Vaginal Bleeding - Causes

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If you ovulate regularly, what is the cause of your abnormal vaginal bleeding?

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What conditions cause abnormal vaginal bleeding in women who are ovulating regularly?

Abnormal vaginal bleeding in women who are ovulating regularly, most commonly involve excessive, frequent, irregular, or decreased bleeding. Some of the common conditions that produce each of these symptoms are discussed below.

Excessively heavy menstrual bleeding (menorrhagia)

Excessively heavy menstrual bleeding, called menorrhagia, is menstrual bleeding of greater than about eight tablespoons per month (normal menstrual bleeding produces between two and eight tablespoons per cycle). The most common pattern of menorrhagia is excessive bleeding that occurs in regular menstrual cycles and with normal ovulation.

There are several important reasons that menorrhagia should be evaluated by a doctor. First, menorrhagia can cause a woman substantial emotional distress and physical symptoms, such as severe cramping. Second, the blood loss can be so severe that it causes a dangerously lowered blood count (anemia), which can lead to medical complications and symptoms such as dizziness and fainting. Third, there can be dangerous causes of menorrhagia that require more urgent treatment.

Benign (noncancerous) causes of menorrhagia include:

  • Uterine fibroids (benign tumors of smooth muscle; this type of tumor is known as a leiomyoma)
  • Endometrial polyps (tiny benign growths that protrude into the womb)
  • Adenomyosis (the presence of uterine lining tissue within the muscular wall of the uterus)
  • Intrauterine devices (IUD's)
  • Underactive thyroid function (hypothyroidism)
  • The autoimmune disorder systemic lupus erythematosus
  • Blood clotting disorders such as inherited bleeding disorders
  • Certain medications, especially those that interfere with blood clotting

Though not common, menorrhagia can be a sign of endometrial cancer. A potentially precancerous condition known as endometrial hyperplasia can also result in abnormal vaginal bleeding. This situation is more frequent in women who are over the age of 40.

Although there are many causes of menorrhagia, in most women, the specific cause of menorrhagia is not found even after a full medical evaluation. These women are said to have dysfunctional uterine bleeding. Although no specific cause of the abnormal vaginal bleeding is found in women with dysfunctional uterine bleeding, there are treatments available to reduce the severity of the condition.

Irregular vaginal bleeding; menstrual periods that are too frequent (polymenorrhea)

Menstrual periods that are abnormally frequent (polymenorrhea) can be caused by certain sexually transmitted diseases (STDs) (such as Chlamydia or gonorrhea) that cause inflammation in the uterus. This condition is called pelvic inflammatory disease. Endometriosis is a condition of unknown cause that results in the presence of uterine lining tissue in other locations outside of the uterus. This can lead to pelvic pain and polymenorrhea. Sometimes, the cause of polymenorrhea is unclear, in which case the woman is said to have dysfunctional uterine bleeding.

Menstrual periods at irregular intervals (metrorrhagia)

Irregular menstrual periods (metrorrhagia) can be due to benign growths in the cervix, such as cervical polyps. The cause of these growths is usually not known. Metrorrhagia can also be caused by infections of the uterus (endometritis) and use of birth control pills (oral contraceptives). Sometimes after an evaluation, a woman's doctor might determine that her metrorrhagia does not have an identifiable cause and that further evaluation is not necessary at that time.

Perimenopause is the time period approaching or around menopause. It often is characterized by irregular menstrual cycles, including menstrual periods at irregular intervals and variations in the amount of blood flow. Menstrual irregularities may precede the onset of true menopause (defined as the absence of periods for one year) by several years.

Decreased amount or duration of menstrual flow (hypomenorrhea)

An overactive thyroid function (hyperthyroidism) or certain kidney diseases can both cause hypomenorrhea. Oral contraceptive pills can also cause hypomenorrhea. It is important for women to know that lighter, shorter, or even absent menstrual periods as a result of taking oral contraceptive pills does not indicate that the contraceptive effect of the oral contraceptive pills is inadequate. In fact, many women appreciate this "side effect" of oral contraceptives.

Bleeding between menstrual periods (intermenstrual bleeding)

Women who are ovulating normally can experience light bleeding (sometimes referred to as "spotting") between menstrual periods. Hormonal birth control methods (oral contraceptive pills or patches) as well as IUD use for contraception may sometimes lead to light bleeding between periods. Psychological stress, certain medications such as anticoagulant drugs, and fluctuations in hormone levels may all be causes of light bleeding between periods. Other conditions that cause abnormal menstrual bleeding, or bleeding in women who are not ovulating regularly also can be the cause of intermenstrual bleeding.

Return to Vaginal Bleeding

See what others are saying

Comment from: 35-44 Female (Patient) Published: June 30

I have been bleeding heavy for over a month. I've using the overnight pads, always the purple one, and two at a time. I buy two bags at a time and it still doesn't work always, I have accidents. I don't think it is menstrual because I pass large masses or clots. I am frustrated, my husband is patient but this is getting on my nerves. I went to the emergency room (ER) and they told me it is break through bleeding. I am still trying to figure that one out. Doctor gave me some medicine but that was short lived. I am tired and at my wits' end. Every cough you are looking, sitting long scared to stand up, all dark clothes in the summer; I need relief as soon as possible.

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Comment from: llstalnaker, 45-54 Female (Patient) Published: March 17

I have been bleeding for 38 days now, I have used over 200 tampons and had to wear thick pads while wearing the tampons, and have gone through 3 bags of the pads. I went to a clinic and I showed them how much blood I was losing about every 20 minutes. I was told they could not see me, and told me I needed to go to the emergency room (ER). I went to the ER, and at that time I had only been bleeding for 21 days, they told me my blood work was fine. They said I had a few cysts on my ovaries, and during the whole time of my pelvic exam they had to use a thing that continually suctioned my blood out just to do the exam. They put me on a medication called Provera for 7 days and sent me home, told me to make an appointment with a gynecologist to have a pap smear and a biopsy. However I ended up in another ER about 3 days later short of breath, stayed for 2 days and was told from all the blood loss I had anemia. I was told to take iron pills and sent home, however it is now the 38th day and I'm still bleeding heavy, if the doctors don"t know what to do, then I sure don"t. I am now very weak, hurt all over, pale, and very frustrated, no insurance and the free clinics just tell me to go to the ER, where they do nothing. So I am just at a loss.

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