Vaginal Bleeding

Abnormal uterine bleeding is a common presenting symptom in the family practice setting. In women of childbearing age, a methodical history, physical examination, and laboratory evaluation may enable the physician to rule out causes such as pregnancy and pregnancy-related disorders, medications, iatrogenic causes, systemic conditions, and obvious genital tract pathology. Dysfunctional uterine bleeding (anovulatory or ovulatory) is diagnosed by exclusion of these causes. In women of childbearing age who are at high risk for endometrial cancer, the initial evaluation includes endometrial biopsy; saline-infusion sonohysterography or diagnostic hysteroscopy is performed if initial studies are inconclusive or the bleeding continues. Women of childbearing age who are at low risk for endometrial cancer may be assessed initially by transvaginal ultrasonography. Postmenopausal women with abnormal uterine bleeding should be offered dilatation and curettage; if they are poor candidates for general anesthesia or decline dilatation and curettage, they may be offered transvaginal ultrasonography or saline-infusion sonohysterography with directed endometrial biopsy. Medical management of anovulatory dysfunctional uterine bleeding may include oral contraceptive pills or cyclic progestins. Menorrhagia is managed most effectively with nonsteroidal anti-inflammatory drugs or the levonorgestrel intrauterine contraceptive device. Surgical management may include hysterectomy or less invasive, uterus-sparing procedures.

Abnormal uterine bleeding is bleeding between monthly periods, prolonged bleeding or an extremely heavy period. This can be caused by hormone changes, cancer, fibroids, polyps or early pregnancy.

Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. Vaginal bleeding is considered to be abnormal if it occurs:

Abnormal uterine bleeding can have many causes: fibroids, endometrial hyperplasia, contraceptives such as IUDs, or infection. Find out more in this patient FAQ.

Every woman has been there: You think your period is over, so you ditch the panty liners and grab the white pants. And then, when you least expect it, you see red. Or maybe pink. It’s just a few spots, but enough to ruin your day (not to mention your pants).

Vaginal bleeding that's unrelated to your period might signal a problem. Learn about possible causes and when you should see a doctor.