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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In this Article

• Vaginal bleeding facts
• What is normal vaginal bleeding?
• What is abnormal vaginal bleeding?
• What conditions cause abnormal vaginal bleeding in women who are ovulating regularly?
• What conditions cause abnormal vaginal bleeding in women who are not ovulating regularly or vaginal bleeding after menopause?
• What causes abnormal vaginal bleeding during or after sexual intercourse?
• What causes abnormal vaginal bleeding during pregnancy?
• What tests are used to evaluate abnormal vaginal bleeding?
• How is irregular or abnormal vaginal bleeding treated?
• Find a local Obstetrician-Gynecologist in your town
• Vaginal Bleeding Index

Treatment for irregular vaginal bleeding depends on the underlying cause. After the cause is determined, the doctor decides if treatment is actually necessary. Sometimes, all that is needed is for dangerous causes to be ruled out and to determine that the irregular vaginal bleeding does not bother the woman enough to warrant medication or treatment. If thyroid, liver, kidney, or blood clotting problems are discovered, treatment is directed toward these conditions.

Medications for treatment of irregular vaginal bleeding depend on the cause. Examples are described below:

• If the cause of the bleeding is lack of ovulation (anovulation), doctors may prescribe either progesterone to be taken at regular intervals, or an oral contraceptive, which contains progesterone, to achieve a proper hormonal balance. Such treatment dramatically decreases the risk of uterine cancer in women who do not ovulate.
• If the cause of irregular vaginal bleeding is a precancerous change in the lining of the uterus, progesterone medications may be prescribed to reduce the buildup of precancerous uterine lining tissues in an attempt to avoid surgery.
• When a woman has been without menses for less than six months and is bleeding irregularly, the cause may be menopausal transition. During this transition, a woman is sometimes offered an oral contraceptive to establish a more regular bleeding pattern, to provide contraception until she completes menopause, and to relieve hot flashes. A woman who is found to be menopausal as the cause of her irregular bleeding may  also receive menopause counseling if she has troubling symptoms.
• If the cause of irregular vaginal bleeding is polyps or other benign growths, these are sometimes removed surgically to control bleeding because they cannot be treated with medication.
• If the cause of bleeding is infection, antibiotics are necessary. Bleeding during pregnancy requires urgent evaluation by an obstetrician. Endometriosis can be treated with medications and/or surgery (such as laparoscopy).
• Sometimes, the cause of excessive bleeding is not apparent after completion of testing (dysfunctional uterine bleeding). In these cases, oral contraceptives can improve cycle control and lessen bleeding.
• If bleeding is excessive and cannot be controlled by medication, a surgical procedure called dilation and curettage (D&C) may be necessary. In addition to alleviating the excessive bleeding, the D&C provides tissue that can be analyzed for additional information that can rule out abnormalities of the lining of the uterus.
• Occasionally, a hysterectomy is necessary when hormonal medications cannot control excessive bleeding. However, unless the cause is pre-cancerous or cancerous, this surgery should only be an option after other solutions have been tried.

Many new procedures are being developed to treat certain types of irregular vaginal bleeding. For example, studies are underway to evaluate techniques that selectively block the blood vessels involved in the bleeding. These newer methods may be less complicated options for some patients and as they are further evaluated they will likely become more widely available.

REFERENCES:

ACOG. Endometrial hyperplasia.

MedscapeReference.com. Dysfunctional Uterine Bleeding.

Previous contributing medical author: Carolyn Janet Crandall, MD, MS, FACP