When should you worry about abnormal vaginal bleeding?

If you’ve never had a regular menstrual period before, you might not know what qualifies as “abnormal” bleeding from the vagina.

So, how do you know when to see a doctor about it? Does the definition of “abnormal” change, if you’ve already gone through menopause? And, are there any situations in which abnormal vaginal bleeding might warrant a trip to the emergency room?

We went to gynecologic oncologist Abigail Zamorano, M.D. for answers. Here’s what she shared.

What are the symptoms of ‘abnormal’ vaginal bleeding?

In pre-menopausal women, abnormal vaginal bleeding means:

• irregular periods
• newly heavy periods
• bleeding between periods
• bleeding after sex
• anything that is not normal for you

In post-menopausal women, it means any type of bleeding. The average age of menopause is 51 or 52, so after that (or after a year of no periods), you really should not have any vaginal bleeding at all.

Keep in mind that menopause is not determined strictly by age — particularly among cancer patients. Even a very young woman could be in surgical menopause due to the removal of her ovaries, or chemical menopause due to the effects of chemotherapy.

So, why am I bleeding but not on my period?

Most abnormal vaginal bleeding isn’t due to cancer. It could be due to many other causes or conditions, including some that are benign, or not cancerous. Those include:

• Adenomyosis: This is when endometrial tissue (the interior uterine lining) grows into the muscular wall of the uterus. It is not cancer and does not become cancer, but it can cause painful, heavy periods and abnormal or irregular bleeding.
• Medications: One example is tamoxifen, which is used to prevent a breast cancer recurrence and can be associated with abnormal bleeding. Other medications that may lead to abnormal bleeding include blood thinners, such as those used to treat blood clots or prevent strokes.
• Birth control: Some types of birth control can cause irregular bleeding, including intrauterine devices (IUDs) and other forms of hormone-based contraception, such as birth control pills and under-skin implants.
• Blood disorders: These include hemophilia and coagulopathy.
• Polyps: These growths can develop in the uterus, cervix or vagina, as well as the kidneys, ureters, bladder or urethra. They can be cancerous, precancerous, or benign.
• Uterine fibroids, also known as leiomyoma: Even if you have known fibroids, any bleeding after menopause should be evaluated by a doctor.
• Vaginal or endometrial (uterine lining) atrophy: This is the natural thinning of vaginal and uterine tissues that occurs after menopause. Small tears in this delicate tissue can cause bleeding.

Endometrial hyperplasia may also be the reason for abnormal bleeding. This overgrowth of the uterine lining doesn’t always progress to cancer, but sometimes it does. That’s why it’s considered a precancerous condition and needs to be treated.

Cancerous causes of abnormal vaginal bleeding include endometrial cancer (the most common gynecologic cancer), vaginal cancer, vulvar cancer and cervical cancer. Cervical cancer, in particular, can cause very heavy bleeding.

When should I see a doctor about abnormal vaginal bleeding?

Any unexpected bleeding still deserves prompt evaluation.

If you’re already in menopause, you need to be checked out within a few weeks if you have any amount of bleeding at all (even spotting). For pre-menopausal women, get checked out if you notice a change in your cycle that is new and persistent.

It can be difficult to tell sometimes if bleeding is coming from the vagina, the bladder or the rectum. Seeing a doctor can help make that distinction and determine what tests, studies or exams are necessary to find out the cause.

Are there any red flags for abnormal vaginal bleeding?

Yes. Contact a doctor or visit an emergency room immediately if you’re saturating two maxi pads an hour for two hours in a row. That is too much blood loss. Any amount of abnormal vaginal bleeding also warrants a trip to the emergency room if you look pale or unwell, or feel dizzy and weak.

How is abnormal vaginal bleeding treated?

That depends on what’s causing it. If it’s cancer, we’ll create a treatment plan for you based on the type of cancer and how advanced it is. This may include surgery, chemotherapy and/or radiation therapy. It’s important to remember that the earlier a cancer is detected, the more likely it is to be cured.

Oral contraceptives, dilation and curettage (D&C), ablation, embolization, and hysterectomy are all sometimes used to treat the benign causes of abnormal uterine bleeding. Your general gynecologist can discuss these options with you to see what may be best based on your condition.

What’s the one thing women should know about abnormal vaginal bleeding?

Some women get used to not seeing their gynecologist regularly once they reach menopause or stop having kids. But that’s a mistake.

Every woman should be seeing a gynecologist every year (or at least every other year) for a well-woman exam. That’s the best way for us to find issues early, when they’re easier to treat.

Request an appointment at UT MD Anderson online or call 1-877-632-6789.