ranges from 21–35 days and bleeding lasts for 3–10 days. You may have a period every 21 days or every 35 days but that can be normal for you.
- Abnormal vaginal bleeding can be bleeding that is heavier or longer than usual, bleeding that happens as part of your period but is irregular, or bleeding in between periods.
- The cause depends on the type of abnormal vaginal bleeding you have.
- See your doctor if you are worried about abnormal vaginal bleeding or your usual pattern of periods has changed.
- Treatment of abnormal vaginal bleeding will depend on the condition you have.
See your GP or doctor if you have any of the symptoms below or call Healthline on 0800 611 116 if you are unsure what to do:
What are the different types of 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.
What are the causes of abnormal vaginal 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:
Vaginal bleeding at unusal 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
- faster heart rate or palpitations.
See your GP or doctor if you have any of the symptoms above or call Healthline on 0800 611 116 if you are unsure what to do.
How are the causes of abnormal vaginal bleeding diagnosed?
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 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.
How is abnormal vaginal bleeding treated?
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).
- Levonorgestrel (Mirena) IUD
- progestogens, which include Depo Provera (injection), Desogestrel (Cerazette) (tablet), norethisterone (tablet), medroxyprogesterone acetate (tablet)
- combined oral contraceptive pill
Surgery may be needed for certain conditions such as fibroids, polyps or cancers. Your doctor will advise what treatment is needed for your condition.
How can I care for myself with abnormal vaginal bleeding?
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
- 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.
The following links provide further information about abnormal vaginal bleeding. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
Patient information for heavy periods and bleeding in between periods National Women's Health, Auckland DHB, NZ
Abnormal vaginal bleeding Ministry of Health, NZ
Patient education: abnormal uterine bleeding (beyond the basics) Up To Date, US
Abnormal uterine bleeding MSD Manual, US
What causes heavy periods and abnormal vaginal bleeding? Patient Info, UK
- Abnormal vaginal bleeding 3D Regional HealthPathways, NZ, 2020
- Flowcharts for the clinical practice guidelines for cervical screening in New Zealand 2020 Ministry of Health, NZ, 2020
- Investigating and managing abnormal vaginal bleeding: an overview BPAC, NZ, 2019
|Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.|