Abnormal Vaginal Bleeding
Abnormal vaginal bleeding is unexpected bleeding from the vagina. The source of the bleeding may be from the vagina or uterus. If it comes from the uterus, it's called abnormal uterine bleeding. Abnormal bleeding from the vagina can be caused by things like a disease, an injury to the vagina, or a problem with the cervix. These may be from sex, an object in the vagina, an infection, or polyps on the cervix.
When you have unexpected bleeding, it's important to let your doctor know. Your doctor can do an exam and tests to see if the bleeding is coming from your vagina or uterus. They can also check for problems. Treatment depends on the cause of the bleeding.
Bleeding during pregnancy is a different problem. If you are pregnant and have any amount of bleeding from the vagina, be sure to tell your doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Severe vaginal bleeding means that you are soaking 1 or 2 pads or tampons in 1 or 2 hours, unless that is normal for you. For most women, passing clots of blood from the vagina and soaking through their usual pads or tampons every hour for 2 or more hours is not normal and is considered severe. If you are pregnant: You may have a gush of blood or pass a clot, but if the bleeding stops, it is not considered severe.
Moderate bleeding means that you are soaking more than 1 pad or tampon in 3 hours.
Mild bleeding means that you are soaking less than 1 pad or tampon in more than 3 hours.
Minimal vaginal bleeding means "spotting" or a few drops of blood.
Many prescription and nonprescription medicines can cause changes in vaginal bleeding. A few examples are:
- Aspirin and other medicines (called blood thinners) that prevent blood clots.
- Corticosteroids, such as prednisone.
- Hormone therapy.
- Thyroid medicines.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Shock is a life-threatening condition that may quickly occur after a sudden illness or injury.
Adults and older children often have several symptoms of shock. These include:
- Passing out (losing consciousness).
- Feeling very dizzy or lightheaded, like you may pass out.
- Feeling very weak or having trouble standing.
- Not feeling alert or able to think clearly. You may be confused, restless, fearful, or unable to respond to questions.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
With some types of vaginal bleeding, it may be okay to wait to see if the bleeding stops on its own. If the bleeding continues or gets worse, see your doctor to find out the reason for the bleeding.
If you use tampons for abnormal vaginal bleeding, be sure to change them often. And don't leave one in place when the bleeding has stopped. A tampon left in the vagina may put you at risk for toxic shock syndrome (TSS). TSS is a rare but deadly illness. It develops suddenly after a bacterial infection rapidly affects several organ systems.
If you are age 40 or older, you may be experiencing perimenopause.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
- New fever or pain.
- Bleeding increases or becomes more severe.
- Symptoms occur more often or are more severe.
Preparing For Your Appointment
You can help your doctor diagnose and treat your condition by being prepared for your appointment.
Current as of: November 22, 2021
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine