Team AckoSept 25, 2023
Vaginal Bleeding (VB) during periods is something most women are all too familiar with. However, there are several abnormal causes of bleeding outside of menstruation as well. This could be due to injury or infections or, more commonly, due to a disease of the uterus. Read ahead to know more about this issue.
Vaginal Bleeding is a clinical phenomenon that refers to one of the following.
Bleeding in between menstrual cycles
Abnormal bleeding during menstruation
Bleeding during pregnancy
Bleeding following menopause (Post-menopausal bleeding)
The common causes of Vaginal Bleeding include the following.
Excessive bleeding with frequent changing of pads
Bleeding for less than 2 days or more than 7 days
Passage of clots
Frequent periods (within 21 days)
Infrequent periods (after over 35 days)
Missing period in the absence of pregnancy
Bleeding in between two regular cycles
A fibroid is a non-cancerous growth in the uterus. They can be single or multiple in number. Large fibroids can cause heavy periods or frequent episodes of VB.
Uterine polyps are growths in the inner lining of the uterus called the endometrium (this is also the layer that is shed when a woman menstruates). Polyps commonly cause abnormal bleeding.
Both of these are painful conditions that result in irregular VB because the endometrium migrates to areas where it isn’t normally seen.
Along with bleeding, infections may be associated with fever, abdominal and pelvic pain, nausea, vomiting, painful urination, decreased urine output, vaginal discharge, pain during intercourse, etc. This includes sexually transmitted diseases as well.
Inflammation of any part of the female reproductive tract can result in VB. Pelvic Inflammatory Disease (PID) is another condition where the infection spreads from the vagina upwards to affect other structures of the female reproductive tract like the uterus, fallopian tubes, and ovaries.
Any injury to the female reproductive canal can cause bleeding. This may be blunt trauma or a penetrating injury.
The regularity and uniformity of the menstrual cycle are maintained by a delicate system of hormones. Some of the common hormonal imbalances resulting in abnormal VB are mentioned below.
Thyroid abnormalities: Hypothyroidism can cause heavy menstrual bleeding, irregular cycles, and sometimes absent periods as well. In hyperthyroidism, women may have amenorrhea or missing periods in the absence of pregnancy, infrequent cycles, reduced duration of bleeding, irregular cycles, and even early menopause.
Polycystic Ovarian Syndrome (PCOS): This is one of the most common causes of menstrual irregularities in women. In PCOS, there is an excess of testosterone and a decrease in the level of female sex hormones (estrogens).
Withdrawal Bleeding: Oral contraceptive pills result in Vaginal Bleeding when they are stopped.
An important cause of abnormal Vaginal Bleeding can be cancers arising from the female reproductive tract. Cancers present with abnormal VB, pelvic and lower abdominal pain, painful intercourse, vaginal discharge, loss of weight, malaise, etc. When there is VB encountered in women who have crossed menopause, there should be high suspicion of cancer. Cancers that can affect the female reproductive tract include the following.
Endometrial cancer & hyperplasia
Vaginal Bleeding can occur as a side effect of certain medications such as tamoxifen which is used to treat breast cancer. Any retained objects like tampons in the vaginal tract can result in bleeding. Intrauterine Devices (IUDs) are used as a means of contraception as well as treatment for abnormal bleeding. However, rarely, these devices can cause bleeding as a side effect.
Bleeding disorder: Any condition in which blood clotting is affected can result in bleeding from all body orifices including Vaginal Bleeding.
Liver failure: Severe liver failure can result in an absence of production of the clotting factors, which can result in excess bleeding. Some of these patients may present with abnormal Vaginal Bleeding.
Vaginal Bleeding that occurs during pregnancy is usually abnormal. The menstrual cycle does not occur during pregnancy as fertilisation has occurred and there is no ovulation. Bleeding during pregnancy can be due to the following.
Early spotting: This is a normal process that occurs during the early weeks of pregnancy. It is due to the embryo becoming implanted or fixed to the uterine wall.
Miscarriage or spontaneous abortion (when it occurs before 24 weeks of pregnancy)
Placenta previa: This is a condition where the placenta (the structure that transfers oxygen and nutrients from the mother to the foetus) is abnormally present in a position over the cervical opening. Placenta previa is diagnosed by ultrasound, and in such patients, vaginal examination is prohibited as it can cause severe bleeding.
Placental abruption: This is a condition where the placenta prematurely separates from the uterine wall and it can result in Vaginal Bleeding.
Ectopic pregnancy: Usually in pregnancy, the fertilised egg undergoes implantation or fixation inside the uterus in the endometrium where it undergoes development to form a foetus. Rarely, the fertilised egg may implant in a site other than the uterine cavity, like the ovary, fallopian tube, abdomen, etc. This condition is called an ectopic pregnancy. An ectopic pregnancy cannot progress normally. If it is not removed, it can undergo rupture, which can be life-threatening.
The diagnosis and treatment of abnormal Vaginal Bleeding is a complex process and begins with a detailed history and examination. Your doctor may advise investigations such as ultrasound, blood tests, and pregnancy tests.
The treatment of abnormal Vaginal Bleeding depends on the cause. Lifestyle changes like losing weight, being more active, and eating a healthy diet are useful in managing certain commonly encountered causes of menstrual irregularities such as PCOS.
The medical management of abnormal Vaginal Bleeding includes the following.
Birth control methods: Hormonal pills, patches, rings, etc., which are used to modify the hormonal cycles affecting bleeding. These are the most commonly used medicines for the treatment of menstrual irregularities.
Intrauterine contraceptive devices (IUDs)
Drugs like Tranexamic acid used to control bleeding
Antibiotics for infections
Thyroid supplements for hypothyroidism and antithyroid medicines for hyperthyroidism
Metformin, an anti-diabetic medication, is used in the treatment of PCOS
For certain conditions, surgical procedures may be required. Some of these procedures include the following.
Endometrial ablation in which the endometrium is surgically destroyed.
Dilatation & Curettage (D&C) is another technique in which the endometrium is scooped out.
Hysterectomy is the surgical removal of the uterus.
Vaginal Bleeding is a concern that must be addressed at the earliest. As there are a wide variety of causes ranging from simple to serious, only a medical professional can help assess what should be done next. Prolonged bleeding can result in anaemia and weakness.
Consulting a gynaecologist is of utmost importance in such a situation. They will prescribe medication to stop bleeding and determine if it is due to trauma, hormonal imbalance, or other medical issues.
There are several causes of bleeding in the first trimester. It could be normal or could indicate a miscarriage. It is vital to visit a doctor in case of any Vaginal Bleeding during pregnancy.
Vaginal Bleeding after menopause could be a sign of cancers in the female reproductive tract. Early diagnosis helps in prompt treatment and better prognosis.
Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions. Vaginal Bleeding is also written as VB in this article.
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