Normal vaginal bleeding is the periodic blood flow from the uterus.

• Normal vaginal bleeding is also called menorrhea. The process by which menorrhea occurs is called menstruation.
• In order to determine whether bleeding is abnormal, and its cause, the doctor must answer 3 questions: Is the woman pregnant? What is the pattern of the bleeding? Is she ovulating?
• Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding.
• There are many causes of abnormal vaginal bleeding that are associated with irregular ovulation.
• A woman who has irregular menstrual periods requires a physical examination with a special emphasis on the thyroid, breast, and pelvic organs.
• Treatment for irregular vaginal bleeding depends on the underlying cause. After the cause is determined, the doctor decides if treatment is actually necessary.

What is normal vaginal bleeding?

Normal vaginal bleeding is the periodic blood that flows as a discharge from the woman's uterus. Normal vaginal bleeding is also called menorrhea. The process by which menorrhea occurs is called menstruation.

Normal vaginal bleeding occurs as a result of cyclic hormonal changes. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. The hormones also regulate the menstrual cycle. The ovary, or female gonad, is one of a pair of reproductive glands in women. They are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones. During each monthly menstrual cycle, an egg is released from one ovary. The egg travels from the ovary through a Fallopian tube to the uterus.

Unless pregnancy occurs, the cycle ends with the shedding of part of the inner lining of uterus, which results in menstruation. Although it is actually the end of the physical cycle, the first day of menstrual bleeding is designated as "day 1" of the menstrual cycle in medical jargon.

The time of the cycle during which menstruation occurs is referred to as menses. The menses occurs at approximately four week intervals, representing the menstrual cycle.

Menarche is the time in a girl's life when menstruation first begins. Menopause is the time in a woman's life when the function of the ovaries ceases and menstrual periods stop. Menopause is defined as the absence of menstrual periods for 12 consecutive months. The average age of menopause is 51 years old.

Abnormal vaginal bleeding can relate to an issue with your reproductive system (a gynecologic condition) or to other medical problems or certain medications.

If you're in menopause — generally defined as 12 months, give or take, without a menstrual period — any vaginal bleeding may be a cause for concern and should be evaluated.

Possible causes of abnormal vaginal bleeding include:

Cancers and precancerous conditions

1. Cervical cancer
2. Endometrial cancer (uterine cancer)
3. Endometrial hyperplasia
4. Ovarian cancer
5. Uterine sarcoma
6. Vaginal cancer

Endocrine system factors

1. Hyperthyroidism (overactive thyroid)
2. Hypothyroidism (underactive thyroid)
3. Polycystic ovary syndrome (PCOS)
4. Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)

Fertility and reproduction factors

1. Ectopic pregnancy
2. Fluctuating hormone levels
3. Miscarriage (before the 20th week of pregnancy)
4. Pregnancy
5. Random ovulatory cycles
6. Sexual intercourse
7. Perimenopause
8. Vaginal atrophy (genitourinary syndrome of menopause)

Infections

1. Cervicitis
2. Chlamydia trachomatis
3. Endometritis
4. Gonorrhea
5. Pelvic inflammatory disease (PID)
6. Ureaplasma vaginitis
7. Vaginitis

Medical conditions

1. Celiac disease
2. Severe systemic disease, such as kidney or liver disease
3. Thrombocytopenia
4. Von Willebrand disease (and other blood clotting disorders)

Medications and devices

1. Forgotten (retained) tampon
2. Intrauterine device (IUD)
3. Stopping or changing birth control pills or menopausal hormone therapy (withdrawal bleeding)
4. Tamoxifen side effect

Noncancerous growths and other uterine conditions

1. Adenomyosis
2. Cervical polyps
3. Endometrial polyps
4. Uterine fibroids
5. Uterine polyps

Trauma

1. Blunt trauma or penetrating injury to the vagina or cervix
2. Sexual abuse

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

• If the cause of the bleeding is a 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 that she is approaching menopause. During this transition, a woman is sometimes offered an oral contraceptive to establish a more regular bleeding pattern, to provide contraception until she achieves menopause (defined as 12 months without a menstrual period), 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 an infection, antibiotics are necessary. Bleeding during pregnancy requires prompt 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 the 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.

Vaginal bleeding is a symptom, not a disease. It could be caused by a number of different things, from infections to endometriosis to polyps.

The two main risk factors for vaginal bleeding are age and sexual activity.
The older you get, the more likely it is that vaginal bleeding is caused by menopause or another hormone-related condition.
And as you get older, your period may become heavier and last longer than it did when you were younger.
If you're sexually active, there are also some risk factors for vaginal bleeding. For example, if you have sex too often or too vigorously, you might cause trauma to your cervix or uterus that results in bleeding.
If this happens often enough, it can lead to scar tissue formation in your vagina (called adhesions), which can cause pain during sex and make it difficult to conceive later on down the road because it makes it hard for sperm to reach an egg (this is called infertility).

Some of the most common risk factors for vaginal bleeding include:

• Menstruation
• Pregnancy
• Sexually transmitted diseases (STDs) like gonorrhea or chlamydia
• Pelvic inflammatory disease (PID)
• Endometriosis
• A family history of uterine cancer.
• Previous surgery on your reproductive organs (including hysterectomy).
• Bleeding between periods
• Bleeding after intercourse
• Having an IUD (intrauterine device) inserted
• Having had a baby recently or having an abortion
• Having your period earlier than expected
• Uterine fibroids: Uterine fibroids are noncancerous tumors that develop from the muscle layer of your uterus and can cause abnormal bleeding during your period or before it begins. These growths often occur with no symptoms at all until they become large enough to interfere with your fertility by blocking fallopian tubes or compressing other reproductive structures like ovaries or rectum.

Symptoms
A sudden change in your normal discharge,Painful urination or sex,Bleeding after sex,Bleeding after an injury,Bleeding after a Pap smear,Itchy or sore vulva (the outside part of your vagina)
Conditions
Abnormal vaginal bleeding
Drugs
Tranexamic acid (Cyklokapron),Diclofenac sodium or diclofenac potassium (Cataflam,Voltaren),Clopidogrel (Plavix)

There is no cure for vaginal bleeding, but there are some things you can do to help manage your symptoms.

• First and foremost, remember that there's nothing wrong with you. Bleeding down there is totally normal and natural. It happens to most women at some point in their lives—and it's usually not even that bad!
• If you're experiencing heavy or frequent bleeding, it's important to see a doctor so they can make sure you don't have any underlying health issues that may be causing it. If your doctor finds any underlying issues like uterine fibroids or polyps, they can remove them from your body so they don't continue causing bleeding.
• If your doctor doesn't find anything wrong with you after running tests for other conditions like endometriosis or pelvic inflammatory disease (PID), then your next step is probably going to be hormonal birth control (like Yaz) or hormone replacement therapy (HRT). In either case, these methods should stop the bleeding altogether-and if they don't, see your doctor again so they can find out why not!

Medications used to treat vaginal bleeding include:

• Antibiotics: These are used to treat infections that may be causing vaginal bleeding. Antibiotics can also be prescribed as a preventative measure if you're at risk of developing an infection.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These include ibuprofen or aspirin, which can help relieve pain and inflammation associated with some types of vaginal bleeding.
• Hormone therapy: This type of medication is often used when there are issues with your hormones, such as excessive menstrual flow or menopause symptoms like hot flashes and night sweats.

Symptoms
A sudden change in your normal discharge,Painful urination or sex,Bleeding after sex,Bleeding after an injury,Bleeding after a Pap smear,Itchy or sore vulva (the outside part of your vagina)
Conditions
Abnormal vaginal bleeding
Drugs
Tranexamic acid (Cyklokapron),Diclofenac sodium or diclofenac potassium (Cataflam,Voltaren),Clopidogrel (Plavix)