Abnormal Vaginal Bleeding in Women and Young Girls or in Pregnancy

Menstrual bleeding is the only regular vaginal bleed that occurs in girls and women after menarche. The menstrual cycle starts with menstruation (vaginal bleeding) which usually lasts between 3 to 7 days and the entire cycle runs for approximately 28 days on average. Bleeding at any other time should be considered as abnormal. If it occurs as a once-off episode between periods or even in menopause without any other signs and symptoms, it may not be a cause for concern.  Sometimes the abnormality may be associated with the menstrual bleed which can be heavier or longer than normal. However, when persistent then it should be investigated as it could be associated with serious disease which could even be life-threatening.

Types of Abnormal Bleeding from the Vagina

There are different terms to describe the various types of vaginal bleeding that are considered to be abnormal.

  • Metrorrhagia is the term for any bleed that does not occur at the time of menstruation. It is also known as intermenstrual bleeding.
  • Menorrhagia is the term for prolonged menses or excessive.
  • Polymenorrhea is the term for too frequent menstruation.
Menopause is the cessation of menses that also marks the end of woman’s reproductive years. If a women, usually of 45 years or older, experiences no periods for at least 12 months then it is considered to be menopause. However, there are other causes and even diseases for cessation of periods. Sometimes bleeding may occur in menopause and it is therefore known as postmenopausal bleeding.

Causes of Abnormal Vaginal Bleeding

There are a host of possible causes and abnormal vaginal bleeding should be investigated further by a medical professional. The site of bleeding can be anywhere in genitourinary system and sometimes bleeding from the urethra is mistaken for a vaginal bleed. Some of the causes include :

  • Gynecological Disorders
  • Cancer of the vagina, cervix, or uterus
  • Cervicitis
  • Dysfunctional uterine bleeding (DUB)
  • Endometriosis
  • Foreign body in the vagina
  • Injury of the cervix, vagina, or vulva
  • Polyps of the cervix or endometrium (uterus)
  • Polycystic ovary syndrome
  • Uterine fibroids
  • Vaginitis
  • Non-Gynecological or Systemic Causes
  • Hyperprolactinemia
  • Hypothyroidism
  • Bleeding disorders
  • Medication like hormonal contraceptives and hormone replacement therapy.
  • Intra-uterine devices (IUDs)

Pregnant Women

Vaginal bleeding is of greatest concern in pregnancy. It may be a sign of a threatened abortion or ectopic pregnancy if it occurs early in pregnancy. In late pregnancy, vaginal bleeding may be due to abruptio placentae or placenta previa which are very serious conditions that require careful monitoring or medical intervention. Sometimes a bleed in late pregnancy may occur with uterine polyps.

Babies and Young Girls

Vaginal bleeding in children is uncommon. When it does occur it infants it may be due to the estrogens from the mother’s circulation crossing the placenta and is then present in the baby after birth. This can cause vaginal bleeding in infants. In older children, vaginal bleeding should always be investigated first for the possibility of sexual abuse. Other causes may include vaginal or cervical warts, foreign bodies in the vagina or tumors. Sometimes puberty may occur at a much younger age than normal and this is known as precocious puberty.

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