myUpchar प्लस+ के साथ पूरेे परिवार के हेल्थ खर्च पर भारी बचत

Any bleeding which occurs from the vagina is known as vaginal bleeding. When it happens normally due to menstrual cycles it is known as menorrhoea. However, a heavy menstrual bleeding or any abnormal bleeding which occurs other than a woman's monthly menses is a matter of concern.

There are various causes of vaginal bleeding which might be related to factors other than the reproductive system. These may include the medical condition of the woman, medication, intrauterine devices, blood disorders, and more.

Abnormal bleeding from the vagina should not be ignored and should be reported to a doctor because it may indicate a serious underlying medical condition. The timely diagnosis and treatment of an abnormal vaginal bleeding are very important for the reproductive as well as the general health of the woman. The treatment of vaginal bleeding depends on its underlying cause and may include medication, hormone therapy, and if needed, a surgery.

The causes of vaginal bleeding may be broadly classified as reproductive, iatrogenic (due to medical treatments), and systemic. The cause of vaginal bleeding in women of different age groups has also been explained below.

  1. Vaginal bleeding associated with the reproductive system
  2. Vaginal bleeding due to medical treatments
  3. Systemic causes of vaginal bleeding
  4. Vaginal bleeding in women of different ages

The female reproductive system is formed by the mutual functioning of multiple organs. Any abnormality of one organ may affect the other and sometimes the whole body. Following are a few reproductive system disorders which may result in an abnormal vaginal bleeding:

  1. Vaginal bleeding during periods
  2. Vaginal bleeding after sex
  3. Vaginal bleeding due to infection
  4. Vaginal bleeding due to injury
  5. Vaginal bleeding during pregnancy
  6. Vaginal bleeding due to tumours and abnormal growths
  7. Ovulation disorders and vaginal bleeding
  8. Cancer associated vaginal bleeding

Vaginal bleeding during periods

Period or the monthly vaginal bleeding occurs due to the normal shedding of the endometrium (the inner lining of the uterus). This happens when the egg which is released by the ovaries is not fertilised. Menstrual bleeding is normal and is not something to be worried about until it is very heavy and there is an excessive loss of blood. According to NHS-UK, normal duration of menses ranges from two to seven days with an average of five days. Vaginal bleeding beyond this is abnormal and should be treated immediately because if it continues for a couple months, it may lead to iron deficiency anemia in the affected woman.

Treatment
The treatment of heavy menstrual bleeding includes both hormonal and non-hormonal methods.

  • Hormonal methods
    These are the most effective methods for treating heavy menstrual bleeding. Progesterone of the body declines sharply when menses start and this decline is responsible for inflammation of the endometrium. This is why giving progesterone will reduce the inflammation and shedding of the endometrium, and prevent excessive bleeding. The hormonal method makes use of an intrauterine system which slowly releases the hormone in the body, combination contraceptive pills, oral progesterone tablets, and hormone injections.
     
  • Non-hormonal methods
    Non-hormonal methods include exercise to maintain a healthy weight, antifibrinolytic medication (medicines which prevent the breakdown of fibrin present in the blood clot), and non-steroidal anti-inflammatory drugs (NSAIDs). Maintaining a healthy weight helps in normal functioning of the ovaries. Being obese may pose you to a greater risk of ovarian dysfunction. Antifibrinolytic medicines prevent excessive blood loss by inhibiting the fibrin breakdown in blood clots. NSAIDs help in reducing inflammation of the endometrium and prevent heavy menstrual bleeding.

Vaginal bleeding after sex

Vaginal bleeding commonly occurs during sex for the initial couple times because of hymen (a thin covering over the vaginal opening) tear and frictional tear or abrasion of the vaginal lining. However, if it is experienced everytime you have sex, a few days or weeks after sex then it might be due to pelvic disorders such as pelvic inflammatory disease, sexually transmitted infections such as Chlamydia or Gonorrhea, dryness of the lining due to a reduction in the lubrication of the vagina after menopause, polyps, inflammation of the cervix among others.

Treatment

Bleeding which occurs immediately after or during sex is mild and usually does not require treatment. However, prolonged bleeding and bleeding a few days or weeks after having sex might indicate an injury or infection of the vagina. If left unreported, it may lead to severe complications such as the spread of infection, excessive blood loss, HIV-AIDS, and other serious medical conditions.

Vaginal bleeding due to infection

Infections of the reproductive system such as pelvic inflammatory disease, sexually transmitted diseases such as Chlamydia and Gonorrhea, and fungal infections may also cause vaginal bleeding between two menstrual periods. 

Treatment

The treatment of infections of the reproductive systems usually involve medications such as antibiotics, antivirals, and anti-inflammatory medicines. These medicines reduce the number of disease-causing bacteria/viruses/fungi and inflammation in the uterus or vagina. As a result, over a period of time, abnormal bleeding from the vagina stops.

Vaginal bleeding due to injury

A blow to the pelvic region, fracture of the pelvic bone, or injury to the pelvic organs because of sexual assault can also cause profuse and sometimes life-threatening vaginal bleeding. In such cases, it is very important to visit a gynecologist to save the life of the traumatized girl or woman.

Treatment

An injury to the vagina may be treated using anti-inflammatory medicines, antibiotic prophylaxis (to prevent the development of infections), or a surgery if needed. In the case of a sexual abuse, counselling therapy for the girl and her parents is also needed.

Vaginal bleeding during pregnancy

A recent study on “Vaginal bleeding” suggests, that bleeding during pregnancy is not normal but it happens very commonly. Almost one in three pregnancies have been reported to have vaginal bleeding at some point. The possible causes of vaginal bleeding during different trimesters of pregnancy are as follows:

First trimester

The possible reasons for vaginal bleeding during the first trimester include:

  • Fusion of the embryo (the initial stage of pregnancy when the cells start dividing to develop into a future fetus) to the wall of the uterus.
  • Miscarriage
  • Fusion or implantation of the embryo at abnormal places such as the fallopian tube and the abdominal cavity. This is known as ectopic pregnancy.
  • An abnormal accumulation of blood between the placenta (the cord that connects the growing embryo to the mother’s body) and the wall of the uterus. This is known as subchorionic haemorrhage.

Treatment

  • Mild bleeding which occurs because of the fusion of the embryo is normal and does not require any treatment. The bleeding occurs in a small amount or as spotting.
  • An ectopic pregnancy can be treated with medications such as abortion pills, or surgically by laparoscopic salpingectomy (removal of the fallopian tube along with the embryo) or salpingostomy (removal of the embryo only). A ruptured ectopic pregnancy is a medical emergency and needs immediate medical attention.
  • A miscarriage is treated by removing the demised fetus from the uterus. It can be done by medication or surgery.

Second Trimester

Following are the reasons for abnormal bleeding from the vagina during the second trimester of pregnancy:

  • Attachment of the placenta to the uterus near the opening of the birth canal. 
  • Abnormal attachment of the placenta to the muscle layer (myometrium) of the uterus.
  • Sudden breaking away or detachment of the placenta from the wall of the uterus.
  • A sudden demise of the fetus within the uterus.

Treatment

  • Normal attachment results in mild bleeding which usually does not require treatment. But, if the bleeding is in excess or occurs for a long duration, immediately inform the gynaecologist.
  • Abnormal attachment of placenta and a miscarriage needs to be treated by removing it either with medication or surgery. 

Third Trimester

A few causes for abnormal vaginal bleeding when a woman is in her third trimester of pregnancy are as follows:

  • Sudden breaking away of the whole or a part of the placenta.
  • Placental growth invading the muscle layer of the uterus.
  • Premature labour.

Treatment

Treatment may involve medications to stop bleeding and relax uterine contractions or labour, a blood transfusion to replace lost blood, and in rare cases a caesarian section (surgery of the pelvic area) to remove the fetus from the womb or complete removal of the ruptured uterus (hysterectomy).

Vaginal bleeding due to tumours and abnormal growths

A few non-cancerous tumours which may cause an abnormal vaginal bleeding are listed below:

  • Fibroids
    Fibroids are non-cancerous growths within the uterus. They are formed due to an overgrowth of the muscle layer of the uterus. Fibroids are usually asymptomatic and are detected by chance. They may be of various sizes and multiple in number. Fibroids can develop anywhere in the uterus and depending upon that, they may result in excessive menstrual bleeding or bleeding between period dates.

  • Endometriosis
    Endometriosis is a disease in which there is a benign (non-cancerous) growth of the endometrium at places other than the uterus such as fallopian tubes, ovaries, cervix, and abdominal space. Under the influence of hormones, this endometrium may also shed and cause abnormal vaginal bleeding along with pelvic pain.

  • Hyperplasia of the endometrium
    An increase in the rate of production of cells of a tissue is known as hyperplasia. When this happens in the inner lining of the endometrium of the uterus, it is known as endometrial hyperplasia. This is a condition which occurs because of the raised level of estrogen hormone and a decline in the progesterone level. It most commonly occurs in women between 50-54 years of age or women who are obese. It is also one of the frequent reasons for an abnormal bleeding from the uterus and the vagina. If left untreated, it can transform into endometrial cancer.

  • Polyp
    A polyp is a non-cancerous growth which occurs due to an overgrowth of the glands and their surrounding connective tissue or stroma in the endometrium. Polyps may form anywhere in the walls or the roof of the uterus, and the opening of the cervix (the birth canal). They have also been considered one of the common causes of abnormal uterine and vaginal bleeding. Rarely, polyps may also transform into cancerous lesions.

  • Adenomyosis
    Adenomyosis is also a benign (non-cancerous) tumour in which the endometrium grows into the muscle layer (myometrium) of the uterus by pushing through a breach in it. It results in pain in the pelvic region, abnormal bleeding and in extreme cases, infertility.

Treatment

Small tumours could be treated with medication. However, those which are large and cause heavy bleeding or pain, have to be surgically removed. Sometimes when the tumours are multiple in number and involve the outer wall of the uterus, a complete removal of the uterus might be necessary. Treating endometriosis is very important because it has a high risk of developing into endometrial cancer.

Ovulation disorders and vaginal bleeding

Women who have menstrual cycles without regular ovulation (egg release) may also often experience vaginal bleeding. This happens because when the egg is not released, the effect of estrogen on the endometrium is reduced and it leads to the thickening of the endometrium. As a result, the woman experiences a heavy menstrual bleeding. If it lasts for a long duration, it may result in anemia. 

Treatment

The treatment of ovulatory disorders includes exercise for weight reduction, insulin-sensitizing drugs such as metformin, hormone treatment with gonadotropins, and laparoscopic ovarian drilling to induce ovulation in women who want to conceive. In vitro fertilisation (IVF) is also a good option for them.

Cancer associated vaginal bleeding

A rare cause of menstrual bleeding is the development of cancer in the female reproductive system. Cancers can develop anywhere in the vagina, uterus, cervix, vulva, fallopian tubes, or ovaries. The most common reproductive tract cancer which occurs in women is cervical cancer. It is caused by the Human Papilloma Virus and is considered one of the leading causes of death in Asian women and women around the world. 

Treatment

The treatment of cancer depends on the stage of cancer. Initial stages may be treated with chemotherapy only, however, later stages need a combination of chemotherapy, radiotherapy, and surgery.

The causes of vaginal bleeding are related to certain medical treatments are known as iatrogenic causes. A few of them which have been listed below:

  1. Hormone therapy induced vaginal bleeding
  2. Contraceptive pills and vaginal bleeding
  3. Antidepressants and vaginal bleeding
  4. Vaginal bleeding due to clot dissolving medicines
  5. Vaginal bleeding due to IUDs

Hormone therapy induced vaginal bleeding

A recent study on adverse effects of hormone replacement therapy suggests that some women who receive this therapy may experience abnormal bleeding from the vagina. The hormone replacement therapy is given after menopause to maintain the levels of the sex hormones like estrogen and progesterone in the body.

Treatment

Usually, moderate doses of supplement hormones given in the Hormone Replacement Therapy do not have side effects. Hence, you may consult your gynecologist regarding the side effects of the therapy. Reducing the dose of the hormones may stop the abnormal bleeding from your vagina.

Contraceptive pills and vaginal bleeding

Use of contraceptive pills has also been found to be a cause of abnormal bleeding from the uterus and the vagina. Contraceptive pills are steroid hormone tablets which are used for birth control. 

Treatment

Before stopping the steroids, consult your physician or gynecologist. The doctor will decide whether you need to stop or reduce the dosage of the steroid hormones to prevent vaginal bleeding and other side effects.

Antidepressants and vaginal bleeding

A study, "The risk of vaginal and postpartum bleeding after the use of antidepressants during pregnancy", suggested that these medicines increase the risk of vaginal bleeding during early pregnancy. Hence, it is recommended to take medication pregnancy only after consulting a doctor.

Treatment

The effects of these medicines wear off once they are stopped. However, you should always consult your therapist before stopping the medications by yourself because it may result in a relapse of your condition.

Vaginal bleeding due to clot dissolving medicines

According to a recent study called “Abnormal uterine bleeding in women receiving direct oral anticoagulants for the treatment of venous thromboembolism”, abnormal vaginal and uterine bleeding is a common symptom in women who receive medicines for clot busting.

Treatment

Consult your physician and inform about the symptoms, duration and the amount of vaginal bleeding that you experience. Do not stop medications on your own because this may result in the formation of a clot or blockage of the arteries, which can also be life-threatening.

Vaginal bleeding due to IUDs

Some women who opt for an intrauterine device as a birth control method may experience vaginal bleeding in the initial days of placing the device in the uterus. This happens because the body takes some time to heal and attach the device to the uterus. After complete healing, the bleeding stops. In some cases, the device placement may fail and the women may get an infection. This results in continuous bleeding from the uterus and the vagina.

Treatment

Mild bleeding is not of major concern and does not usually require treatment. However, if your bleeding does not stop, immediate medical attention is required to prevent sepsis (infection and toxin accumulation in the tissues). An infected IUD needs to be removed along with medication with antibiotics and anti-inflammatory medicines to treat the infection.

There are certain medical conditions which make a woman more prone to an abnormal vaginal bleeding. A few of them are listed below:

  1. Bleeding disorders and vaginal bleeding
  2. Vaginal bleeding due to thyroid problems
  3. Vaginal bleeding due to liver cirrhosis

Bleeding disorders and vaginal bleeding

A recent article on “Abnormal Uterine Bleeding including coagulopathies and other menstrual disorders” suggests that women who have bleeding or clotting disorders may sometimes present with vaginal or uterine bleeding. These disorders cause a decrease in the blood's ability to timely form clots and stop the bleeding normally. Hence, even a small wound causes a delay in blood clotting and leads to prolonged bleeding from the site of injury.

Treatment

Bleeding disorders should be immediately reported to a physician. These usually occur because of a deficiency of clotting factors in the body. Treatment may include supplementation with clotting factors either through fresh frozen plasma containing the factor, or blood transfusion.

Vaginal bleeding due to thyroid problems

A study on the “Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of the Walled City of Delhi” suggested that women who have thyroid problems, especially the ones who have reduced thyroid production have been found to have menstrual problems. Some might also present with vaginal or uterine bleeding as a symptom.

Treatment

Hypothyroidism is usually treated by medicines which help in improving the function of the thyroid gland or replenish the deficient thyroid hormones in the body.

Vaginal bleeding due to liver cirrhosis

A study, “The diagnosis and treatment of abnormal uterine bleeding in nonpregnant patients with hepatic cirrhosis”, suggests that abnormal uterine bleeding is present in women who have liver cirrhosis. It is usually experienced as excessive bleeding during menstrual cycles. This happens because the liver is a vital organ for producing factors which are responsible for clotting blood. In case of a cirrhosis, their production, effective function and availability get disrupted.

Treatment

Treatment of cirrhosis involves removal of the causative factor which is damaging the liver. This may include antiviral or antibiotics, anti-inflammatory medicines, limiting alcohol intake, and sometimes surgery.

  • In non-pregnant woman
    The causes of abnormal bleeding along with treatment in nonpregnant women in reproductive age are mentioned above.
     
  • In pregnancy
    The possible reasons for abnormal bleeding at different stages of pregnancy have been discussed above in detail. 
     
  • In newborn and adolescent girls
    In newborn babies, the endometrium withdraws itself from being stimulated by the mother’s high estrogen levels. As a result, they may sometimes show abnormal bleeding from the vagina for some time. In older children, vaginal bleeding occurs because of hormonal imbalances and premature or early puberty.
     
  • In postmenopausal women
    The reasons for abnormal uterine or vaginal bleeding in postmenopausal women are hormone replacement therapy, tumors, polyps, medications for mental health, cancer, etc. All these have been mentioned above in detail.
और पढ़ें ...

References

  1. Intira Sriprasert, Tarita Pakrashi, Thomas Kimble, David F. Archer. Heavy menstrual bleeding diagnosis and medical management. Contracept Reprod Med. 2017; 2: 20. PMID: 29201425
  2. Jacqueline A Maybin, Hilary OD Critchley. Medical management of heavy menstrual bleeding. Womens Health (Lond). 2016 Jan; 12(1): 27–34. PMID: 26695687
  3. Florin-Andrei Taran. The Diagnosis and Treatment of Ectopic Pregnancy. Dtsch Arztebl Int. 2015 Oct; 112(41): 693–704. PMID: 26554319
  4. Vanitha N Sivalingam et al. Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care. 2011 Oct; 37(4): 231–240. PMID: 21727242
  5. Oliver A, Overton C. Diagnosis and management of miscarriage. Practitioner. 2014 May;258(1771):25-8, 3. PMID: 25055407
  6. Athol Kent. Management of Placenta Accreta. Rev Obstet Gynecol. 2009 Spring; 2(2): 127–128. PMID: 19609408
  7. Teksin Çırpan, Cem Yaşar Sanhal, Sait Yücebilgin, Serdar Özşener. Conservative management of placenta previa percreta by leaving placental tissue in situ with arterial ligation and adjuvant methotrexate therapy. J Turk Ger Gynecol Assoc. 2011; 12(2): 127–129. PMID: 24591976
  8. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Uterine fibroids: Overview. 2014 Oct 22 [Updated 2017 Nov 16]
  9. Katarzyna Sobczuk, Anna Sobczuk. New classification system of endometrial hyperplasia WHO 2014 and its clinical implications. Prz Menopauzalny. 2017 Sep; 16(3): 107–111. PMID: 29507578
  10. Anastasiadis PG et al. Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding. Eur J Gynaecol Oncol. 2000;21(2):180-3. PMID: 10843481
  11. Janu Mangala Kanthi et al. Clinical Study of Endometrial Polyp and Role of Diagnostic Hysteroscopy and Blind Avulsion of Polyp. J Clin Diagn Res. 2016 Jun; 10(6): QC01–QC04. PMID: 27504357
  12. National Health Service [Internet]. UK; What causes a woman to bleed after sex?.
  13. Fraser IS. Bleeding arising from the use of exogenous steroids. Baillieres Best Pract Res Clin Obstet Gynaecol. 1999 Jun;13(2):203-22. PMID: 10755038
  14. Sebastião Freitas de Medeiros, Márcia Marly Winck Yamamoto, Jacklyne Silva Barbosa. Abnormal Bleeding During Menopause Hormone Therapy: Insights for Clinical Management. Clin Med Insights Womens Health. 2013; 6: 13–24. PMID: 24665210
  15. Nangia Sangita Ajmani et al. Role of Thyroid Dysfunction in Patients with Menstrual Disorders in Tertiary Care Center of Walled City of Delhi. J Obstet Gynaecol India. 2016 Apr; 66(2): 115–119. PMID: 27046965
  16. Lucy Whitaker, Hilary O.D. Critchley. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016 Jul; 34: 54–65. PMID: 26803558
  17. Jeanmonod R, Agresti D. Vaginal Bleeding. [Updated 2019 Feb 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.